Making diabetes self-management education culturally relevant for Filipino Americans in Hawaii

PURPOSE: The purpose of this study was to identify the cultural values, traditions, and perceptions of diabetes risk and self-care among Filipino Americans in Hawaii with type 2 diabetes that facilitate or impede engagement in diabetes self-management behaviors and education classes. METHODS: This qualitative study used 2 rounds of semistructured focus groups and interviews. Participants included 15 patients with type 2 diabetes recruited from a large health-maintenance organization in Hawaii and 7 health care and cultural experts recruited from the community. The taped and transcribed focus groups and interviews were coded thematically. Participants evaluated example materials for diabetes self-management education (DSME) with Filipino Americans. RESULTS: Several aspects of Filipino American culture were identified as central to understanding the challenges of engaging in self-management behaviors and DSME: (1) undertaking self-management while prioritizing the family and maintaining social relationships, (2) modifying diet while upholding valued symbolic and social meanings of food, (3) participating in storytelling in the face of stigma associated with diabetes, and (4) reconciling spiritual and biomedical interpretations of disease causality and its management. Respondents also emphasized the role of several qualitative aspects of perceived risk (eg, dread, control) in moderating their behaviors. Participants suggested ways to make DSME culturally relevant. CONCLUSIONS: Awareness of cultural values and qualitative aspects of perceived risk that influence Filipino Americans' engagement in diabetes self-care behaviors and classes may help to improve teaching methods, materials, and recruitment strategies.     

BMI trajectory and subsequent risk of type 2 diabetes among middle-aged women

Background and aimsLittle is known about how weight trajectories among women during menopausal transition and beyond may be related to risk of type 2 diabetes mellitus (T2DM). The aim of this study was to examine associations between body mass index (BMI) trajectories over 20 years, age of obesity onset, cumulative obese-years and incidence of T2DM among middle-aged women.Methods and results12,302 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed in 1996 (Survey 1, age 45–50), 1998 and then every three years to 2016. Self-reported weight and height were collected for up to eight time points. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes. Growth mixture models were used to identify distinct BMI trajectories. A total of 1380 (11.2%) women newly developed T2DM over an average 16 years of follow-up. Seven distinct BMI trajectories were identified with differential risk of developing T2DM. Initial BMI was positively associated with T2DM risk. We also observed that risk of T2DM was positively associated with rapid weight increase, early age of obesity onset and greater obese-years.ConclusionSlowing down weight increases, delaying the onset of obesity, or reducing cumulative exposure to obesity may substantially lower the risk of developing T2DM.     

Differences in screening mammography outcomes among White, Chinese, and Filipino women

BACKGROUND: The accuracy of screening mammography among Asian women in the United States has received little attention. We determined whether the accuracy of screening mammography for Chinese and Filipino women differs from that of white women. METHODS: We examined a cohort of white, Chinese, and Filipino women 40 years and older who underwent 200,402, 72,604, and 19,087 screening examinations, respectively, between January 1986 and December 2001 in San Francisco County, California, of whom 2177 were diagnosed with breast cancer within 12 months of a screening examination. By linking screening examinations to the regional Surveillance, Epidemiology and End Results program and the California Cancer Registry, we identified the occurrence of any invasive cancer or ductal carcinoma in situ and then calculated the rate of cancer per 1000 screenings and the sensitivity of mammography. RESULTS: The rate of invasive breast cancer per 1000 screenings was 45% lower for Chinese than for white women aged 50 to 69 years (3.8 vs 6.9; P<.001) and 29% lower for Filipino than for white women (4.9 vs 6.9; P = .03). Rates of ductal carcinoma in situ were similar across all ethnic groups (1.6-1.7 per 1000 screenings; P>or=.60). The sensitivity of mammography was similar for white, Chinese, and Filipino women (81.6%-84.3%; P>.30). CONCLUSIONS: Screening mammography has similar accuracy among white, Chinese, and Filipino women, although the absolute benefit of screening, in terms of breast cancer deaths averted, is likely to be less among Asian women because the rates of invasive cancer are lower compared with white women of similar age. Overdiagnosis of ductal carcinoma in situ with screening mammography among Asian women is likely to be comparable to that of white women because the rate of ductal carcinoma in situ was similar in all the examined ethnic groups.     

Fecundability among women with type 1 and type 2 diabetes in the Norwegian Mother and Child Cohort Study

Aims/Hypothesis  

We assessed the effects of type 1 diabetes and type 2 diabetes on fecundability (as manifest by increased time-to-pregnancy [TTP]) in a large cohort of pregnant women.     

