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Purpose: The purpose of this study was to evaluate a diabetes education program that includes a pharmacist as a member of the diabetes management team by assessing the change in hemoglobin A1c (A1C), cholesterol, and blood pressure for patients with type 2 diabetes in outpatient clinics., Methods: This was a retrospective study in outpatient clinics at Shands Jacksonville Medical Center. The patients were assigned into either the pharmacist group or the nonpharmacist group, according to the presence or the absence of a pharmacist in the clinic. The primary end point was the absolute change in A1C versus baseline. Secondary end points included change in cholesterol and blood pressure and the number of patients to attain American Diabetes Association goals. End points were recorded to correlate within 3 months of the initial visit and final visit with a provider., Results: Compared to the nonpharmacist group, patients in the pharmacist group had more advanced and uncontrolled diabetes at baseline. The pharmacist group showed a greater percent change in A1C and improvement between the initial and final clinic visits, after adjusting for baseline confounders. Despite the statistically significant improvement in A1C in the pharmacist group, there was no difference found between the 2 groups for the end points of cholesterol and blood pressure., Conclusion: Including a pharmacist as a part of the diabetes management team may result in lower A1C in patients with more advanced and uncontrolled type 2 diabetes mellitus versus a health care team without a pharmacist.

Purpose: This study explores the potential utility of a culturally tailored diabetes management intervention approach by testing associations between acculturation and diabetes-related beliefs among Mexican-American adults with type 2 diabetes., Methods: Data from 288 Mexican-American adults with type 2 diabetes were obtained via a bilingual, telephone-administered survey. Participants were drawn from a stratified, random sample designed to obtain maximum variability in acculturation. The survey assessed diabetes-related beliefs, intervention preferences, and the following three acculturation constructs from the Hazuda acculturation and assimilation scales: Spanish use, value for preserving Mexican culture, and interaction with Mexican Americans., Results: Only one outcome-preference for a program for Mexican Americans-was associated with all three acculturation variables. Spanish use was positively associated with belief in susto as a cause of diabetes, preference for expert-driven health guidance, and involvement of others in taking care of diabetes. Value for preserving Mexican culture was related to a more holistic view of health, as evidenced by an increased likelihood of consulting a curandero, use of prayer, and interest in a diabetes program with religious content. Value for cultural preservation was also related to higher suspicion of free diabetes programs. Interaction with Mexican Americans was associated with a belief that insulin causes blindness., Conclusion: Findings from this study suggest distinct relationships between acculturation constructs and diabetes-related beliefs and preferences, thus arguing against the use of a single acculturation construct to determine diabetes intervention design. Cultural tailoring may enhance the cultural appropriateness and ultimate effectiveness of diabetes interventions for Mexican American adults.

Purpose: The purpose of this study was to assess dietary intake habits of Mexican American Hispanic adults participating in the En Balance diabetes education program., Methods: En Balance is a 3-month culturally sensitive diabetes education intervention for Spanish-speaking Hispanics. Of the 46 participants enrolled, 39 mainly Mexican American Hispanic adults with type 2 diabetes completed the En Balance program. Participants lived in the Riverside and San Bernardino counties of California, and all participants completed the program by June 2008. Dietary intake was assessed at baseline and at 3 months using the validated Southwest Food Frequency Questionnaire., Results: Clinically important decreases in glycemic control and serum lipid levels were observed at the end of the 3-month program. The baseline diet was characterized by a high intake of energy (2478 ± 1140 kcal), total fat (87 ± 44 g/day), saturated fat (28 ± 15 g/day), dietary cholesterol (338 ± 217 mg/day), and sodium (4236 ± 2055 mg/day). At 3 months, the En Balance group mean intake of dietary fat (P = .045) and dietary cholesterol (P = .033) decreased significantly. Low dietary intakes of docosahexaenoic acid, eicosapentaenoic acid, and vitamin E were also observed in these adults with type 2 diabetes., Conclusions: The En Balance program improved glycemic control and lipid profiles in a group of Hispanic diabetic participants. En Balance also promoted decreases in dietary fat and dietary cholesterol intake.

Purpose: To describe methods used to recruit and retain low-income Latinos in a randomized clinical trial (RCT) of a diabetes self-management intervention at 5 community health centers (CHCs) in Massachusetts., Methods: Consent from primary care providers (PCPs) was obtained to screen their patients. Trained site research coordinators (SRCs) screened, recruited, and enrolled participants following a multistep process (medical record reviews, PCP approval, a patient eligibility interview) and provided support for retention efforts. Assessment staff were trained in motivational strategies to facilitate retention and received ongoing support from a retention coordinator. Electronic tracking systems facilitated recruitment and retention activities., Results: Of an initial pool of 1176 patients, 1034 were active at the time of screening, 592 (57%) were eligible by medical record review, and 487 received PCP approval (92% of reviewed patients). Of these, 293 patients completed the patient screening interview (60% of patients with PCP approval, and 76% of those reached), and 276 were eligible. Sixteen percent of all active patients refused participation, and 8% of contacted patients were unreachable. Two hundred fifty-two patients were randomized after completion of baseline assessments. Clinical, behavioral, and psychosocial assessment completion rates were 92%, 77%, and 86% at 12-month follow-up, respectively, and 93% of patients completed at least one study assessment at 12 months., Conclusions: CHCs are a prime setting for translation research aimed to eliminate diabetes health disparities. Successful recruitment and retention efforts must address institutional/organizational, research team, and patient-related challenges.

Purpose: The purpose of this case study was to determine the feasibility of peer-led telephone counseling for people with type 2 diabetes mellitus related to physical activity (PA) and to establish preliminary efficacy of peer-led telephone counseling for eliciting recommended changes in PA-related cognitions and behaviors for adults with type 2 diabetes mellitus., Methods: A total of 8 adults (5 males and 3 females, aged 59.5 (6.5) years) with type 2 diabetes mellitus completed quantitative self-report measures of aerobic-based PA, resistance training (RT), along with metrics from social cognitive theory (SCT) before and after a 12-week intervention. Qualitative data from weekly peer-led telephone sessions were collected by a peer counselor and subsequently organized into themes and analyzed using a mixed-methods, collective case-study approach., Results: PA behaviors remained relatively constant over the 12-week intervention. Self-efficacy for RT improved (z = -2.03; P = .04). From the peer counselor's perspective, identifiable inhibitors to PA, which included low self-efficacy and disease condition limitations, were successfully translated into enablers/motivators. Perceived health benefits were frequently reported by the peer counselor as motivators for the participants over the study period. Participants believed peer counseling by telephone influenced their decision to continue to participate in PA., Conclusion: Theory-based, peer-led telephone counseling shows some promise for increasing receptiveness to PA, but had little effect on improving behavior for most participants. Further studies will be necessary to determine the effectiveness and the sustainability of this approach.

