“Diabetes is my companion”: Lifestyle and self-management among good and poor control Mexican diabetic patients
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.
References (36)
- et al.
Evaluation meta-ethnography
Social Science & Medicine
(2003) Making sense of diabetes
Social Science & Medicine
(2004)- et al.
Post-diagnosis family adaptation influences glycemic control in women with type 2 diabetes mellitus
Journal of the American Dietetic Association
(2001) - et al.
Porque Me Toco A Mi? Mexican American diabetes patients’ causal stories and their relationship to treatment behaviors
Social Science & Medicine
(1998) - et al.
Food selection and eating patterns
Journal of Nutrition Education
(2001) - et al.
Profiles of people with type 2 diabetes mellitus
Social Science & Medicine
(2004) - et al.
Stories of meaning: Lay perspectives on the origin and management of noninsulin dependent diabetes mellitus among older women in the United States
Social Science & Medicine
(1998) Lessons learned from urban Latinas with type 2 diabetes mellitus
Journal of Transcultural Nursing
(2003)Report of the expert committee on the diagnosis and classification of diabetes mellitus
Diabetes Care
(2003)- et al.
Characteristics of patients with type 2 diabetes in Mexico
Diabetes Care
(2003)