Acculturation and functional impairment among older Chinese and Vietnamese in San Diego County,California

Level of acculturation and the relationship to functional impairment was examined among a group of Chinese (n = 50) and Vietnamese (n = 50) 45 years and older in San Diego County, California. Prevalence of functional impairment and level of acculturation, one-way analysis of variance and Pearson correlations were utilized to examine differences between ethnicity, gender and age groups, as well as significant relationships between various dimensions of impairment and levels of acculturation. Findings indicated that lack of English language skills and lack of use and exposure to English were associated with social and economic resource impairment, mental and physical health impairment, and ADL impairment, as measured by a modified OARS instrument. Data suggested that the visibility and extensiveness of the Vietnamese community may serve to buffer the negative effects associated with the acculturation process for the Vietnamese.     

Hyperglycemia in rodent models of type 2 diabetes requires insulin-resistant alpha cells

To determine the role of glucagon action in diet-induced and genetic type 2 diabetes (T2D), we studied high-fat-diet–induced obese (DIO) and leptin receptor-defective (LepR^−/−) rodents with and without glucagon receptors (GcgRs). DIO and LepR^−/−,GcgR^+/+ mice both developed hyperinsulinemia, increased liver sterol response element binding protein 1c, and obesity. DIO GcgR^+/+ mice developed mild T2D, whereas LepR^−/−,GcgR^+/+ mice developed severe T2D. High-fat–fed (HFF) glucagon receptor-null mice did not develop hyperinsulinemia, increased liver sterol response element binding protein 1c mRNA, or obesity. Insulin treatment of HFF GcgR^−/− to simulate HFF-induced hyperinsulinemia caused obesity and mild T2D. LepR^−/−,GcgR^−/− did not develop hyperinsulinemia or hyperglycemia. Adenoviral delivery of GcgR to GcgR^−/−,LepR^−/− mice caused the severe hyperinsulinemia and hyperglycemia of LepR^−/− mice to appear. Spontaneous disappearance of the GcgR transgene abolished the hyperinsulinemia and hyperglycemia. In conclusion, T2D hyperglycemia requires unsuppressible hyperglucagonemia from insulin-resistant α cells and is prevented by glucagon suppression or blockade.The prevalence of type 2 diabetes (T2D) in the United States was 29.1 million in 2012, and 37% of adults were identified as prediabetic (1). T2D is now present on every continent (2). Despite the magnitude of this threat to world physical and fiscal health, our understanding of the pathogenic pathway is vague and is based largely on epidemiologic correlations. For example, the correlation between T2D and obesity is so high that most obese Americans can be considered prediabetic, but the precise mechanism of this relationship is unknown. Although the “lipotoxic” effects of ectopic lipids were first suggested in 1994 (3) to link diet-induced obesity to T2D and other components of the metabolic syndrome (3–11), the relationship between IR and T2D is still poorly understood. Proposed hypothetical links range from beta cell “glucotoxicity” (12) to the action of modifier genes (13) to failure of redox control (14).It has recently been shown that glucagon receptor-null mice remain normoglycemic and nonketotic despite total insulin deficiency but that transduction of a glucagon receptor cDNA into their liver makes them severely diabetic (15, 16). This proves that, whether or not insulin action is present, suppression of glucagon action prevents hyperglycemia. It has long been known that insulin suppression of glucagon regulates alpha cell secretion (17, 18). Although the presence of hyperglucagonemia was established unequivocally in type 1 diabetes (T1D) (15, 16), direct evidence that it is essential for the hyperglycemia of T2D is lacking. However, it has long been known that glucagon is elevated in T2D (17, 19, 20) and is resistant to suppression by insulin.     

Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger women

OBJECTIVE: To examine the relationship between alcohol consumption and the incidence of type 2 diabetes mellitus among relatively young and middle-aged women. METHODS: In a prospective study, 109 690 women, aged 25 to 42 years, without a history of coronary heart disease, stroke, cancer, or diabetes mellitus completed a detailed lifestyle and medical history questionnaire in 1989. During 10 years of follow-up, we documented 935 incident cases of type 2 diabetes mellitus. RESULTS: We found a nonlinear relationship between alcohol consumption and risk of type 2 diabetes mellitus after adjustment for multiple confounders, including body mass index, smoking, physical activity, and family history of diabetes mellitus (quadratic trend P =.003). Compared with lifelong abstainers, the adjusted relative risks (95% confidence intervals) were 0.80 (0.66-0.96) for those consuming 0.1 to 4.9 g/d, 0.67 (0.50-0.89) for those consuming 5.0 to 14.9 g/d, 0.42 (0.20-0.90) for those consuming 15.0 to 29.9 g/d, and 0.78 (0.34-1.78) for those consuming 30.0 g/d or more. Further adjustment for dietary factors, including glycemic load, trans-fatty acid, polyunsaturated fat, and total fiber intake, did not appreciably alter these findings. The inverse association with light to moderate drinking was most apparent in women who reported wine or beer drinking. Women who reported 30.0 g/d or more of liquor intake showed a significantly increased risk of diabetes mellitus compared with those who did not report liquor intake (adjusted relative risk, 2.50; 95% confidence interval, 1.00-6.23). CONCLUSION: Light to moderate alcoholic beverage consumption may be associated with a lower risk of type 2 diabetes mellitus among women aged 25 to 42 years, although this benefit may not persist at higher levels.     

