“Diabetes is my companion”: Lifestyle and self-management among good and poor control Mexican diabetic patients

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Abstract

This paper identifies naturally occurring lifestyle and self-care practices in managing type 2 diabetes mellitus that are associated with good glycemic control. In-depth, qualitative interviews were conducted in Guadalajara, Mexico, with 31 matched pairs of good and poor control diabetic patients (n=62), who were matched on their duration of disease and use of medications. While many themes were listed by both groups, a comparison of the responses indicated that themes of daily exercise with a preference for walking, eating beef and milk rather than chicken and fish, economic issues, and emotional issues distinguished poor-control patients. Good-control patients were more likely to have a negative reaction to their initial diagnosis, take a more comprehensive approach to control, eat only two meals a day (plus snacks), use noncaloric beverages to satisfy desires for more food, and know what their blood sugar levels should be.

Introduction

This paper identifies lifestyle and self-care practices related to successful glycemic control. Hyperglycemia is associated with poorer outcomes in type 2 diabetes (Turner, Cull, Frighi, & Holman, 1999; UKPDS 33, 1998; UKPDS 34, 1998), and although self-management activities can improve glycemic control, improvements can be small and short lasting (Deakin, McShane, Cade, & Williams, 2005). Quantitative epidemiological studies of correlates of glycemic control have been limited by a focus on demographic variables, such as age, educational level, and gender. Qualitative anthropological studies have been limited by using a single group of patients and not distinguishing good- and poor-control patients in their study design. In this study, a case-control design is combined with qualitative interviewing. In addition, good- and poor-control patients are matched on their duration of disease and use of anti-diabetic medications. These latter two factors are known to affect glycemia and could potentially bias findings if either of the two factors were unequally distributed across the good- and poor-control groups. Thus, our study design highlights lifestyle practices that differentiate the groups.

Anthropological contributions to the study of disease have identified macro-level forces that create epidemics such as the current increase in type 2 diabetes (Chaufan, 2004) and have also demonstrated the importance of the micro-level emic perspective in developing successful interventions. While theoretical work has implicated creation of unhealthy social and physical environments in the overall increase in diabetes (Chaufan, 2004), a continuing problem is the associated increase in morbidity and mortality of affected individuals and the costs to them, their families, and society. Our goal in this study was to focus on individuals and identify strategies used by diabetic patients in good control, so that these might be emphasized in educational efforts for poor-control patients. In addition, we feel that an understanding of the strategies that actually work for control of diabetes may point to the direction that macro-level changes must take to deal with the current epidemic.

Section snippets

Background

Over the past decade in Mexico, there has been a large (22%) increase in cases of diabetes (Aguilar-Salinas et al., 2003), placing a tremendous burden on affected individuals and their families, as well as on the entire health care system. Strict metabolic control of glucose (HbA1c below 7%) is recommended for diabetic patients to prevent or delay complications (American Diabetes Association, 2003; IMSS, 2000), but is not easy to achieve. In the US, 64% of diabetic patients are above 7.0% (

Setting

This study was conducted in Guadalajara, capital of the state of Jalisco, in Mexico. The population of more than four million people is predominantly non-Indian (mestizo). Respondents were patients at a Unidad de Medicina Familiar (Family Medicine Clinic) of the IMSS (Instituto Mexicano de Seguro Social). The IMSS is the government-provided health care system for workers; employees at businesses employing more than 10 people are eligible. The clinic sampled serves over 110,000 people who are

Socio-demographic variables

Each group had 31 patients; this is the number of patients who could be matched according to study criteria. The groups did not differ significantly in terms of age, gender, time since diagnosis, and use of anti-diabetic medications (Table 1). Mean level of HbA1c for good-control patients was 6.25%±0.54 (range 4.9–6.9) and for poor-control patients it was 10.01%±1.62 (range 8.2–13.0). Groups also do not differ in region of origin (rural vs. urban), current residence, or neighborhood

Discussion and conclusions

There is a clear pattern of differences in reported themes between GCPs and PCPs. GCPs tended to react to their diagnosis in a negative manner, showing feelings of loss and perhaps beginning to accept the diagnosis. PCPs appear to have more of a problem assimilating their diagnosis and are more likely to use popular/folk explanations for the cause of their diabetes.

While both GCPs and PCPs are motivated to take care of themselves due to concern and self-esteem for themselves and the value they

Acknowledgment

Funded by CONACYT Grant #34153-S to J. Garcia De Alba and A. Salcedo Rocha and by NSF Grants # SBR 9807373 to R. Baer and # SBR 9727322 to S. Weller. An earlier version of this paper was presented at the meetings of the Society for Applied Anthropology, Dallas, TX, USA, April 2004.

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