Skip to main content
SpringerLink
Log in

Racial/Ethnic Differences in Multiple Self-Care Behaviors in Adults with Diabetes

  • Populations at Risk
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Objective

To assess racial/ethnic differences in multiple diabetes self-care behaviors.

Design

Cross-sectional study.

Participants

21,459 participants with diabetes in the 2003 Behavioral Risk Factor Surveillance survey.

Measurements

The study assessed self-care behaviors including physical activity, fruits/vegetables consumption, glucose testing, and foot examination, as well as a composite of the 4 self-care behaviors across racial/ethnic groups. Multiple logistic regression was used to assess the independent association between race/ethnicity, the composite variable, and each self-care behavior controlling for covariates. STATA was used for statistical analysis.

Results

Overall, 6% engaged in all 4 self-care behaviors, with a range of 5% in non-insulin users to 8% in insulin users. Blacks were less likely to exercise (OR 0.63, 95% CI 0.51, 0.79), while Hispanics and “others” were not significantly different from whites. Hispanics (OR 0.64, 95% CI 0.49, 0.82) and others (OR 0.69, 95% CI 0.49, 0.96) were less likely to do home glucose testing, while blacks were not significantly different from whites. Blacks (OR 1.42, 95% CI 1.12, 1.80) were more likely to do home foot examinations, while Hispanics and others were not significantly different from whites. Blacks (OR 0.56, 95% CI 0.36, 0.87) were less likely to engage in all 4 behaviors, while Hispanics and others were not significantly different from whites. There were no significant racial/ethnic differences in fruit and vegetable consumption.

Conclusions

Few patients engage in multiple self-care behaviors at recommended levels, and there are significant racial/ethnic differences in physical activity, dietary, and foot care behaviors among adults with diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2003. Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health, 2003. Rev. ed. Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health, 2005.

  2. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136(8):565–74.

    PubMed  Google Scholar 

  3. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24(3):561–87.

    Article  PubMed  CAS  Google Scholar 

  4. Harris MI. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care. 2001;24:979–82.

    Article  PubMed  CAS  Google Scholar 

  5. Nelson KM, Reiber G, Boyko EJ. Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III). Diabetes Care. 2002;25(10):1722–8 (Oct).

    Article  PubMed  Google Scholar 

  6. Thackeray R, Merrill RM, Neiger BL. Disparities in diabetes management practice between racial and ethnic groups in the United States. Diabetes Educ. 2004;30(4):665–75.

    Article  PubMed  Google Scholar 

  7. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.

  8. Center for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Operational and User’s Guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

  9. American Diabetes Association. Standards of medical care in diabetes—2006 (position statement). Diabetes Care. 2006;29(1 suppl):S4–S42.

    Google Scholar 

  10. American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for management of diabetes mellitus: the AACE system of intensive diabetes self-management—2002 update. Endocr Pract. 2002;8(1 suppl):40–82.

    Google Scholar 

  11. Veterans Affairs/Department of Defense. Diabetes mellitus: clinical practice guidelines [article online]. Available from http://www.oqp.med.va.gov/cpg/DM/DM3_cpg/frameset.htm. Accessed August 24, 2006.

  12. StataCorp: Stata statistical software: release 8.0. College Station, TX. Stata Corporation, 2004.

  13. American Diabetes Association. Physical activity/exercise and diabetes (position statement). Diabetes Care. 2004;27(1 suppl):S58–S62.

    Google Scholar 

  14. American Diabetes Association. Nutrition principles and recommendations in diabetes (position statement). Diabetes Care. 2004;27(1 suppl):S36–S46.

    Google Scholar 

  15. Egede LE, Zheng D. Modifiable cardiovascular risk factors in adults with diabetes: prevalence and missed opportunities for physician counseling. Arch Intern Med. 2002;162(4):427–33.

    Article  PubMed  Google Scholar 

  16. Egede LE, Poston ME. Racial/ethnic differences in leisure-time physical activity levels among individuals with diabetes. Diabetes Care. 2004;27(10):2493–4.

    Article  PubMed  Google Scholar 

  17. Martin TL, Selby JV, Zhang D. Physician and patient prevention practices in NIDDM in a large urban managed-care organization. Diabetes Care. 1995;18(8):1124–32.

    Article  PubMed  CAS  Google Scholar 

  18. Brown AF, Gregg EW, Stevens MR, et al. Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research into Action for Diabetes (TRIAD) study. Diabetes Care. 2005;28(12):2864–70.

    Article  PubMed  Google Scholar 

  19. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  20. The UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  21. Benjamin, EM. Self-monitoring of blood glucose: the basics. Clin Diabetes. 2002;20:45–7.

    Article  Google Scholar 

  22. Mensing C, Boucher J, Cypress M, et al. National standards for diabetes self-management education. Diabetes Care. 2006;29(1 suppl):S78–S85.

    PubMed  Google Scholar 

  23. Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE. Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Prev Med. 2000;18(1):46–53.

    Article  PubMed  CAS  Google Scholar 

  24. Eyler AA, Matson-Koffman D, Vest JR, et al. Environmental, policy, and cultural factors related to physical activity in a diverse sample of women: The Women’s Cardiovascular Health Network Project—summary and discussion. Women Health. 2002;36(2):123–34.

    PubMed  Google Scholar 

  25. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288:475–82.

    Article  PubMed  Google Scholar 

  26. Karter AJ, Ferrara A, Darbinian JA, Ackerson LM, Selby JV. Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care. 2000;23:477–83.

    Article  PubMed  CAS  Google Scholar 

  27. Nelson KM, Chapko MK, Reiber G, Boyko EJ. The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System. Health Serv Res. 2005;40(2):361–72.

    Article  PubMed  Google Scholar 

  28. Serdula M, Coates R, Byers T, et al. Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations. Epidemiology. 1993;4:455–63.

    Article  PubMed  CAS  Google Scholar 

  29. Shea S, Stein AD, Lantigua R, Basch CE. Reliability of the behavioral risk factor survey in a triethnic population. Am J Epidemiol. 1991; 133:489–500.

    PubMed  CAS  Google Scholar 

  30. Bowlin SJ, Morrill BD, Nafziger AN, Lewis C, Pearson TA. Reliability and changes in validity of self-reported cardiovascular disease risk factors using dual response: the behavioral risk factor survey. J Clin Epidemiol. 1996;49:511–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Dr. Egede is supported by grant #5K08HS11417 from the Agency for Health Care Research and Quality. Dr. Nwasuruba is supported by R24 MD000536 from the National Center on Minority Health and Health Disparities.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Texas Health Center at Tyler, Tyler, TX, USA

    Chiagozie Nwasuruba MD

  2. Charleston VA TREP, Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    Mokbul Khan PhD & Leonard E. Egede MD, MS

  3. Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, Charleston, SC, 29425, USA

    Leonard E. Egede MD, MS

Authors
  1. Chiagozie Nwasuruba MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mokbul Khan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leonard E. Egede MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leonard E. Egede MD, MS.

Additional information

Potential Financial Conflicts of Interest:

The authors do not have any conflicts of interest to report.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nwasuruba, C., Khan, M. & Egede, L.E. Racial/Ethnic Differences in Multiple Self-Care Behaviors in Adults with Diabetes. J GEN INTERN MED 22, 115–120 (2007). https://doi.org/10.1007/s11606-007-0120-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-007-0120-9

Key words

Search

Navigation