Perceptions of Diabetes Distress, Neighborhood Disorder, and Health Behaviors in an Urban Sample of Adults with Diabetes

Abstract

Type 2 diabetes (T2DM) affects a greater proportion of socially and economically disadvantaged individuals. Differential sources of distress may have important consequences for diabetes health behaviors and glycemic control. This study aimed examined relationships between indicators of distress (socioeconomic, neighborhood disorder, and diabetes-specific) alongside diabetes self-care behaviors and glycemic control.;Adults (N= 941) with T2DM with A1 c >7% were recruited for a larger trial of a telephonic intervention in the South Bronx. The current study used a cross-sectional design, with the exception of neighborhood disorder which was assessed at 6-months. Analyses included: 1) correlations to assess these associations; 2) regression models to examine individual and neighborhood factors upon health behaviors and glycemic control; and 3) moderation effects of individual and neighborhood level disadvantage on the association between diabetes distress and self-care behaviors.;Participants (n= 480) were predominately middle-aged adults (mean[SD]=56.4[11.7] years old), female (67%), Latino (68%), had incomes below {dollar}20,000 (77%), and completed the 11th grade or less (50%). Results illustrated significant and more consistent correlations between diabetes distress and self-care than between neighborhood disorder and self-care. Education was associated with better dietary adherence (r= .09. p= .040), while income was not associated with any self-care behavior. Regression models explained more variance in self-care behaviors when diabetes distress was entered into the models (R2= .11, p< .001 for diet, R2= .08, p< .001 for medication) than neighborhood disorder (R2= .02, p= .131 for diet, R2= .02,p= .021 for medication). Neighborhood disorder, however, was independently associated with diabetes distress (B= .04, p< .001). Moderation analyses showed that relationships for diabetes distress with exercise and diet were stronger for individuals with higher levels of educational attainment and lower levels of neighborhood disorder.;Diabetes distress, unlike neighborhood disorder, was consistently associated with health behaviors. Individuals with less education and those who perceive less disorder may have other sources of distress, not captured here, which impede self-care. Further, these individuals may require further guidance in making health behavior changes. Diabetes-providers, including medical home care teams, are advised to take into account neighborhood context described when evaluating and addressing diabetes-specific distress.