Abstract
We investigated whether self-reported racial discrimination was associated with continuous glucose levels and variability in individuals with diabetes, and whether diabetes distress mediated these associations. Seventy-four Black and White women with type 2 diabetes completed the Experience of Discrimination scale, a measure of lifetime racial discrimination, and the Problem Areas in Diabetes, a measure of diabetes distress. Participants wore a continuous glucose monitor for 24 h after 8 h of fasting, a standard meal, and a 4-h run in period. Higher discrimination predicted higher continuous mean glucose and higher standard deviation of glucose. For both mean and standard deviation of glucose, a race × discrimination interaction indicated a stronger relationship between discrimination and glucose for Whites than for Blacks. Diabetes distress mediated the discrimination–mean glucose relationship. Whites who report discrimination may be uniquely sensitive to distress. These preliminary findings suggest that racial discrimination adversely affects glucose control in women with diabetes, and does so indirectly through diabetes distress. Diabetes distress may be an important therapeutic target to reduce the ill effects of racial discrimination in persons with diabetes.
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References
Pascoe AE, Richman LS. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135:531–54.
Lewis TT, Kravitz HM, Janssen I, Powell LH. Self-reported experiences of discrimination and visceral fat in middle-aged African-American and Caucasian women. Am J Epidemiol. 2011;173(11):1223–31.
Wagner JA, Tennen H, Finan PH, Ghuman N, Burg MM. Self-reported racial discrimination and endothelial reactivity to acute stress in women. Stress Health. 2012 epub ahead of print.
Lewis TT, Aiello AE, Leurgans S, Kelly J, Barnes LL. Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults. Brain Behav Immun. 2010;24(3):438–43.
Aikens JE, Mayes R. Elevated glycosylated albumin in NIDDM is a function of recent everyday environmental stress. Diabetes Care. 1997;20(7):1111–3.
Piette JD, Bibbins-Domingo K, Schillinger D. Health care discrimination, processes of care, and diabetes patients’ health status. Patient Educ Couns. 2006;60(1):41–8.
Pieterse AL, Todd NR, Neville HA, Carter RT. Perceived racism and mental health among Black American adults: a meta-analytic review. J Couns Psychol. 2012;59(1):1–9.
Williams DR, Haile R, Mohammed SA, Herman A, Sonnega J, Jackson JS, Stein DJ. Perceived discrimination and psychological well-being in the U.S.A. and South Africa. Ethn Health. 2012;17(1–2):111–33.
Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47.
Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. 2010;33:23–8.
Jackson JS, Williams DR, Torres M. In: Maney A, editor. Perceptions of discrimination: the stress process and physical and psychological health. Washington, DC: National Institute for Mental Health; 1997.
Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and health status in a racially diverse sample. Med Care. 2008;46:905–14.
Fujishiro K. Is perceived racial privilege associated with health? Findings from the behavioral risk factor surveillance system. Social Sci Med. 2009;68:840–4.
Wagner JA, Tennen H, Finan PH, Ghuman N, Burg MM. Self-reported racial discrimination and endothelial reactivity to acute stress in women. Stress Health. 2013;29(3):214–21.
Di Flaviani A, Picconi F, Di Stefano P, Giordani I, Malandrucco I, Maggio P, Palazzo P, Sgreccia F, Peraldo C, Farina F, Frajese G, Frontoni S. Impact of glycemic and blood pressure variability on surrogate measures of cardiovascular outcomes in type 2 diabetic patients. Diabetes Care. 2011;34(7):1605–9.
Wagner J, Tennen H, Wolpert H. Continuous glucose monitoring: a review for behavioral researchers. Psychosom Med. 2012;74(4):356–65.
Chamberlain JJ, Small D. Successful use of a single subcutaneous continuous glucose monitor sensor for 28 days in a patient with Type 1 diabetes. Clinical Diabetes. 2008;26:138–9.
Wagner J, Abbott G. Depression and depression care in diabetes: relationship to perceived discrimination in African Americans. Diabetes Care. 2007;30(2):364–6.
Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med. 2008;25:1096–101.
Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61:1576–96.
Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, Schwartz CE. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–60.
DirecNet Investigators. The accuracy of the CGMS in children with Type 1 diabetes: results of the diabetes research in children network (DirecNet) accuracy study. Diabetes Technol Ther. 2003;5:781–9.