Purpose: The purpose of this article is to describe the process of translating evidence-based dietary guidelines into a tailored nutrition education program for Korean American immigrants (KAI) with type 2 diabetes mellitus (DM)., Methods: Community-based participatory research (CBPR) is a research process involving researchers and communities to build a collaborative partnership. The study was conducted at a community-based organization. In a total of 79 KAI (intervention, n = 40; control, n = 39) with uncontrolled type 2 DM (A1C ≥ 7.5%), 44.3% were female and the mean age was 56. 5 ± 7.9 years. A culturally tailored nutrition education was developed by identifying community needs and evaluating research evidence. The efficacy and acceptability of the program was assessed., Results: In translating dietary guidelines into a culturally relevant nutrition education, culturally tailored dietary recommendations and education instruments were used. While dietary guidelines from the American Diabetes Association (ADA) were used to frame nutrition recommendations, additional content was adopted from the Korean Diabetes Association (KDA) guidelines. Culturally relevant intervention materials, such as Korean food models and an individually tailored serving table, were utilized to solidify nutritional concepts as well as to facilitate meal planning. Evaluation of the education revealed significantly increased DM-specific nutrition knowledge in the intervention group. The participants' satisfaction with the education was 9.7 on a 0 to 10-point scale., Conclusion: The systematic translation approach was useful for producing a culturally tailored nutrition education program for KAI. The program was effective in improving the participants' DM-specific nutrition knowledge and yielded a high level of satisfaction. Future research is warranted to determine the effect of a culturally tailored nutrition education on other clinical outcomes.

Purpose: The purpose of this study was to examine physical activity counseling and program preferences in a sample of adults with type 2 diabetes. Specifically, the objectives were to determine physical activity preferences (objective 1), and whether there were any significant differences between age and/or sex groups for these preferences (objective 1a). A subsidiary objective was to explore potential associations of key social-cognitive constructs (ie, self-efficacy and social support) with physical activity preferences (objective 2)., Methods: This exploratory study consisted of a quantitative, secondary analysis of survey data from a national sample of adults with type 2 diabetes (N = 244). A qualitative follow-up employing telephone interviews was conducted with 14 individuals., Results: Consistent with hypotheses, walking was the most preferred physical activity behavior and there was a preference for engaging in physical activity with others. There were significant (P values < .05) differences in counseling and program preferences between demographic (age and sex), and physical activity cognitive scores. For example, a significantly (P < .05) higher physical activity intensity preference was found in men and younger participants., Conclusions: Tailoring interventions and physical activity programs to the specific preferences of individuals is an important component for health professionals and researchers in facilitating this behavior.

Purpose: The purpose of this study was to evaluate the effectiveness of integrative health (IH) coaching on psychosocial factors, behavior change, and glycemic control in patients with type 2 diabetes., Methods: Fifty-six patients with type 2 diabetes were randomized to either 6 months of IH coaching or usual care (control group). Coaching was conducted by telephone for fourteen 30-minute sessions. Patients were guided in creating an individualized vision of health, and goals were self-chosen to align with personal values. The coaching agenda, discussion topics, and goals were those of the patient, not the provider. Preintervention and postintervention assessments measured medication adherence, exercise frequency, patient engagement, psychosocial variables, and A1C., Results: Perceived barriers to medication adherence decreased, while patient activation, perceived social support, and benefit finding all increased in the IH coaching group compared with those in the control group. Improvements in the coaching group alone were also observed for self-reported adherence, exercise frequency, stress, and perceived health status. Coaching participants with elevated baseline A1C (>/=7%) significantly reduced their A1C., Conclusions: A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs. Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy, accountability, and clinical outcomes.

Purpose: The purpose of this qualitative study was to identify psychosocial resources and barriers to self-management among African American adolescents with type 2 diabetes and their mothers., Methods: African American adolescents (n = 10) aged 14 to 19 years old with type 2 diabetes for >1 year and their mothers (n = 10) were recruited from the pediatric diabetes clinic of a large medical center practice. Participants were independently interviewed and responded to a series of open-ended questions concerning illness experiences and resources and barriers to diabetes self-management. This study used a modified grounded theory approach to data coding and analysis., Results: Adolescents and mothers shared similar perceptions of resources and barriers to self-management. Resources included mother's role as the primary support person, emergence of greater self-efficacy and coping over time, family recognition of the seriousness of diabetes, and the presence of supportive peers. Barriers included comorbidity, dietary and other regimen challenges, negative peer influences, and financial problems., Conclusions: Resources and barriers identified in this study represent the multiple contexts that influence type 2 diabetes (eg, individual, family, peer, economic, and cultural).

Purpose: The purpose of this study was to conduct a diabetes education program delivered by community health workers (CHWs) in community settings and to evaluate its effectiveness in improving glycemic control and self-management skills in Hispanics/Latinos with type 2 diabetes., Methods: Trained CHWs recruited Hispanic/Latino community residents with self-reported type 2 diabetes, implemented intervention in nonclinical locations, and collected data on diabetes knowledge, self-care behaviors, self-efficacy, depression, A1C, weight, and blood pressure. Classes applied participatory techniques and were delivered in 2-hour group sessions over 10 weeks. Two focus groups collected qualitative postintervention data., Results: Seventy participants enrolled, and 47 completed pretest and posttest data. Improvements were significant for A1C (P = .001) and systolic blood pressure (P = .006). Other positive outcomes were diabetes knowledge, physical activity, spacing carbohydrates, following a healthy eating plan, and eating fruits and vegetables. Improved behaviors also included foot care, glucose self-monitoring, and medication adherence. Depressive symptoms showed a positive trend in intent-to-treat analysis (P = .07), but self-efficacy did not change significantly (P = .142). Qualitative information reported an increase in participants' perceived competence in self-care and a positive influence of CHWs in participants' compliance with the program., Conclusions: A diabetes self-management education program for Hispanics/Latinos led by CHWs can be implemented in community settings and may effectively improve behavioral skills and glycemic control.

Purpose: The purpose of this pilot/feasibility study was to evaluate the use of insulin regimens among individuals with poorly controlled type 2 diabetes. In addition, a secondary aim was to build the body of evidence regarding the use of insulin pumps in patients with type 2 diabetes., Methods: The setting was a suburban private endocrinology practice. Patients were a convenience sample of 15 adults, aged 40 to 64 years with poorly controlled type 2 diabetes, as defined by a hemoglobin A1C (A1C) of 8% or higher when continuous subcutaneous insulin infusion (CSII) was initiated. Baseline, 3-month, 6-month, and 1-year A1C, body mass index (BMI), basal and bolus insulin use, and number of office visits were collected through medical record review. Descriptive, independent, and paired t tests were used to evaluate data., Results: A significant reduction in basal insulin use was found. Significant reductions in A1Cs were found at 3 months, 6 months, and 1 year. A significant increase in BMI was noted., Conclusions: Results indicated improvement in glycemic control with CSII for some patients with an associated increase in BMI. Reduction of basal insulin use was significant and, for some, cost effective using CSII. Current policies regarding CSII use in patients with type 2 diabetes need to be re-evaluated.

