Living with diabetes and disadvantage: A qualitative, geographical case study

Aims and objectives To explore the relationships among emotional distress, cognitive function and life satisfaction in people living with type 2 diabetes mellitus (T2DM), and to verify the mediating role of cognitive function. Background People with T2DM face cognitive decline caused by age and disease complications. Emotional distress will reduce their life satisfaction, and cognitive function will also affect the life satisfaction, but whether cognitive function mediates the effect of emotional distress on life satisfaction has not been verified. Design A cross‐sectional study. Methods A total of 200 people living with T2DM in the community by convenience sampling were enrolled from November–December 2018. Data collection involved a demographic and disease characteristic questionnaire, Problem Areas in Diabetes Scale, Subjective and Objective Cognitive Function Evaluation and Life Satisfaction Questionnaire. Data analysis included descriptive statistics and structural equation modelling. This report followed the STROBE guideline. Results The emotional distress and subjective memory complaints of cognitive function had a significant positive correlation, while both emotional distress and cognitive function showed significant negative correlations with life satisfaction. In addition, cognitive function completely mediated the relationship between emotional distress and life satisfaction. Conclusion The cognitive function played a mediating role in life satisfaction and explains how emotional distress affects life satisfaction of people with T2DM. Therefore, it is suggested that diabetes nurses should early identify the decline of cognitive function, and to intervene at an early stage. Relevance to clinical practice This study provides opinions on the mediating factors of cognitive function. Coping strategies and supporting resources to help the T2DM people to improve their life satisfaction are suggested.

Objective: The objective of this study was to evaluate an Aboriginal‐led diabetes lifestyle program catering to urban Aboriginal people in an Aboriginal organisation. Methods: Mixed‐methods study that employed routinely collected physiological data and audio‐recorded focus group sessions. Physiological data were analysed using a multi‐level model to account for participant clustering. Qualitative data were subject to thematic analysis. Results: Participants were overwhelmingly positive about the program. They lost weight and improved their diastolic blood pressure and glycaemic control; however, it was the feelings of belonging and optimism about their ability to improve their health that they most valued. Qualitative analysis revealed three main themes. These were: ‘With the Mob’, ‘For the Mob’ and ‘Program Elements. The strengths of the program lay in its indigeneity, low‐cost and easy‐to‐prepare diet, and cultural and communication skills of the director. Conclusions: Recommendations for improvement included educating participants on the pathophysiology of diabetes, the refinement of online elements and the introduction of face‐to‐face group exercise. Implications for public health: Programs of this nature should be expanded and evaluated longitudinally with multiple cohorts.

Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information–Motivation–Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.