Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes

Abstract

BackgroundComorbid depression and diabetes mellitus (DM) compound challenges to disease management such as low health literacy, insufficient access to care, and social or linguistic isolation. Korean Americans (KAs), predominantly first-generation immigrants, suffer from a high prevalence of type 2 DM and depression. Limited research on KAs has prevented the development of effective interventions.ObjectivesTo compare the prevalence of depression in KAs with DM and all Americans with/without DM, and to explore correlates of comorbid DM and depression and strategies to address KAs' DM and depression.MethodsKAs' data were from a clinical trial of a community-based self-help intervention to improve KAs' DM and mental health outcomes. National Health and Nutrition Examination Survey data sets enabled comparison. Clinical indicators included hemoglobin A1C, lipid panel, and body mass index. Psychobehavioral indicators included self-efficacy for DM management, quality of life, and depression (Patient Health Questionnaire-9 (PHQ-9)).ResultsMore KAs with DM had depression (44.2%) than did all Americans with DM (28.7%) or without DM (20.1%). Significantly more KAs with DM had mild (29.3%) or clinical (14.9%) depression than did Americans with DM (mild, 17.2%; clinical, 11.5%) or without (mild, 13.8%; clinical, 6.3%). One of six KAs with DM (16.9%) thought of suicide or self-harm (Americans with/without =5.0%, 2.8%). The self-help intervention reduced the mean PHQ-9 from 5.4 at baseline to 4.1 at 12 months.LimitationsExternal validity might be limited; KAs' data were from one study site.ConclusionsThe prevalence of depression and DM among KAs warrants the development of efficacious interventions.Trial registration numberNCT01264796.

Motivating people to sustain healthy lifestyles using persuasive technology: A pilot study of Korean Americans with prediabetes and type 2 diabetes

“…This was a trial done at a single center with a single ethnic minority sample. Certain sample (population) characteristics, such as the participants’ high adherence to the program (e.g., high retention rate) might not be transferable to other settings, because the study center has remained within the community for many years, serving KAs who are, as first-generation immigrants, eager for health education in Korean [19].…”

“…As part of the goal-setting process, we shared the most well-established evidence-based TLC recommendations from various programs sponsored by public agencies, including the DPP [10,25], the DPP Outcomes Study [26], and Look AHEAD [27]. In addition, we highlighted the quantitative results from our previous studies as well as compelling testimonials from participants who participated our traditional TLC intervention programs [17–19]. Table 1 details the goals for each group in this study.…”

“…To address these scientific and practice gaps in implementing TLC in ethnic minority populations, we designed a program that combines scalable health technology with TLC protocols for diabetes management and tested it in several clinical trials in the KA community. Our original program, “the Self-Help Intervention Program for KAs with DM (SHIP),” was designed to provide first-generation KA immigrants with diabetes with culturally tailored diabetes self-management enhancement services delivered by bilingual Korean community health workers (CHWs) and a bilingual nurse team [17–19].…”

Untitled

“…Given the compelling need to build a foundation for integrating diabetes care and oral health, the present study examined how the presence of diabetes affect self-rated oral health and dental service use in older Korean Americans. This population is appropriate to target for several reasons: (a) they are one of the rapidly expanding immigrant groups and they are the fifth largest Asian American subgroup [16,17]; (b) they manifest marked disparities in health and healthcare [18]; and (c) their prevalence of diabetes and unmet needs for dental care are high [19][20][21]. Despite their low rate of traditional risk factors for diabetes such as obesity, Koreans have a high prevalence of diabetes.…”

“…Although the precise reasons for this are not clear, a genetic predisposition toward high central adiposity and dysfunction of β-cells in the pancreas have been discussed as potential contributing factors [22]. A sizable body of literature has examined physical and mental health implications of diabetes in older Korean Americans, [20,21] but attention has rarely been paid to oral health arena.…”