Adults with diabetes were surveyed to determine the extent to which respondents perceived specific preventive regimens (diet, exercise, weight control, and education) had been prescribed or recommended, adhered to their prescribed regimens, and identified barriers to nonadherence.
METHODS
Surveys were mailed to 2 samples of adults diagnosed with diabetes. The clinic sample was from health department clinics (n=264); the agency sample was from a nonprofit agency serving people with diabetes (n=1 11).
RESULTS
Of the 4 preventive measures under investigation, diet plans and weight reduction were perceived as most commonly recommended by health professionals; exercise schedules were the least commonly recommended. Diabetes self-management education was reportedly recommended more often among the agency sample. In terms of adherence, approximately half of both samples were able to lose weight. A smaller portion of the clinic sample was able to get needed foods and exercise, and maintain weight loss. The most frequently cited reasons for nonadherence were cost, transportation, and other health conditions.
CONCLUSIONS
Improvement in the implementation of preventive behaviors is needed, particularly exercise schedules. Barriers to care, such as costs and transportation, may need special consideration.
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References
1.
1. Department of Health and Human Services. Healthy People 2010. With Understanding and Improving Health Objectives for Improving Health. 2nd ed.Washington, DC: US Government Printing Office; 2000.
2.
2. National Diabetes Data Group. Diabetes in America. 2nd ed.Washington, DC: US Dept of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995.
3.
3. American Diabetes Association. Implications of the Diabetes Control and Complications Trial. Diabetes Care. 2001; 24(suppl 1):S25-S27.
4.
4. American Diabetes Association. Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care. 2001; 24(suppl 1):S28-S32.
5.
5. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2001; 24:S33-S43.
6.
6. Briscoe VJ. Managing the Client With Type 2 Diabetes. Sacramento, Calif: CME Resource #412; 1997.
7.
7. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. N Engl J Med.1993;329: 978-985.
8.
8. Glasgow RE, Ruggiero L, Eakin EG, et al. Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care. 1997;20:562-567.
9.
9. Fisher L, Chesla CA, Bartz RJ, et al. The family and type 2 diabetes: a framework for intervention. Diabetes Educ. 1998; 24:599-607.
10.
10. Nuttall FQ, Chasuk RM. Nutrition and the management of type 2 diabetes. J Fam Pract. 1998;47:S45-S53.
11.
11. Trief PM, Grant W, Elbert K, et al. Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes. Diabetes Care. 1998;21:241-245.
12.
12. Stolar MW and the Endocrine Fellows Foundation Study Group. Clinical management of the NIDDM patient. Impact of the American Diabetes Association practice guidelines, 1985-1993. Diabetes Care. 1995;18:701-707.
13.
13. Hiss RG, Anderson RM, Hess GE, et al. Community diabetes care. Diabetes Care. 1994;17:1124-1134.
14.
14. Chin MH, Auerbach SB, Cook S, et al. Quality of diabetes care in community health centers. Am J Public Health. 2000;90:431-434.
15.
15. Van Putten JM. Diabetes Self-Management Education Within Managed Care Organizations in Ohio. Summary Report, March 1998. Columbus, Ohio: Ohio State University, College of Medicine and Public Health; 1998.
16.
16. Dillman DA. Mail and Telephone Surveys: The Total Design Method. New York: John Wiley & Sons; 1978.
17.
17. Michigan Diabetes Research and Training Center. The Diabetes Care Profile (DCP). Ann Arbor, Mich: University of Michigan Medical Center; 1993.
18.
18. De Leiva A.What are the benefits of moderate weight loss?Exp Clin Endocrinol Diabetes. 1998;106:S10-S13.
19.
19. Brown SA, Upchurch S, Anding R, et al. Promoting weight loss in type 11 diabetes. Diabetes Care. 1996;19: 613-624.
20.
20. Grodstein F, Levine R, Troy L, et al. Three-year follow-up of participants in a commercial weight-loss program: Can you keep it off?Arch Intern Med.1996;156:1302-1306.
21.
21. Hunt LM, Arar NH, Larme AC. Contrasting patient and practitioner perspectives in type 2 diabetes management. West J Nurs Res.1998;20:656-682.
22.
22. Marrero DG, Moore P, Langefeld CD, et al. Increasing the use of intensified management of diabetes: an education program for physicians. J Cont Educ Health Prof. 1991;11: 283-294.
23.
23. Travis T.Patient perceptions of factors that affect adherence to dietary regimens for diabetes mellitus. Diabetes Educ. 1997;23:152-156.
24.
24. Collins RW, Anderson JW. Medication cost savings associated with weight loss for obese non-insulin-dependent diabetic men and women. Prev Med.1995;24:369-374.
25.
25. O'Brien JA, Shomphe LA, Kavanagh PL, et al. Direct medical costs of complications resulting from type 2 diabetes in the US. Diabetes Care. 1998; 21:1122-1128.
26.
26. Gorelick PB, Richardson D, Hudson E, et al. Establishing a community network for recruitment of African Americans into a clinical trial. The African-American Antiplatelet Stroke Prevention Study. J Natl Med Assoc. 1996;88:701-704.
27.
27. Keyserling TC, Ammerman AS, Carmen D, et al. A diabetes management program for African American women with type 2 diabetes. Diabetes Educ. 2000;26:796-805.
28.
28. Wallerstein N.Powerlessness, empowerment, and health: implications for health promotion programs. Am J Health Prom. 1992;6:197-205.
29.
29. Elliott WJ, Maddy R, Toto R, Bakris G.Hypertension in patients with diabetes. Overcoming barriers to effective control. Postgrad Med.2000; 107:29-32, 35-35, 36-36,38-38.
30.
30. Hosey G, Gordon S, Levine A.Type 2 diabetes in people of color. Nurs Pract Forum. 1998;9:108-114.
31.
31. Uzoma CU, Feldman RH. Psychosocial factors influencing inner city black diabetic patients' adherence with insulin. Health Educ. 1989;20:29-32.
32.
32. Hunt LM, PughJ, Valenzuela M.How patients adapt diabetes self-care recommendations in everyday life. J Fam Pract. 1998;46:207-215.
33.
33. Hernandez CA. The experience of living with insulin-dependent diabetes: lessons for the diabetes educator. Diabetes Educ. 1995;21:33-37.
34.
34. Lurie N.Medical care and the poor: focus on hypertension and diabetes. In: Rogers DE, Ginzberg E, eds. Medical Care and the Health of the Poor. Boulder, Colo: Westview Press; 1993.
35.
35. Lasker RD, and the Committee on Medicine and Public Health. Medicine and Public Health: The Power of Collaboration. New York: New York Academy of Medicine; 1997.
36.
36. McNabb WL. Adherence in diabetes: Can we define it and can we measure it?Diabetes Care. 1997;20:215-218.
37.
37. Polivka BJ. A conceptual model for community interagency collaboration. Image: Nurs Scholarship. 1995;27: 110-115.