Gross TM, Bode BW, Einhorn D, Kayne DM, Reed JH, White NH, Mastrototaro JJ. Performance evaluation of the MiniMed continuous glucose monitoring system during patient home use. Diabetes Technol Ther. 2000;2(1):49–56.
Høi-Hansen T, Pedersen-Bjergaard U, Thorsteinsson B. Reproducibility and reliability of hypoglycaemic episodes recorded with continuous glucose monitoring system (CGMS) in daily life. Diabetes Med. 2005;22(7):858–62.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
Blaney P. Affect and memory: a review. Psychol Bull. 1986;99:229–46.
Buss AH, Perry M. The aggression questionnaire. J Personal Soc Psychol. 1992;63:452–9.
Gallo LC, Smith TW. Construct validation of health-relevant personality traits: interpersonal circumplex and five-factor model analyses of the Aggression Questionnaire. Int J Behav Med. 1998;5(2):129–47.
Felsten G, Hill V. Aggression Questionnaire hostility scale predicts anger in response to mistreatment. Behav Res Ther. 1999;37(1):87–97.
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.
Ayalon L, Gum AM. The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults. Aging Ment Health. 2011;15(5):587–94.
Barnes LL, de Leon CF, Lewis TT, Bienias JL, Wilson RS, Evans DA. Perceived discrimination and mortality in a population-based study of older adults. Am J Public Health. 2008;98(7):1241–7.
Fisher L, Hessler D, Glasgow RE, Arean PA, Masharani U, Naranjo D, Strycker LA. REDEEM: a pragmatic trial to reduce diabetes distress. Diabetes Care. 2013;36(9):2551–8.
Gibbons FX, O’Hara RE, Stock ML, Gerrard M, Weng CY, Wills TA. The erosive effects of racism: reduced self-control mediates the relation between perceived racial discrimination and substance use in African American adolescents. J Personal Soc Psychol. 2012;102(5):1089–104.
Jamieson JP, Koslov K, Nock MK, Mendes WB. Experiencing discrimination increases risk taking. Psychol Sci. 2013;24(2):131–9.
Wagner JA, Osborne CY, Mendenhall EA, Budris LM, Belay S, Tennen HA. Beliefs about racism and health among African American women with diabetes: a qualitative study. J Nat Med Assoc. 2011;103:224–32.
Johnson P, Risica PM, Gans KM, Kirtania U, Kumanyika SK. Association of perceived racial discrimination with eating behaviors and obesity among participants of the SisterTalk study. J Natl Black Nurses Assoc. 2012;23(1):34–40.
van Son J, Nyklícek I, Pop VJ, Blonk MC, Erdtsieck RJ, Spooren PF, Toorians AW, Pouwer F. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care. 2013;36(4):823–30.
Leyva B, Zagarins SE, Allen NA, Welch G. The relative impact of diabetes distress vs depression on glycemic control in hispanic patients following a diabetes self-management education intervention. Ethn Dis. 2011;21(3):322–7.
Brondolo E, Rieppi R, Kelly KP, Gerin W. Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique. Ann Behav Med. 2003;25:55–65.
De Vogli R, Brunner E, Marmot MG. Unfairness and the social gradient of metabolic syndrome in the Whitehall II study. J Psychosom Res. 2007;63(4):413–9.
Greene ML, Way N, Pahl K. Trajectories of perceived adult and peer discrimination among Black, Latino, and Asian American adolescents: patterns and psychological correlates. Dev Psychol. 2006;42(2):218–36.
Lazarus RS. A strategy for research on psychological & social factors in hypertension. J Human Stress. 1978;4(3):35–40.
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This study was supported by a Grant from the National Institute of Diabetes, Digestive, and Kidney Diseases to Dr. Wagner 5R21DK074468. Dr. Osborn is supported by NIDDK K01DK087894.
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Wagner, J.A., Tennen, H., Feinn, R. et al. Self-Reported Discrimination, Diabetes Distress, and Continuous Blood Glucose in Women with Type 2 Diabetes. J Immigrant Minority Health 17, 566–573 (2015). https://doi.org/10.1007/s10903-013-9948-8
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DOI: https://doi.org/10.1007/s10903-013-9948-8