Purpose The purpose of this study is to examine differences in diabetes self-care activities by race/ethnicity and insulin use. Data were from the 2011 Behavioral Risk Factor Surveillance System for adults with diabetes. Outcomes included 5 diabetes self-care activities (blood glucose monitoring, foot checks, nonsmoking, physical activity, healthy eating) and 3 levels of diabetes self-care (high, moderate, low). Logistic regression models stratified by insulin use were used to estimate the odds of each self-care activity by race/ethnicity. Only 20% of adults had high levels of diabetes self-care, while 64% had moderate and 16% had low self-care. Racial/ethnic differences were apparent for every self-care activity among non–insulin users but only for glucose monitoring and foot checks among insulin users. Overall, American Indian / Alaska Natives had higher odds of glucose monitoring; blacks had higher odds of foot checks; and Hispanics had higher odds of not smoking compared with non-Hispanic Whites. Non-insulin-using American Indian / Alaska Natives had higher odds of foot checks, and non-insulin-using Hispanics had higher odds of fruit/vegetable consumption. Participation in specific diabetes self-care behaviors differs by race/ethnicity and by insulin use. Yet, few adults with diabetes of any race/ethnicity engage in high levels of self-care. Findings suggest that culturally tailored messages about diabetes self-care may be needed, in addition to more effective population promotion of healthy lifestyles and risk reduction behaviors to improve diabetes control and overall health. Diabetes educators can be a catalyst for adopting a population approach to diabetes management, which requires addressing both prevention and management of diabetes for all patients.
Bibliographical noteFunding Information:
Dr Johnson, Dr Rockwood, and Ms Ghildayal were supported by an intramural award from Medica Research Institute (grant number IAP-45-2013). Dr Everson-Rose was supported in part by the National Institute for Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) (grant number MD003422) with additional support provided by the Applied Clinical Research Program and Program in Health Disparities Research at the University of Minnesota. Contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of Medica Research Institute, the National Institute on Minority Health and Health Disparities, or National Institutes of Health. None of the authors has any conflicts of interest, financial interests, or affiliations relevant to this manuscript.