Purpose: The purpose of this study was to examine patients' diabetes risk factors, comorbid conditions, and patient participation in and primary care practitioner (PCP) referrals to a rural diabetes self-management education (DSME) program., Methods: A total of 295 patients in a rural community were identified by their PCP as having type 2 diabetes (T2D). Using patient information that was collected and entered into a diabetes data management system, patients' risk factors, comorbid conditions, and patient participation in and PCP referral patterns to a DSME program were examined., Results: Of the 295 patients with T2D, 162 (65%) reported that they had never received any DSME services. Despite educator efforts to improve patient participation and PCP awareness of local DSME services, 123 (76%) of the 162 patients never received a subsequent referral for DSME. Those patients who did receive a referral had a higher number of risk factors and comorbid conditions than those who did not receive a referral. Eighty-three percent of the patients who received a PCP referral attended the DSME program., Conclusions: The findings reaffirm concerns that DSME patient participation and PCP referral practices are poor. Advocacy efforts should force policies and procedures that will make DSME a mandatory service and universally accessible. Unless referral practices are attended to, it is doubtful that the United States will reach the Healthy People 2010 objective for diabetes education.

Purpose: The purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness., Methods: Various recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 +/- 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (alpha = .05)., Results: Following the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy., Conclusions: A systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy.

Purpose: The mechanism by which depression influences health outcomes in persons with diabetes is uncertain. The purpose of this study was to test whether depression is related to self-care behavior via social motivation and indirectly related to glycemic control via self-care behavior., Methods: Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, depression, and diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the predicted pathways., Results: Higher levels of depressive symptoms were significantly related to having less social support and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance., Conclusions: Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, foot care, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation.

Purpose: The purpose of this pilot study was to examine the feasibility and effectiveness of a community-based, culturally focused, exercise program for adults in the Hispanic community with type 2 diabetes., Methods: A pretest/posttest design using a culturally designed exercise program through dance was used. A total of 19 Mexican American men and women (39 to 64 years of age) with type 2 diabetes were recruited. Mean preprogram and postprogram differences were examined in hemoglobin A1C, lipid panel, body mass index (BMI), and psychological well-being., Results: Feasibility was demonstrated by exceeding our recruitment goal and achieving an 84% completion rate and 75% attendance rate for the exercise sessions. Mean hemoglobin A1C, lipids, and psychological well-being demonstrated trends toward improvement from the beginning of the program to the end. BMI remained unchanged. Physical activity increased and all participants met the physical activity goals from the national physical activity guidelines for Americans by the end of the program., Conclusions: The culturally focused exercise program detailed here is effective in promoting regular physical activity among Hispanic adults with type 2 diabetes.

Purpose: The purpose of this study was to evaluate the effectiveness of a self-help physical activity program for persons with type 2 diabetes. Effectiveness was measured by cardiovascular indicators, hemoglobin A1C, anthropometric indicators, and activity levels., Methods: This intervention study included 53 individuals with type 2 diabetes. Participants were randomly assigned. Participants in the intervention group attended the usual Diabetes Self-Management Education Program (DSMEP) and received a copy of the book, Manpo-kei; a concise handout summarizing the key points of Manpo-kei; and a pedometer. Participants not assigned to the intervention attended the usual DSMEP only. Data collection was completed at the beginning of the study and 3 months later using a lifestyle and diabetes questionnaire, a physical activity questionnaire, and cardiovascular and anthropometric measures., Results: Those who participated in the intervention demonstrated a significant decrease in hemoglobin A1C, weight, and body fat. In addition, they increased their number of daily steps as measured by the pedometer. The control group also demonstrated a significant decrease in hemoglobin A1C and weight. Both groups demonstrated increases in their regular weekly activity. At the end of the study period, the intervention group had a significantly lower diastolic blood pressure than the control group., Conclusions: Pedometers can be a helpful strategy to motivate persons with diabetes to increase physical activity. However, it appears that attendance at DSMEP alone may be enough to increase physical activity for persons with type 2 diabetes.

Purpose: The purpose of this study was to assess whether the VA-MEDIC (Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction), a pharmacist-led group medical visit program, could improve achievement of target goals in hypertension, hyperglycemia, hyperlipidemia, and tobacco use in patients with type 2 diabetes compared to usual care., Methods: This was a randomized controlled trial of VA-MEDIC intervention in addition to usual care versus usual care alone in diabetic patients to reduce cardiac risk factors. VA-MEDIC consisted of a 40- to 60-minute educational component by nurse, nutritionist, physical therapist, or pharmacist followed by pharmacist-led behavioral and pharmacological interventions over 4 weekly sessions. Measures The attainment of target goals in hemoglobin A1C (A1C), blood pressure, fasting lipids, and tobacco use recommended by the American Diabetes Association., Results: Of 118 participants, 109 completed the study. VA-MEDIC (n = 58) participants were younger and had greater tobacco use at baseline than usual care but were similar in other cardiovascular risk factors. After 4 months, a greater proportion of VA-MEDIC participants versus controls achieved an A1C of less than 7% and a systolic blood pressure less than 130 mm Hg. No significant change was found in lipid control or tobacco use between the 2 study arms., Conclusion: Pharmacist-led group medical visits are feasible and efficacious for improving cardiac risk factors.

Purpose: The purpose of this study was to evaluate the impact of an innovative intervention that utilized a certified medical assistant with specific diabetes training to work with a multidisciplinary diabetes care team to help provide basic diabetes education and self-care support in low-income minority populations with type 2 diabetes., Methods: Enrolled participants were randomized to either the medical assistant coaching (MAC) group (N = 25) or the treatment as usual (TAU) group (N = 25). Deidentified data was obtained on a matched no contact control (NCC) group (N = 50)., Results: Analysis of covariance (ANCOVA) comparisons revealed no significant differences between the 3 groups on A1C, but a trend was observed. A1Cs decreased across time for the MAC group, while increasing for the TAU and NCC groups. ANCOVA comparisons also indicated that the MAC group experienced significantly greater increases in perceived empowerment and a larger, although nonsignificant, reduction in perceived diabetes related problems than the TAU group., Conclusions: This randomized controlled pilot study suggests that the inclusion of a medical assistant self-care coach as part of the diabetes care team holds promise in improving outcomes and should be further examined in a large-scale study.

