Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes.

The purpose of this focus group intervention was to characterize the health beliefs, self-care practices, diabetes education needs, weight-loss issues, and facilitators and barriers to diabetes health care in black women with non-insulin-dependent diabetes. Major themes that emerged from the focus group were motivation to prevent complications, unrealistic weight goals set by providers, multiple barriers to diet and exercise, and a dual role of family as supporter and deterrent to diabetes management, especially related to diet. These findings suggest that culturally sensitive and appropriate patient educational programs must be provided for minority groups such as black women who have higher rates of diabetes-related complications.

Non-insulin-dependent diabetes and obesity in the black and Hispanic population: culturally sensitive management.

The prevalence of diabetes is considerably higher among ethnic minorities, particularly black and Hispanic Americans, than in the nonminority white population. Obesity, a significant risk factor for non-insulin-dependent diabetes mellitus (NIDDM), also is more common in these ethnic groups. Because the combined effects of obesity and NIDDM can lead to potentially serious complications, overweight patients with NIDDM must be treated aggressively. However, effective treatment of these ethnic groups requires a sensitivity to and recognition of their unique cultural values. Diabetes educators and health care providers need to take into account specific ethnic beliefs, customs, food patterns, and health care practices, with the goal of incorporating these cultural factors into a practical and beneficial treatment regimen.

Metabolic impact of education in NIDDM.

OBJECTIVE: To evaluate the impact of a model program of diabetes education and weight reduction on diabetes control and weight loss in obese individuals with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Eighty-two obese diabetic subjects were randomized to three levels of educational intensity: 1) a single individual session, 2) a 12-wk behavior-oriented diabetes education and weight control group intervention, or 3) group intervention plus six individual follow-up sessions. Repeated measures of weight, fasting blood glucose, and HbA1c were collected. Measures of diabetes knowledge, skills, and attitudes were also obtained. RESULTS: By 6 mo, all three intervention groups had a significant weight loss (P less than 0.01). The mean weight loss of approximately 10 lb was independent of treatment group and was maintained over the duration of the study. However, significant improvement in metabolic control was associated with participation in the diabetes education-weight reduction intervention. CONCLUSIONS: The findings of this study indicate that a cognitive behavioral group intervention of diabetes knowledge and weight reduction training can produce weight loss and improvements in diabetes control. The addition of individual counseling as a follow-up maintenance strategy does not appear to have any advantage.

Weight reduction interventions for persons with a chronic illness: findings and factors for consideration.

Obesity in persons with a concomitant chronic illness poses complex issues relating to the choice of appropriate interventions. More recent emphasis on modification of risk factors has resulted in the need to prescribe complex therapeutic regimens with multiple treatment goals. The traditional approach to weight reduction in such persons has been nutrition education. Studies have shown, however, that knowledge alone does not translate into self-care behaviors that in turn result in weight loss and weight maintenance. Although the latter outcomes continue to be primary goals of therapy in obese individuals with a chronic illness, improvement in the physiologic parameters associated with the illness is also a desired outcome. Behavior therapy and group support appear to be enabling factors that go beyond knowledge to facilitate behavior change and subsequent changes in health-related indexes. This article describes various approaches to the problem of combined interventions for patients education and weight reduction. Findings and factors are discussed about whether the primary goal of weight reduction interventions for persons with a chronic illness should focus on pounds lost or improvement in metabolic or physiologic status.

Patient perceptions of diabetes treatment goals.

The current treatment of type II noninsulin dependent diabetes mellitus (NIDDM) and obesity involves complex regimens for weight reduction and improvement in metabolic control that necessitate active participation by the patient in establishing treatment goals and strategies. However, well-documented rates of nonadherence suggest that weaknesses may exist in patient-provider communications that preclude such patient participation. This study examines patient perceptions of diabetes treatment goals as established with their health care providers. Fifty-four individuals with type II NIDDM and obesity were surveyed. To determine the degree of congruence between patient and health care provider, the physicians of study participants were also surveyed. A 53% discrepancy rate was found to exist in the area of overall treatment goals. In addition, a 57% and 43% rate of discrepancy was found for the specific goals of weight loss and blood glucose levels, respectively. Further findings and the implications for practice are discussed in this paper.