The Role of Active Family Nutritional Support in Navajos’ Type 2 Diabetes Metabolic Control

Abstract

OBJECTIVE -We examined if active family nutritional support is associated with improved metabolic outcomes for Diné (Navajo) individuals living with type 2 diabetes.RESEARCH DESIGN AND METHODS -The presence of family support, using variables identified in earlier ethnographic research, was assessed via surveys in a convenience sample of 163 diabetic individuals. Diabetes outcome measures (HbA 1c , serum glucose, triglycerides, total cholesterol, creatinine, and systolic and diastolic blood pressure measures) were extracted from participants' medical records. Bivariate analyses and multiple logistic regressions were conducted.RESULTS -All measures of family support showed a relation with one or more indicators of metabolic control in bivariate analyses. In multivariate analyses, respondents were more likely to be in the best tertile for triglyceride (P Ͻ 0.05), cholesterol (P Ͻ 0.05), and HbA 1c (P Ͻ 0.05) if another person cooked most of the meals. Respondents in families who bought/cooked "light" foods were more likely to be in the best tertile for triglyceride (P Ͻ 0.005) and cholesterol levels (P Ͻ 0.005), and those in families whose members ate "light" foods with them were more likely to be in the best tertile for triglycerides (P Ͻ 0.005). When all three support variables were entered into a multivariate model, only the variable "other family members cook the majority of the meals" was significantly associated with being in the lowest triglyceride (P ϭ 0.05), HbA 1c (P Ͻ 0.05), or cholesterol tertiles (P Ͻ 0.05). These relationships were most evident for women with diabetes.CONCLUSIONS -Active family nutritional support, as measured by culturally relevant categories, is significantly associated with control of triglyceride, cholesterol, and HbA 1c levels. The findings suggest that the family is a more useful unit of intervention for Diné individuals than for the individual alone when designing diabetes care strategies. Diabetes Care 26:2829 -2834, 2003D iabetes has reached epidemic proportions among the Diné (Navajo): over one in five adults aged Ն20 years (22.9%) have diabetes, which is a prevalence rate five times higher than the age-standardized rate for the U.S. population as a whole (1). Among Diné individuals aged 45-64 years and Ն65 years, diabetes prevalence rates increase to 40.1 and 41.3%, respectively (1). Complications from the disease can also be devastating. Nearly one-third (30.9%) of those with the disease had cardiovascular disease, which is a rate 5.2 times greater than age-and sex-matched Diné without diabetes (2). Cerebrovascular disease, peripheral vascular disease, microalbuminuria, and hospital admissions occurred at rates 10.2, 6.8, 4, and 2 times greater, respectively, for Diné with diabetes than for those without the disease (2-4). Among Diné with diabetes, 30% reported problems with vision, 20% with feet, and 17% with kidneys (1). Thus, identification of factors that improve metabolic control in the disease is of paramount importance to the Diné.Fisher et al. (5) have identified f...

The Impact of Social Support on Outcomes in Adult Patients with Type 2 Diabetes: A Systematic Review

“…Sample sizes ranged from 15 to 3,535 participants. In both designs, more studies suggested that higher levels of social support were associated with improved diabetes-related clinical outcomes (HbA1c, BP, lipids) [17, 22, 24, 26, 28••, 29•, 30, 33, 34, 35••, 36••, 37, 38]. This association held true regardless of the avenue for social support exchange or delivery (i.e., peer support, couples/spouse, and nurse manager) [22, 23, 34, 35••, 36••, 37, 38].…”

“…Both of these behavioral-targeted support mechanisms improved clinical outcomes in diabetes management [24, 30, 33]. Furthermore, Epple and colleagues demonstrated that diet-related clinical outcomes (low-density lipoprotein [LDL], total cholesterol, triglycerides [TG], and HbA1c) were best when “other family members” (not the patient with T2DM) cooked the meals [33]. It should be mentioned as well that these “best outcomes” were observed in female participants [33].…”

Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: Does social support matter?

“…Little is known regarding the influence of social support and T2DM-related outcomes or behaviors among American Indians. An examination with Navajos with T2DM found that when the majority of the meals were cooked by family members for someone with T2DM, they were more likely to have lower HbA1c levels (Epple, Wright, Joish, & Bauer, 2003). A more recent qualitative study with American Indians and Alaska Natives with T2DM found that social support emerged as an important aspect in their T2DM management.…”

American Indian/Alaska Native Willingness to Provide Biological Samples for Research Purposes

“…Studies like the Strong Heart Study [4–6], the Zuni Kidney Project [7–9], and the Cherokee Diabetes Study [10] focus on AI/AN and use biological sampling with full permission from participants to collect samples for research purposes. However, it is common for studies to extract data from medical records or previously collected samples [11]. …”