Unlabelled: Diabetes in pregnancy is a major public health problem in Mexico. Nutrition therapy is an important component of treatment. Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes. Its effect on different types of diabetes mellitus has not been studied., Purpose: The authors assessed the effect of a medical nutrition therapy (MNT) program on perinatal complications in Mexico City., Methods: Quasi-experimental design with a historical control. Women were assigned to a MNT program (n = 88) and were followed up with every 2 weeks until delivery (2004-2007). The control group (n = 86) was selected from medical charts (2001-2003) and the same inclusion criteria were used. In each group, 55% of women had type 2 diabetes mellitus and 45% had gestational diabetes. The MNT program included a moderate intake of carbohydrate (40%-45% of total energy) and reduction in energy intake, capillary glucose self-monitoring, and education. The control group received usual hospital routine care. Statistical analysis included descriptive statistics, chi-square, and multivariate logistic regression (OR, 95% CI) as indicated., Results: Women in the MNT program had a lower risk of preeclampsia, fewer maternal hospitalization, and neonatal deaths in both types of diabetes. Low birth weight was less frequent only in women with gestational diabetes receiving MNT, while neonatal intensive care unit admissions were lower only in women with type 2 diabetes., Conclusions: An intensive MNT program, including counseling, education, and capillary glucose self-monitoring, has a positive effect over preeclampsia, maternal hospitalization, and neonatal death in women with diabetes in pregnancy. MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy.

Purpose: The purpose of this pilot study was to test a dance intervention and explore the role of peer support to improve the diabetes outcomes of A1C, weight, body fat, and blood pressure in African American women with type 2 diabetes., Methods: This study was conducted in a community-based outpatient clinic. A mixed methods design was used. A total of 46 women, 26 to 83 years of age, were randomized to either the 12-week dance group or usual care group. Both between group and intraindividual group differences were analyzed from baseline to 12 weeks. Focus group interviews explored the role of peer support through semistructured discussions for the women enrolled in the dance group., Results: Results showed significant group mean differences in systolic blood pressure (BP) and body fat. Paired t tests showed significant reductions in all the diabetes outcomes for the dance group and significant increases in glycolated hemoglobin (A1C) and systolic BP for the usual care group. The emergent themes of the focus groups were that a diabetes diagnosis was devastating, and changing eating habits and taking medications was often difficult. Peer support in the dance group was expressed as camaraderie, enjoyment, and laughter, which fostered attendance., Conclusions: Dancing 2 times per week for 12 weeks produced significant group differences in systolic BP and body fat and significant intraindividual changes. The implications are that dancing in a supportive environment with peers may be an effective strategy for diabetes educators to help those with diabetes to become more physically active and improve diabetes outcomes and overall health.

Purpose: The purpose of this study was to examine the influence of diet family support on glucose outcome in Korean immigrants with type 2 diabetes, taking into consideration patient gender., Methods: A total of 143 Korean immigrants with type 2 diabetes were recruited from a West Coast Koreatown. On completing questionnaires (demographic, health history, and the Diabetes Family Behavior Checklist-II [DFBC]), a participant was given a finger stick blood test for glycosylated hemoglobin (A1C). Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated after measurements were taken. Analyses assessed the independent associations of diet family support, gender, and diet family support by gender interactions with glucose outcome., Results: A higher level of diet family support was significantly associated with lower A1C, indicating the beneficial effect of diet family support on glucose control. Although the main effect of gender on A1C was not significant, the effect of the product term of family support and gender was, indicating that the significant beneficial impact of diet family support on A1C depends on gender. The impact is much more pronounced in men (B = -.516) than women (B = -.038)., Conclusions: Family support, specific to diet, is significantly associated with glucose outcomes in Korean immigrants with type 2 diabetes. That is, more perceived family support was associated with better glucose control. The positive impact of family support on glucose outcome was significantly stronger in men than in women, even after other factors were taken into consideration.

Purpose: The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants (KAIs) with type 2 diabetes., Methods: A randomized controlled pilot trial with 2 parallel arms (intervention vs control) with a delayed intervention design was used. A total of 79 KAIs, recruited from the Baltimore-Washington area, completed baseline, 18-week, and 30-week follow-ups (intervention, n = 40; control, n = 39). All participants had uncontrolled type 2 diabetes (hemoglobin A1C >or=7.5%) at baseline. The authors' comprehensive, self-help intervention program for type 2 diabetes management (SHIP-DM) consisted of a 6-week structured psychobehavioral education, home glucose monitoring with teletransmission, and bilingual nurse telephone counseling for 24 weeks. The primary outcome of the study was A1C level, and secondary outcomes included an array of psychobehavioral variables., Results: Using analysis of covariance, the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample. Specifically, the amount of reduction in A1C among intervention group participants was 1.19% at 18 weeks and 1.31% at 30 weeks, with 10% and 15.5% of the participants achieving the suggested goal of A1C <7% at 18 and 30 weeks of follow-up, respectively., Conclusions: The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program, self-monitoring, and follow-up counseling, in terms of maintaining the improved intervention effects obtained and in terms of glucose control.

Purpose: To evaluate the effectiveness of a structured education group program in metabolic control in patients with type 2 diabetes., Methods: A randomized controlled trial was conducted in a public teaching hospital and tertiary care center. Participants were 104 patients with type 2 diabetes not using insulin (aged 59 +/- 9.5 years, diabetes duration of 10.5 +/- 6.70 years, 53% women) randomized to attend an 8-hour structured group education program (delivered in 4 sessions, for 4 weeks, by a trained nurse educator) or to usual care. A pretest and posttest assessed the patients' knowledge before and after the course. The main outcome measures were A1C, weight, blood pressure, and lipids at 4-month intervals, up to 12 months., Results: A1C levels decreased significantly in the intervention group after the 4th month and remained lower than in the control group until the 12th month (multivariate analysis of covariance, with baseline A1C as a covariate). Weight, blood pressure levels, total cholesterol, and high-density lipoprotein levels improved significantly, and similarly, in both groups., Conclusions: A structured education group program centered in self-management improves the glycemic control in patients with type 2 diabetes, reaching the peak effect at 4 months, and lasting for up to 12 months.

Purpose: The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a randomized usual-care control group at 6 months., Methods: A total of 345 adults with type 2 diabetes but no criteria for high A1C were randomized to a usual-care control group or 6-week community-based, peer-led diabetes self-management program (DSMP). Randomized participants were compared at 6 months. The DSMP intervention participants were followed for an additional 6 months (12 months total). A1C and body mass index were measured at baseline, 6 months, and 12 months. All other data were collected by self-administered questionnaires., Results: At 6 months, DSMP participants did not demonstrate improvements in A1C as compared with controls. Baseline A1C was much lower than in similar trials. Participants did have significant improvements in depression, symptoms of hypoglycemia, communication with physicians, healthy eating, and reading food labels (P < .01). They also had significant improvements in patient activation and self-efficacy. At 12 months, DSMP intervention participants continued to demonstrate improvements in depression, communication with physicians, healthy eating, patient activation, and self-efficacy (P < .01). There were no significant changes in utilization measures., Conclusions: These findings suggest that people with diabetes without elevated A1C can benefit from a community-based, peer-led diabetes program. Given the large number of people with diabetes and lack of low-cost diabetes education, the DSMP deserves consideration for implementation.