Identification of patient-centered outcomes among African American women with type 2 diabetes

AimsAfrican American women carry a disproportionate diabetes burden, yet there is limited information on strategies to identify outcomes women perceive as important intervention outcomes (patient-centered outcomes). This study presents a brief strategy to solicit these outcomes and to describe outcomes identified using the highlighted strategy.MethodsThirty-four African-American women with type 2 diabetes were enrolled in group-based, diabetes/weight management interventions. A diabetes educator asked participants to write down their intervention expectations followed by verbal sharing of responses. Expectation-related themes were identified using an iterative, qualitative, team analytic approach based on audio-recorded responses.ResultsThe majority of the expectation-related themes (6 of 10) were reflective of self-care education/management and weight loss-related patient-centered outcomes. The remaining themes were associated with desires to help others prevent or manage diabetes, reduce negative diabetes-related emotions, get rid of diabetes, and stop taking diabetes medications.ConclusionThis study adds to a limited body of knowledge regarding patient-centered outcomes among a group that experiences a disproportionate diabetes burden. Future work could include integrating outcomes that are less commonly addressed in diabetes-related lifestyle interventions (e.g., diabetes-related negative emotions), along with more commonly addressed outcomes (e.g., weight loss), to increase the patient-centeredness of the interventions.     

Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

We compared the prevalence of diabetes in women who experienced gestational diabetes mellitus (GDM) with that in the general population and identified risk factors for the development of diabetes.The analysis included 868 subjects (620 GDM and 248 single positive (SP) for one of the diagnostic criteria). The post-partum examinations included 2 h 75 g oral glucose tolerance tests, lipid profiles, anthropometric measurements, and documentation of medical history, diet, and lifestyle. All participants were followed up at 6 weeks after parturition and subsequent follow-ups were conducted annually. General population subjects were identified from the 2001 Korean National Health and Nutrition Survey and age-matched for case–control analysis.Eleven (4.4%) and 71 (11.5%) subjects in the SP and GDM groups, respectively, developed diabetes, while 22 (2.5%) subjects in the general population group presented with diabetes. The risk of developing diabetes was 3.5 times greater for GDM subjects than for general population subjects, after adjusting for confounding factors. A multiple logistic regression model revealed that GDM, a family history of diabetes, and waist circumference were independently associated with the development of diabetes.We concluded that GDM women in Korea are at high risk of diabetes irrespective of the absence of putative risk factors.     

Secondary analysis of perceptions and meanings of type 2 diabetes among Mexican American women

PURPOSE: The purpose of this study was to explore explanatory models of diabetes from the perspective of Mexican American women with type 2 diabetes. METHODS: In-depth interviews were conducted in a secondary analysis of an interpretive interactionism study to investigate the meanings of diabetes from the perspectives of Mexican American women with type 2 diabetes. The sensitizing concept used was Kleinman's explanatory models of illness. The original study sample included 20 Mexican American women between the ages of 27 and 45 with varying lengths of time since diagnosis. RESULTS: Data analysis was an interactive process. The data were collapsed into explanatory models of diabetes categorized as defining, getting, having, describing, or taking care of diabetes. The meaning of having diabetes was viewed as a life threat with complications and a shortened life. CONCLUSIONS: Diabetes complications, viewed as symptoms, were structured in the explanatory models developed from the contextual arenas of family and community. Given the family and community history of diabetes, genetic predisposition to the disease, and perceived life threat, understanding Mexican American women's explanatory models about diabetes serves as a basis for negotiating therapeutic interventions.     

Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus

BACKGROUND: Although the association between smoking and increased risk of coronary heart disease (CHD) is well established in the general population, this relationship is less well-defined among individuals with diabetes. OBJECTIVE: To assess the relationship between cigarette smoking and risk of CHD among women with type 2 diabetes mellitus in the Nurses' Health Study cohort. METHODS: The Nurses' Health Study, a prospective cohort study of 121,700 US female registered nurses surveyed in 11 states and followed up from July 1, 1976, through July 1, 1996, involved a total of 6547 women diagnosed as having type 2 diabetes mellitus. Incident cases of CHD were our main outcome measure in this study. RESULTS: We documented 458 incident cases of CHD (200 fatal CHD-related cases and 258 nonfatal myocardial infarctions) during 20 years (68,227 person-years) of follow-up. We found a dose-response relationship between current smoking status and risk of CHD among diabetic women. Compared with never smokers, the relative risks (RRs) for CHD were 1.21 (95% confidence interval [CI], 0.97-1.51) for past smokers, 1.66 (95% CI, 1.10-2.52) for current smokers of 1 to 14 cigarettes per day, and 2.68 (95% CI, 2.07-3.48) for current smokers of 15 or more cigarettes per day in multivariate analyses (P<.001 for trend). The multivariate RR of CHD among diabetic women who had stopped smoking for more than 10 years was similar to that among diabetic women who were never smokers (RR, 1.01; 95% CI, 0.73-1.38). In secondary analyses involving diabetic and nondiabetic women, the multivariate-adjusted RR of CHD for those with diabetes who currently smoked (> or = 15 cigarettes per day) compared with those who never smoked was 7.67 (95% CI, 5.88-10.01). CONCLUSIONS: Cigarette smoking is strongly associated with an increased risk of CHD among women with type 2 diabetes mellitus. Furthermore, quitting smoking seems to decrease this excess risk substantially; women with diabetes should be strongly advised against smoking.CK     

Dietary patterns, meat intake, and the risk of type 2 diabetes in women

BACKGROUND: Although obesity is the most important risk factor for type 2 diabetes, evidence is emerging that certain foods and dietary factors may be associated with diabetes. To examine the association between major dietary patterns and risk of type 2 diabetes mellitus in a cohort of women. METHODS: We prospectively assessed the associations between major dietary patterns and risk of type 2 diabetes in women. Dietary information was collected in 1984, 1986, 1990, and 1994 from 69,554 women aged 38 to 63 years without a history of diabetes, cardiovascular disease, or cancer in 1984. We conducted factor analysis and identified 2 major dietary patterns: "prudent" and "Western." We then calculated pattern scores for each participant and examined prospectively the associations between dietary pattern scores and type 2 diabetes risks. RESULTS: The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, while the Western pattern included higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. During 14 years of follow-up, we identified 2699 incident cases of type 2 diabetes. After adjusting for potential confounders, we observed a relative risk for diabetes of 1.49 (95% confidence interval [CI], 1.26-1.76, P for trend, <.001) when comparing the highest to lowest quintiles of the Western pattern. Positive associations were also observed between type 2 diabetes and red meat and other processed meats. The relative risk for diabetes for every 1-serving increase in intake is 1.26 (95% CI, 1.21-1.42) for red meat, 1.38 (95% CI, 1.23-1.56) for total processed meats, 1.73 (95% CI, 1.39-2.16) for bacon, 1.49 (95% CI, 1.04-2.11) for hot dogs, and 1.43 (95% CI, 1.22-1.69) for processed meats. CONCLUSION: The Western pattern, especially a diet higher in processed meats, may increase the risk of type 2 diabetes in women.     

gamma-Glutamyltransferase, obesity, and the risk of type 2 diabetes: observational cohort study among 20,158 middle-aged men and women

Serum gamma-glutamyltransferase (GGT) concentration within its normal range has emerged as an important predictor in the pathogenesis of diabetes. We studied serum GGT as a predictor of type 2 diabetes incidence and a possible interaction between obesity and GGT on the development of type 2 diabetes in men and women. A prospective cohort study of 20,158 Finnish men and women aged 25-64 yr who participated in cardiovascular risk-factor surveys carried out in four areas during 10 yr. The average follow-up time was 12.7 yr, and there were 388 incident diabetes cases. Serum GGT cut points were at the 25th, 50th, 75th, and 90th percentiles. Initiation of new diabetes medication defined incidence cases. After adjustment for known risk factors of type 2 diabetes, relative risks for incident diabetes across GGT categories were 1.0, 1.2, 2.3, 3.1, and 3.9 among men and 1.0, 0.8, 1.7, 3.5, and 6.4 among women (P for trend < 0.01, respectively). Body mass index appeared to be more strongly associated with type 2 diabetes in both men and women over age 50 yr with GGT median or greater, compared with subjects with GGT less than median. In conclusion, in women as well as men, serum GGT level within its normal range predicted type 2 diabetes and may modify the well-known association between body mass index and type 2 diabetes.