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Tailored diabetes education may reduce renal disease risk in black women
Although a culturally tailored intervention program was effective in decreasing renal disease risk among black women, usual care was equally effective, according to recent findings.
In a secondary analysis of the Self-Care Intervention for Black Women with Type 2 Diabetes, Allison Vorderstrasse, DNSc, APRN, CNE, of Duke University School of Nursing, and colleagues evaluated 109 black women with type 2 diabetes to determine whether participation in a culturally relevant coping skills training intervention decreased renal disease risk.
Allison Vorderstrasse
In the primary study, participants were randomly assigned to either an experimental group exposed to a culturally pertinent, cognitive-behavioral diabetes self-management and coping skills training intervention (n = 52) or a usual care group receiving conventional group diabetes education followed by group question and answer discussions (n = 57).
In a secondary analysis, researchers assessed four renal disease risk factors that were quantified in the parent study, including hypertension as measured by systolic/diastolic blood pressure, elevated HbA1c, high BMI and increased triglyceride levels. The researchers grouped the participants into risk groups according to prevalence of these factors at baseline and assessed changes in risk factors over time among risk groups. The four variables were evaluated at baseline, 3, 6, 9, 12 and 24 months. The majority of participants were found to have HbA1c at least 7% and obesity (75.93%).
The researchers further stratified the participants based on intervention group and risk cluster as follows: low-risk control group, high-risk control group, low-risk intervention group and high-risk intervention group.
Overall, a significant decline over time was found for systolic BP (P = .004). Among the high-risk cluster, there was a mean reduction in systolic BP from 135 mm Hg to 131 mm Hg over the course of the study with a greater decrease in the high-risk control group (136 mm Hg to 130 mm Hg) compared with the high-risk intervention group (134 mm Hg to 133 mm Hg). The low-risk intervention group experienced a 5 mm Hg decrease in systolic BP compared with a 3 mm Hg decrease among the low-risk control group.
Overall, there was a significant decrease in triglycerides over time (P = .032). The high-risk cluster experienced a decrease in mean triglycerides from 251 mg/dL to 186 mg/dL whereas the low-risk cluster experienced an increase from 97 mg/dL to 119 mg/dL. Significant differences were found in triglyceride levels between the two clusters of participants in general (P < .001) and over time (P < .05) whereas no differences were found between the intervention groups.
Over time, a significant decrease in HbA1c was also revealed. The high-risk cluster showed a greater decrease in HbA1c from 9/18% to 7.31% compared with the low-risk cluster from 7.64% to 7.51%.
“In summary, the significant improvements in mean [systolic BP], HbA1c and triglycerides overall show that the study had a significant impact on renal disease risk, especially among high-risk participants, most notably in the control group,” the researchers wrote. “The results indicated that African American women with [type 2 diabetes] who are at high risk for renal disease would benefit from culturally tailored diabetes self-management and coping skills training interventions; however, some minor alterations may be beneficial for sustained outcomes and improvements in other renal disease risk factors.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.