Purpose: This study developed and tested a culturally appropriate, church-based intervention to improve diabetes self-management. Research Design and Methods This was a randomized trial conducted at 24 African American churches in central North Carolina. Churches were randomized to receive the special intervention (SI; 13 churches, 117 participants) or the minimal intervention (MI; 11 churches, 84 participants). The SI included an 8-month intensive phase, consisting of 1 individual counseling visit, 12 group sessions, monthly phone contacts, and 3 encouragement postcards, followed by a 4-month reinforcement phase including monthly phone contacts. The MI received standard educational pamphlets by mail. Outcomes were assessed at 8 and 12 months; the primary outcome was comparison of 8-month A1C levels., Results: At baseline, the mean age was 59 years, A1C 7.8%, and body mass index 35.0 kg/m(2); 64% of participants were female. For the 174 (87%) participants returning for 8-month measures, mean A1C (adjusted for baseline and group randomization) was 7.4% for SI and 7.8% for MI, with a difference of 0.4% (95% confidence interval [CI], 0.1-0.6, P = .009). In a larger model adjusting for additional variables, the difference was 0.5% (95% CI, 0.2-0.7, P < .001). At 12 months, the difference between groups was not significant. Diabetes knowledge and diabetes-related quality of life significantly improved in the SI group compared with the MI group. Among SI participants completing an acceptability questionnaire, intervention components and materials were rated as highly acceptable., Conclusions: The church-based intervention was well received by participants and improved short-term metabolic control.

Purpose: The purpose of this qualitative descriptive study was to explore the sociocultural influences and social context associated with living with type 2 diabetes among migrant Latino adults., Methods: A qualitative descriptive study using grounded theory techniques was conducted. In-depth semistructured interviews were completed with 10 participants (6 female and 4 male) ranging in age from 46 to 65 years and with a duration of diabetes diagnosis ranging from 1.5 to 40 years., Results: An overarching meta-theme of self-management in a social environment emerged. Every aspect of the process of self-management, as described in the 4 major themes-(1) family cohesion, (2) social stigma of disease, (3) social expectations/perception of "illness," and (4) disease knowledge and understanding-was influenced by the social context., Conclusions: The familist traditions, central to the Mexican culture, had both positive and negative consequences on diabetes management. Tailoring clinical care and developing novel education approaches, to include family and community, is central to improving the health of this population. Recognizing and acknowledging the social stigma associated with diabetes, for this population, will promote understanding and improve clinician-patient communication. The sociocultural influences that affect diabetes management practices (eg, include family, in particular the primary female caregiver, and establish community- and home-based education sessions) must be integrated into clinical practice. Future research focused on population-defined health and disease self-management, novel educational interventions, and family and community interventions focusing on the concept of social stigma of disease is indicated to further affect the health disparities of this population.

Purpose: The purpose of this secondary analysis was to describe and compare physiological, psychosocial, and self-management characteristics of urban black and rural white women with type 2 diabetes (T2D) in the northeast United States., Methods: A descriptive, cross-sectional secondary analysis was conducted with baseline data from 2 independent study samples: rural white women and urban black women., Results: Results revealed the sample were on average educated, working, low-income, mid-life women with poor glycemic and blood pressure control, despite having a usual source of primary care. When compared, black women were younger, had lower income levels, worked more, and were often single and/or divorced. They had worse glycemic control, significantly higher levels of diabetes-related emotional distress, and less support than white women., Conclusion: Despite differences in geography and study findings, both groups had suboptimal physiological and psychosocial levels that impede self-management. These findings serve to aid in the understanding of health disparities, emphasizing the importance of developing and evaluating effective interventions of diabetes care for women with T2D.

Purpose: The purpose of this pilot study was to determine the feasibility of offering the authors' Diabetes Coaching Program (DCP), adapted for African Americans, in a sample of African American adults with type 2 diabetes., Methods: The study used a 1-group, pretest-posttest design to test the acceptance and potential effectiveness of the DCP. Subjects were a convenience sample of 16 African Americans (8 women, 8 men) with type 2 diabetes; 12 subjects (6 women, 6 men) completed the program. The DCP included 4 weekly class sessions devoted to resilience education and diabetes self-management, followed by 8 biweekly support group meetings. Psychosocial process variables (resilience, coping strategies, diabetes empowerment) and proximal (perceived stress, depressive symptoms, diabetes self-management) and distal outcomes (body mass index [BMI], fasting blood glucose, HbA1C, lipidemia, blood pressure) were assessed at baseline and at 6 months after study entry. Qualitative data were collected at 8 months via a focus group conducted to examine the acceptability of the DCP., Results: Preliminary paired t tests indicated statistically significant improvements in diabetes empowerment, diabetes self-management, BMI, HbA1c, total cholesterol, low-density lipoprotein cholesterol, and systolic and diastolic blood pressure. Medium to large effect sizes were reported. Resilience, perceived stress, fasting blood glucose, and high-density lipoprotein cholesterol improved, but changes were not statistically significant. Focus group data confirmed that participants held positive opinions regarding the DCP and follow-up support group sessions, although they suggested an increase in program length from 4 to 8 weeks., Conclusions: The pilot study documented the feasibility and potential effectiveness of the DCP to enhance diabetes empowerment, diabetes self-management, and reductions in the progression of obesity, type 2 diabetes, and cardiovascular disease in the African American community. Randomized experimental designs are needed to confirm these findings.

Purpose: The purpose of this article is to present the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TOD2AY) study and a description of the implementation of the standard diabetes education (SDE) program., Methods: A total of 218 participants (one third of the eventual sample of 750) were initially enrolled in the study. To date, the mean age of participants was 14.3 + 2.1 years, with 63% being female. Families of study participants were largely low or middle income (more than half report family income <$35 000) and about three-quarters were minority., Results: More than three-quarters (79%) of families achieved full mastery of the entire SDE program. Mastery required on average 5.5 + 1.3 sessions. In addition, 62% of the families were able to achieve mastery of the session topic in a single visit., Conclusions: In summary, the TOD2AY study SDE program fills the need for effective, engaging materials for youth and their families to use in mastering essential type 2 diabetes skills and knowledge.

Purpose: The purpose of this study was to describe diabetes self-management practices and service utilization among Gullah families in South Carolina., Methods: Data were obtained from 1276 persons with type 2 diabetes through interviews using the Family Health History Questionnaire. This was a primary analysis of a project conducted in conjunction with a parent study (Project SuGar) which focused on the molecular aspects of diabetes. Descriptive statistics were used for data analysis., Results: Diabetes self-management behaviors were not consistent with recommendations from the American Diabetes Association. Over half (55.6%) reported exercising, but only 27.7% reported self-glucose monitoring. Service utilization was poor, less than half, (41.1%) reported referral to a diabetic class/diet, 32.8% reported making yearly visits to the ophthalmologist, 22.3% reported visiting the dentist, and only 12.8% reported visiting the podiatrist., Conclusions: Although some self-management behaviors were identified, Gullah family members remain at risk for preventable diabetes complications. Education must reflect behaviors and beliefs valued by Gullah individuals. Culturally appropriate educational programs may increase use of health care services aimed at decreasing preventable complications of type 2 diabetes in the Gullah population.

