Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study

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Abstract

Background

The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods

This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results

The sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers.

Conclusions

Evidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.

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The Three R's: How Community Based Participatory Research Strengthens the Rigor, Relevance and Reach of Science.

Carolina Balazs, Rachel Morello-Frosch (2013)

In the last few decades, community based participatory research (CBPR) has emerged as an important approach that links environmental health and justice advocates with research institutions to understand and address environmental health problems. CBPR has generally been evaluated for its impact on policy, regulation, and its support of community science. However, there has been less emphasis on assessing the ways in which CBPR (re)shapes and potentially improves the scientific enterprise itself. This commentary focuses on this under-emphasized aspect of CBPR-how it can strengthen science. Using two case studies of environmental health CBPR research-the Northern California Exposure Study, and the San Joaquin Valley Drinking Water Study-we posit that CBPR helps improve the "3 R's"of science-rigor, relevance and reach-and in so doing benefits the scientific enterprise itself.

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Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose

Karla Galaviz, Mary Beth Weber, Audrey N. Straus … (2018)

OBJECTIVE Understanding the real-world impacts of lifestyle modification (LSM) for diabetes prevention is imperative to inform resource allocation. The purpose of this study was to synthetize global evidence on the impact of LSM strategies on diabetes incidence and risk factors in one parsimonious model. RESEARCH DESIGN AND METHODS PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for studies published between January 1990 and April 2015. Effectiveness/translation studies of any design testing LSM strategies, targeting high-risk populations (with prediabetes or diabetes risk factors), and reporting diabetes incidence, weight, or glucose outcomes were included. We extracted number of diabetes cases/incidence rates and mean changes in weight (kg), fasting blood glucose (FBG, mmol/L), 2-h postload glucose (mmol/L), and hemoglobin A 1c (%). Pairwise random-effects and frequentist random-effects network meta-analyses were used to obtain pooled effects. RESULTS Sixty-three studies were pooled in the meta-analysis ( n = 17,272, mean age 49.7 years, 28.8% male, 60.8% white/European). In analyses restricted to controlled studies ( n = 7), diabetes cumulative incidence was 9% among intervention participants and 12% among control participants (absolute risk reduction 3%; relative risk 0.71 [95% CI 0.58, 0.88]). In analyses combining controlled and uncontrolled studies ( n = 14), participants receiving group education by health care professionals had 33% lower diabetes odds than control participants (odds ratio 0.67 [0.49, 0.92]). Intervention participants lost 1.5 kg more weight [−2.2, −0.8] and achieved a 0.09 mmol/L greater FBG decrease [−0.15, −0.03] than control participants. Every additional kilogram lost by participants was associated with 43% lower diabetes odds (β = 0.57 [0.41, 0.78]). CONCLUSIONS Real-world LSM strategies can reduce diabetes risk, even with small weight reductions.

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Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.

Margaret Powers, Joan Bardsley, Marjorie Cypress … (2016)

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Author and article information

Contributors

Robin Whittemore:

ORCID: http://orcid.org/0000-0001-9434-0230

robin.whittemore@yale.edu

Mireya Vilar-Compte: mireya.vilar@ibero.mx

Selene De La Cerda: selene.delacerda@gmail.com

Denise Marron: denisemarron5@gmail.com

Rosabelle Conover: rosabelle.conover@gmail.com

Roberta Delvy: roberta.delvy@yale.edu

Annel Lozano-Marrufo: annellozanomarrufo@gmail.com

Rafael Pérez-Escamilla: rafael.perez-escamilla@yale.edu

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-9276

Publication date (Electronic): 23 August 2019

Publication date PMC-release: 23 August 2019

Publication date Collection: 2019

Volume: 18

Electronic Location Identifier: 133

Affiliations

[1 ]ISNI 0000000419368710, GRID grid.47100.32, Yale School of Nursing, ; 400 West Campus Drive, West Haven, CT 06516 USA

[2 ]ISNI 0000 0001 2156 4794, GRID grid.441047.2, Universidad Iberoamericana, ; Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Álvaro Obregón, Mexico City Mexico

[3 ]ISNI 0000000419368710, GRID grid.47100.32, Yale School of Public Health, ; 60 College Street, New Haven, CT 06510 USA

Author information

Robin Whittemore http://orcid.org/0000-0001-9434-0230

Article

Publisher ID: 1035

DOI: 10.1186/s12939-019-1035-x

PMC ID: 6708131

PubMed ID: 31443659

SO-VID: d4a1fa0b-111b-40d5-9702-07aa4f494054

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 March 2019

Date accepted : 13 August 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000056, National Institute of Nursing Research;

Award ID: NR015856

Award Recipient : Robin Whittemore

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ScienceOpen disciplines: Health & Social care

Keywords: type 2 diabetes,diabetes self-management in mexico,health disparities

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ScienceOpen disciplines: Health & Social care

Keywords: type 2 diabetes, diabetes self-management in mexico, health disparities

Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study

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Most cited references 30

The Three R's: How Community Based Participatory Research Strengthens the Rigor, Relevance and Reach of Science.

Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.

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