A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study

Abstract

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)–United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

Diabetes Self-Management Behaviors, Health Care Access, and Health Perception in Mexico-US Border States

“…Recall bias was minimized by using a standardized data collection protocol and a standardized, well-structured questionnaire. 21,22 Last, there is always the concern that participants may not have understood the questions that were being asked of them due to the educational levels in both cohorts. For example, there was a discrepancy in the Arizona cohort, with the majority reporting they had an eye examination with pupil dilation, but 76.9% reported they had not been told that diabetes affected eyes or that they have retinopathy.…”

“…34 Most Mexicans with T2DM and low levels of diabetes education are not familiar with the A1C test, and they frequently confuse the blood glucose test with an A1C. 22,35…”

“…34 Most Mexicans with T2DM and low levels of diabetes education are not familiar with the A1C test, and they frequently confuse the blood glucose test with an A1C. 22,35 There were differences between the numbers of times in the past 12 months the respondents had their feet exam-ined by the provider (mean [SD]: Arizona, 2.12 [2.17]; Mexico, 3.54 [4.7]). An annual comprehensive foot examination should be conducted for all patients.…”

“…The study protocol for the Mexican sample was approved by institutional ethics and research committees. Additional information about design, sample, and data collection procedures can be found in McEwen et al 22…”

“…The study protocol for the Mexican sample was approved by institutional ethics and research committees. Additional information about design, sample, and data collection procedures can be found in McEwen et al 22 Potential respondents from both sites were included who met the following criteria: (1) 18 years of age or older; (2) Hispanic or Mexican; (3) living in one of the 4 Arizona border counties or living in one of the main cities of the metropolitan area (Monterrey, San Nicolas, San Pedro, Guadalupe, Apodaca, and Escobedo), Monterrey, Nuevo Leon, Mexico; (5) told by a doctor they have diabetes; and (6) responded to the BRFSS diabetes module questions. Women diagnosed with gestational diabetes were excluded from the study.…”