Purpose: The purpose of this article was to review the published literature and evaluate the economic benefits and costs associated with diabetes education., Methods: The Medline database (1991--2006) and Google were searched. Articles that addressed the economic and/or financial outcomes of a diabetes-related self-care or educational intervention were included. The study aim, population, design, intervention, financial and economic outcomes, results, and conclusions were extracted from eligible articles., Results: Twenty-six papers were identified that addressed diabetes self-management training and education. Study designs included meta-analysis (1); randomized controlled trials (8); prospective, quasi-experimental, and pre-post studies (8); and retrospective database analyses (9). The studies conducted cost analyses (6), cost-effectiveness analyses (13), cost-utilization analyses (7), and number needed to treat analyses (2). More than half (18) of the 26 papers identified by the literature review reported findings that associated diabetes education (and disease management) with decreased cost, cost saving, cost-effectiveness, or positive return on investment. Four studies reported neutral results, 1 study found that costs increased, and 3 studies did not fit into these categories., Conclusions: The findings indicate that the benefits associated with education on self-management and lifestyle modification for people with diabetes are positive and outweigh the costs associated with the intervention. More research is needed to validate that diabetes education provided by diabetes educators is cost-effective.

Purpose: Telemedicine technology may offer an avenue to implement diabetes self-management education (DSME) for people with diabetes in underserved rural communities. The continuous quality improvement process was used to identify the problem, collect and analyze data, and develop and implement a DSME program via telemedicine (DSME-T) in an underserved rural community., Methods: A pilot study was conducted in 2006, implementing a DSME-T utilizing facilities at the University of Arkansas for Medical Sciences and a rural community hospital in Arkansas (Ozark Health, Inc). A total of 38 people were enrolled to receive DSME-T. Participant knowledge, self-efficacy, and self-care practices were assessed before participants began the education program and after they had completed it. Also, select clinical measures (glycosylated hemoglobin, lipid profile, and urine microalbumin) were collected., Results: A total of 66% of participants (n = 25) completed the DSME-T program. A significantly greater proportion of participants demonstrated improved knowledge (39% vs 83%; P = .012), endorsed greater self-efficacy (54% vs 86%; P = .016), and reported more frequent self-care practices to manage their diabetes at the conclusion of the study period., Conclusions: The results of this pilot study suggest that DSME-T may offer opportunities for DSME among rural residents with diabetes. Plans are in place to explore the possibility of sustaining and expanding the program to other underserved rural communities.

Purpose: This article addresses the gap between research and practice by describing the feasibility and outcomes of an evidence-based diabetes self-management health education program. The Healthy Changes program used a peer-led group format to promote physical activity and healthful eating practices, using culturally relevant materials and measures., Methods: Older adults (mean age = 69.2 years; SD = 10.7) with type 2 diabetes (N = 243) were recruited from 9 communities to participate in the Healthy Changes program. Components included goal setting, problem solving, group support, and interactive lectures from experts. Measures of eating patterns, physical activity, body weight, community resources, self-rated health, and self-efficacy were administered at baseline, and at 4, 8, and 12 months., Results: Participants attended on average 13 weekly sessions, and showed improvements in health behaviors, supportive resources, and self-efficacy at 4, 8, and 12 months., Conclusions: The Healthy Changes program can be successfully translated into community settings and led by trained peer leaders, yielding health improvements similar to those reported in efficacy trials. Trained peer leaders are key to effective program implementation. Peer-led groups enhance goal attainment by giving participants a venue to discuss obstacles and strategize solutions.

Purpose: The purpose of this article was to describe effective recruitment and retention strategies used in a community-based intervention study for older, rural African American women with type 2 diabetes., Methods: The study's design was a randomized control test using a 3-group experimental design in a sample of 180 older, rural African American women (55 years of age and older), with type 2 diabetes. The study employed a range of strategies to successfully recruit and retain older African American women. These strategies were initially developed based on a review of the literature and the investigators' prior experience. They were modified as the research progressed., Results: More than a quarter of the participants were recruited from outpatient clinics. In-person outreach to health care providers was essential to engage and retain their help in recruiting patients. The research team made it easy and rewarding for women to participate in the study by providing a toll-free phone number, culturally appropriate intervention materials, intervention in the home, and incentives. Developing a relationship of trust with participants and the community was critical throughout the study period. Through the use of these strategies, the target enrollment of 180 women was met with 91% retention rate at the completion of the study., Conclusion: The use of multiple strategies can enhance recruitment and retention of rural, older African American women into a research study. Strategies are most effective when they build a relationship of trust with participants and the community and make it easy and rewarding for women to participate.

Purpose: The purpose of this study was to evaluate the efficacy of a multidisciplinary diabetes self-management program. The study focused on improving diabetes control by synchronizing regularly scheduled provider visits with a multidisciplinary diabetes education program. This intervention was instituted in Hispanic patients with long-standing poorly controlled type 2 diabetes., Methods: The study was initiated as a performance improvement project. A group of 44 type 2 diabetes patients followed by the internal medicine faculty with HbA1c levels greater than 9.5 over a 12-month period was identified. Twenty-three of the identified patients were enrolled in a synchronous care group. A cohort control group of the remaining 21 patients not participating in the intervention was followed with routine care. The intervention group shared similar demographic characteristics, medication regimens, initial diabetes control, and a number of provider visits with the control group. The primary outcome of interest for the study is the HbA1c level., Results: The findings demonstrated that our synchronous management approach significantly improved HbA1c level over standard management for medically indigent Hispanic patients with long-standing poorly controlled type 2 diabetes (P < .001). The majority of the patients (89%) in the Intensive Management Group had declines in HbA1c level from baseline, compared to the Standard Management Group (60%, P = .04)., Conclusion: The temporal linkage between routine provider visits and a diabetes self-management education intervention in poorly controlled Hispanic patients with long-standing type 2 diabetes led to a significant improvement in HbA1c levels.

