Predictors of Disease-Management and Glycemic Control among Latinos with Type 2 Diabetes: A Social-Ecological Perspective

Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals with greater social-environmental support manage their diabetes more effectively than those with less support. Natural support systems may play an especially important role in disease-management among Latinos, due to the cultural value placed on personal relationships (i.e., “personalismo”) and family (i.e., “familismo”). We examined the relationships between support for disease-management (SDM), adherence to a diabetes self-care regimen (DSC), indicators of health-risk, and depression among 170 Latinos with Type 2 diabetes in San Diego County. Participants were recruited from community clinics, and ranged in age from 21 to 75 years (M = 50.81, SD = 10.69); 72% were female, and 87% were born in Mexico. Participants who perceived greater SDM from their neighborhood/community, family/friends, and self (i.e., personal SDM) also reported better adherence (R² = .33, p < .001) and less depression (R² = .09, p = .001). In turn, depression was positively associated with HbA1c (i.e., an integrated marker of blood glucose control, where higher levels indicate worse control; r = .16, p < .05), while SDM from the neighborhood/community was inversely related to body mass index (r = -.15, p < .05) and serum triglycerides (r = -.16, p < .05). These findings demonstrate that SDM can influence health directly and indirectly, via associations with adherence and psychological well-being. Programs targeting diabetes self-management should assume a social-ecological perspective that considers culturally-relevant, multi-level influences on adherence.