Testosterone plays a critical role in male reproductive and metabolic functioning. Serum testosterone levels decrease with age, and low testosterone is associated with a variety of comorbidities, including insulin resistance, type 2 diabetes, obesity, metabolic syndrome, and cardiovascular disease. Men with type 2 diabetes have been shown to have significantly lower testosterone levels than men without diabetes. Several forms of testosterone replacement therapy (eg, oral, injectable, buccal, transdermal preparations) are available for use in the United States. The primary goals of testosterone therapy are to restore physiologic testosterone levels and reduce the symptoms of hypogonadism. Testosterone therapy may be a viable option in some men with diabetes and low testosterone; however, clinicians must be aware of contraindications to therapy (eg, prostate cancer and male breast cancer), implement appropriate monitoring procedures, and ensure that patient expectations are realistic regarding treatment outcome. Data suggest that testosterone therapy may have a positive effect on bones, muscles, erythropoiesis and anemia, libido, mood and cognition, penile erection, cholesterol, fasting blood glucose, glycated hemoglobin, insulin resistance, visceral adiposity, and quality of life. Sexual health may be a window into men's health; thus, more effective communication strategies are needed between clinicians and men with diabetes to ensure that sexual health topics are adequately addressed. Diabetes educators can play a key role in screening for low testosterone, providing relevant information to patients, and increasing clinician awareness of the need to address men's sexual health and implement appropriate strategies. Multidisciplinary care and individualized treatment are needed to optimize outcome.

Purpose: This study utilized social-ecology to describe sources of social-environmental support for physical activity perceived by people with type 2 diabetes, and examined the relationship between support and physical activity., Methods: Multidimensional support and physical activity were measured in 58 people with diabetes. Descriptive and correlational statistics were used., Results: Support from the media scored highest, followed by the health care team, personal support, workplace, family and friends, and lowest for the community. Physical activity was related to personal, media, and community support., Conclusions: Using a social-ecological approach, health care professionals must focus on enhancing support from media sources, strengthening community context, and bolstering personal self-management. Professionals must also critically examine patient-provider interactions to motivate lifestyle change.

Purpose: The purpose of this study is to investigate parent reports of the diabetes care support their children receive in school, their concerns about diabetes management in school, and their knowledge of federal laws that protect children with diabetes. In addition, the study explores ethnic and socioeconomic status differences in diabetes management in school., Methods: An ethnically heterogeneous sample of 309 parents of children with diabetes was recruited from a community-based and a university-based diabetes outpatient clinic. Parents completed a survey assessing supports their child's school provides for diabetes care, worries about diabetes care in school, and awareness of federal laws that pertain to children with diabetes., Results: Many children did not have a written care plan or a nurse at school, but significantly more white children had these supports than Hispanic or black children. Most children were not allowed to check blood glucose levels or administer insulin in class. Most parents were worried about hyperglycemia and hypoglycemia in school, and most were not at all or only a little confident in the school's ability to care for diabetes. Most parents were not aware of federal laws, but high-income and white parents were more likely to be aware., Conclusions: According to parents in the current study, children receive inadequate diabetes management support in schools. Minority children are less likely to receive supports than white children. Parents are worried about diabetes management in school, but most do not have the knowledge of federal laws necessary to protect their children.

Purpose: The purpose of this meta-analysis was to meet the need to quantify the influence of diabetes self-management training on quality of life (QOL) of adult diabetes patients., Methods: Extensive literature searching located published and unpublished diabetes self-management intervention studies that measured QOL outcomes among at least 5 subjects with type 1 or 2 diabetes. Data were extracted from primary study reports which included interventions designed to improve diabetes self-management and adequate data to calculate effect sizes. Random-effects meta-analytic procedures were used to estimate overall effects between treatment and control groups at outcome assessment and between baseline and outcome data for both treatment subjects and control subjects., Results: Exhaustive searching yielded 20 comparisons across 1892 subjects. The comparisons between treatment and control group outcomes following interventions yielded an effect size of 0.281. The comparisons between treatment group at baseline and outcome measurement yielded an effect size of 0.312 to 0.313. Each of these effect sizes were statistically significant, meaning that the hypothesis that interventions to improve diabetes self-management results in increased QOL was supported. Control subjects did not experience improved QOL while participating in studies., Conclusions: These findings document that people with diabetes experience improved QOL from participation in diabetes self-management training programs. Future diabetes self-management intervention studies should include quality of life outcomes so that this important outcome can be further studied. After more primary studies are available, future meta-analyses can explore important moderator analyses.

Purpose: The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study., Methods: Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period., Results: Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME., Conclusions: The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Purpose: The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes., Methods: Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Questions were asked by trained group facilitators. Transcripts were coded by 3 reviewers. Qualitative analyses were conducted using NVIVO software., Results: A total of 24 adolescents participated in 6 focus groups. Coding resulted in 4 common domains affecting self-management: adolescent psychosocial development; the role of others with diabetes; environmental influences; and adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described., Conclusion: Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Results suggest that improving self-management in adolescents may require multimodal interventions to address individual, family, and social processes.

Purpose: The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes., Methods: This study is a prospective cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes. The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications. The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics. A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study. The concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein (HDL) cholesterol were analyzed at baseline and at 3 months., Results: A significant mean change was observed for HbA1c, fasting plasma glucose, cholesterol/HDL ratio, and HDL after 3 months of education compared with baseline. There were significant reductions in weight, total fat, percent fat, trunk fat, and waist-to-hip ratio compared with baseline. After 3 months, subjects showed a significant positive correlation between changes in body mass index and insulin and weight, total fat, trunk fat, and fat free mass and insulin., Conclusions: A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period. The study demonstrates the importance of designing education intervention studies that are sensitive to cultural diversity, particularly in at-risk diabetic subjects.

Purpose: The purpose of this study was to describe how coping styles among African Americans with type 2 diabetes relate to diabetes appraisals, self-care behaviors, and health-related quality of life or well-being., Methods: This cross-sectional analysis of baseline measures from 185 African Americans with type 2 diabetes enrolled in a church-based randomized controlled trial uses the theoretical framework of the transactional model of stress and coping to describe bivariate and multivariate associations among coping styles, psychosocial factors, self-care behaviors, and well-being, as measured by validated questionnaires., Results: Among participants who were on average 59 years of age with 9 years of diagnosed diabetes, passive and emotive styles of coping were used most frequently, with older and less educated participants using more often passive forms of coping. Emotive styles of coping were significantly associated with greater perceived stress, problem areas in diabetes, and negative appraisals of diabetes control. Both passive and active styles of coping were associated with better diabetes self-efficacy and competence in bivariate analysis. In multivariate analysis, significant proportions of the variance in dietary behaviors and mental well-being outcomes (general and diabetes specific) were explained, with coping styles among the independent predictors. A positive role for church involvement in the psychological adaptation to living with diabetes was also observed., Conclusions: In this sample of older African Americans with diabetes, coping styles were important factors in diabetes appraisals, self-care behaviors, and psychological outcomes. These findings suggest potential benefits in emphasizing cognitive and behavioral strategies to promote healthy coping outcomes in persons living with diabetes.

Purpose: The purpose of this study is to evaluate the impact of a promotores-led diabetes self-management program by comparing the outcomes (knowledge, beliefs, and HbA1c level) of Mexican American patients with type 2 diabetes who received usual diabetic care in a wait-list control group to those who received self-management education and follow-up by promotores in consultation with clinic providers and staff., Methods: This randomized control study compared the results of 63 patients who attended a promotores-led culturally sensitive diabetes self-management course at a community clinic with 68 patients in a wait-list, usual-care control group. Participants were Mexican Americans with type 2 diabetes who were patients at the clinic and at least 18 years of age. At baseline, 3 months, and 6 months, the Diabetes Knowledge Questionnaire (DKQ), Health Beliefs Questionnaire (HBQ), and HbA1c levels (drawn by the clinic laboratory) were collected., Results: There was a significant improvement in the intervention group's DKQ scores over time and in treatment by time. The baseline HbA1c level was 7.49 and did not change over time in either group. The DKQ, HBQ, and HbA1c results were significantly affected by age; the DKQ and HbA1c were affected by years with diabetes., Conclusions: The promotores-led diabetes self-management course improved the knowledge of patients with diabetes. Participant baseline HbA1c level was close to therapeutic level (much lower than reported in previous studies), suggesting participants received good medical care within the community clinic.

Purpose: The purpose of this study was to provide a background of restless legs syndrome (RLS), present the prevalence and demographic findings of a descriptive study of type 2 diabetes with RLS, and provide implications to diabetes educators on the management and education of RLS., Methods: Participants with type 2 diabetes who met the diagnostic criteria for RLS based on the International RLS Study Group Criteria were recruited from the PENN Rodebaugh Diabetes Center from July 2005 through September 2006. Participants who met inclusion and exclusion criteria were mailed a survey to collect data., Results: Of 121 patients with type 2 diabetes, 54 (45%) of the screened sample met the 4 diagnostic criteria for RLS. Of those who met the inclusion and exclusion criteria of the primary study, 18 patients with type 2 diabetes with RLS participated in this study. Along with diabetes, the participants had a variety of comorbid health conditions including hypertension, neuropathies, rheumatoid arthritis, renal failure, and irritable bowel syndrome. Only one third of the participants were being treated for RLS. Thirty-nine percent of the participants with type 2 diabetes were using insulin to manage their diabetes with other oral agents., Conclusions: RLS is a sleep disorder that may affect the management of type 2 diabetes. Diabetes educators must know that sleep disorders can affect long-term health outcomes, and RLS is frequently seen in this cohort of patients.

Purpose: The purpose of this study was to examine what is currently known about diabetes education and care in rural geographical regions. Residents of rural areas are less likely to have access to health care providers, health insurance, or specialty care and are more likely to experience health care disparities as a result. Persons living in rural areas are likely to have greater burdens of chronic disease, including uncontrolled diabetes, and perceive their health as poorer than their urban counterparts., Methods: A conventional literature review focused on type 1 and type 2 diabetes was completed using the search terms rural, diabetes, and education. The databases searched were CINAHL, EBSCO, Pub Med, and Medline. In all, 22 research articles that fit the inclusion criteria were identified., Results: Findings indicated that diabetes education for rural regions can be enhanced by a focus on family, culture, interdisciplinary teams, and technology., Conclusions: Future rural research about diabetes care should carefully define rural, include gender-related studies that describe findings in terms of men and women, and focus on primary prevention.

Purpose: The purpose of this study is to compare the efficacy of a portion-controlled meal replacement diet (PCD) to a standard diet (SD) based on recommendations by the American Diabetes Association in achieving and maintaining weight loss among obese participants with type 2 diabetes., Methods: This study is a university-based, controlled clinical trial. Participants were 119 men and women with diabetes with a body mass index between 25 and 40 kg/m(2), assigned randomly to one of two 34-week, 75% of predicted energy need diets (portion controlled or standard, self-selected, food based) and then followed by 1-year maintenance., Results: Using intention-to-treat analyses, weight loss at 34 weeks and weight maintenance at 86 weeks was significantly better on PCD versus SD. Approximately 40% of the PCD participants lost > or =5% of their initial weight compared with 12% of those on the SD. Significant improvements in biochemical and metabolic measures were observed at 34 weeks in both groups. The retention rate and self-reported ease of adherence in the PCD group were significantly higher throughout the study., Conclusions: A diet using portion-controlled meal replacements yielded significantly greater initial weight loss and less regain after 1 year of maintenance than a standard, self-selected, food-based diet. As PCDs may help obese patients with type 2 diabetes adhere to a weight control program, diabetes educators may consider recommending them as part of a comprehensive approach to weight control.

Objective: The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management., Data Sources: Medline (1990-2007), CINAHL (1990-2007), and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies., Study Selection: Intervention studies that addressed reducing risks to help prevent or minimize diabetes complications were included., Data Extraction: Study design, sample characteristics, interventions, and outcomes were extracted., Data Synthesis: Thirty-three studies, represented by 39 articles, met the criteria for inclusion and were classified as smoking cessation (n = 3), eye examination (n = 2), foot care (n = 10), oral health (n = 2), vaccination (n = 1), cardiovascular risk reduction (n = 9), and comprehensive risk reduction (n = 6). Only 46.3% of the 283 outcomes measured in the 33 studies were significantly improved., Conclusions: Reducing risks involves implementing effective risk reduction behaviors to prevent or slow the progression of diabetes complications. Recognizing risk factors for complications and what constitutes optimal preventive care is an important part of managing diabetes. Intervention studies are lacking in some areas of reducing risks. Further studies are needed to test specific interventions to reduce the risks of diabetes complications.

Objective: The purpose of this systematic review was 2-fold: first, to perform a comprehensive review of relevant studies on the impact of self-monitoring of blood glucose (SMBG) on HbA1c levels for patients with type 2 diabetes mellitus and, second, to explore mediators and moderators within a self-regulation framework., Data Sources: Five databases-Medline, PsychInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health Literature (CINAHL)-were searched., Study Selection: Cross-sectional, longitudinal, and randomized control trials from 1990 to 2006, which included patients with type 2 diabetes not on insulin, were reviewed. In total, 6,769 studies were screened for inclusion, 89 were retrieved for detailed analysis, and 29 met criteria for inclusion in the review., Data Extraction: Data on the impact of SMBG on HbA1c, potential mediators and moderators, study design and participants, and limitations of each study were retrieved., Data Synthesis: Twenty-nine studies were included in this review: 9 cross-sectional studies, 9 longitudinal studies, and 11 randomized controlled trials. Evidence from the cross-sectional and longitudinal studies was inconclusive. Evidence from randomized controlled trials suggests that SMBG may lead to improvements in glucose control. Very few studies examined potential mediators or moderators of SMBG on HbA1c levels., Conclusions: SMBG may be effective in controlling blood glucose for patients with type 2 diabetes. There is a need for studies that implement all the components of the process for self-regulation of SMBG to assess whether patient use of SMBG will improve HbA1c levels.