A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study
AuthorMcEwen, Marylyn Morris
Elizondo-Pereo, Rogelio Andrès
Pasvogel, Alice E.
AffiliationUniv Arizona, Coll Nursing
Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth
Keywordstype 2 diabetes
type 2 diabetes mellitus
behavioral risk factor surveillance system
MetadataShow full item record
PublisherFRONTIERS MEDIA SA
CitationA Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study 2017, 5 Frontiers in Public Health
JournalFrontiers in Public Health
Rights© 2017 McEwen, Elizondo-Pereo, Pasvogel, Meester, Vargas-Villarreal and González-Salazar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractType 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.
NoteOpen Access Journal.
VersionFinal published version
SponsorsPuentes Consortium; Consejo Nacional De Ciencia y Tecnologia de Mexico
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After receiving language concordant, individual health education interventions, do Spanish speaking, diabetic inpatients at a safety net hospital demonstrate acquired diabetes self-management competency as measured by pre-training and post training evaluation of key, diabetes self-management knowledge?Cagle, Jonathan; The University of Arizona College of Medicine - Phoenix; Abdollahi, Shagyegh (The University of Arizona., 2018-03-28)The purpose of this research was to assess the quality of the inpatient, health education diabetes program as it relates to primary Spanish speaking patients. Complications from diabetes account for huge personal and financial costs. There is substantial evidence supporting the use of targeted diabetes education to reduce complications but we need to know if our education interventions are valid. In order to accomplish this by auditing the knowledge of a sample of inpatient diabetics before and after receiving the standard MMC Spanish language diabetes education interventions via Spanish language pre and post surveys (standardized by the previously validated SKILLD survey). Demographic and clinical data were analyzed and all significant data (p value <0.05) were considered for their importance. The data demonstrated that in all 10 items on the survey, overall patients were able to demonstrate significant improvement in survey scores. Additionally, comparisons of demographic data demonstrated that being less than 50 years old was associated with improved survey scores. This indicates overall benefit of the training program as well as possible insight into need for more aggressive training for patients greater than 50 years in age.
Blood cell alterations in diabetes: Implications for ischemia-reperfusion injury in the diabetic heartHokama, Jason Yoshitsune (The University of Arizona., 1999)Diabetes is now considered a major risk factor for cardiovascular disease, particularly ischemic heart disease. Although restoration of coronary blood flow is prudent in order to salvage the region of the myocardium at risk, reperfusion is also associated with an additional injury to the heart. This is known as myocardial ischemia-reperfusion (I-R) injury. The diabetic heart appears to be more susceptible to I-R injury compared to non-diabetic hearts when blood is used as the perfusate suggesting that components within diabetic blood may play a role in exacerbating the damage to the diabetic heart upon reperfusion. In a series of experiments, we tested the hypothesis that leukocytes are retained in the coronary microcirculation to a significant extent early in reperfusion following ischemia. We also examined if diabetic PMNs are hyperactivated, and are able to respond to exogenous inflammatory stimuli. Since diabetic blood is known to be hypercoagulable, we tested the hypothesis that platelet activation adhesion protein expression is increased in diabetic blood. Finally, we examined if platelet-PMN interactions are increased in diabetic blood. Our results indicate that, early in reperfusion following ischemia, leukocyte retention in the coronary capillaries and post-capillary venules is significantly increased in diabetic hearts compared to non-diabetic hearts. Our findings also indicate that PMNs from diabetics are hyperactivated compared to nondiabetic PMNs suggesting that, once sequestered, PMNs in the diabetic coronary microcirculation are able to initiate an exaggerated inflammatory response, which may exacerbate the reperfusion injury. We also found that platelet adhesion protein expression was enhanced in diabetics, an effect that was partially attenuated by aspirin usage. Platelet-PMN conjugate formation was increased in diabetic blood and appeared to enhance ROS production in diabetic PMNs since blockade of these aggregates attenuated PMN ROS production in diabetic blood. The results from these experiments indicate that both hyperactivated PMNs and platelets in diabetic blood likely contribute to exacerbated ischemia-reperfusion injury in the diabetic heart. Once the mechanisms of myocardial reperfusion injury in diabetes are known, therapeutic interventions can be introduced with the hope of attenuating the increased morbidity and mortality associated with ischemic heart disease in the diabetic population.
From Irrigation Engineers to Victims of Type 2 Diabetes: Connecting Natural Resource Conditions with Type 2 Diabetes in the Pima Indians of the Gila River ReservationGachupin, Francine C.; Stowe, Elizabeth; College of Architecture, Planning and Landscape Architecture; Juliano, Joseph (The University of Arizona., 2016)For over a century, Pima Indians living just south of Phoenix, Arizona on the Gila River Indian Reservation have suffered from an epidemic of type 2 Diabetes Mellitus. Over half of the Pima population living on the reservation is diagnosed with diabetes while the socioeconomic conditions of the tribal community are in an unstable and dilapidated state (Unnatural Causes 2008). Fifty percent of the Pimas living on the Gila River Indian Community live below the poverty level (Unnatural Causes 2008). Displacement from traditional customs and neglect from the U.S. federal government are just some of the detrimental impacts the people have faced over the last century (Unnatural Causes 2008). The discussions within this paper will attempt to address how and why the Pima Indians have experienced such severe changes in lifestyle and economy over the last century and what affect this has had on the physical health of the people in the community. By addressing these overarching issues, one should find that socioeconomics and conditions of physical health are strongly connected. Looking even closer though, specifically at the epidemic of type 2 diabetes and the contributing risk factors that this population suffers from, one will begin to question how within just a matter of 3 decades the number of diagnosed cases of type 2 diabetes doubled among the Pima and how the rates are some of the highest recorded in the entire world. Moreover, the underlying issue is not simply a cause of poor diet, change in activity levels and unfavorable genetics, rather - being robbed of a critical natural resource, forced to adapt to unfavorable economic changes and in the end, the U.S. government failure to intervene – are truly the underlying causes that have impacted the health of the Pima Indians of Southern Arizona. The Pimas are people of their natural environment. Having a long history of living along the Gila River, the Pima were water irrigation engineers (Unnatural Causes 2008). Cultivating local crops, living off the land and providing for themselves using waters of the Gila River in an arid climate is as much a part of their culture as is their ancestral bloodline. The research presented in these discussions will look at the identical ancestry of Pima Indians living in Southwestern Sonora, Mexico in the Sierra Madre Mountains of Maycoba in order to evaluate the Pima tribe’s predisposition to the disease. The significance of looking at these groups is that their genetic history is the same based upon linguistic and genealogy studies (Schulz, Bennett, Ravussin, Kidd, Kidd, Esparza, Valencia, 2006). However, the Pima living in Sonora have not seen the same ever-increasing rates of type 2 diabetes or even obesity, as their northern counterparts have. Notably, the Mexican Pima have not experienced the same environmental changes (i.e. drought) either. Subsequently, the Pima of Sonora have been able to continue their traditional ways of life including subsistence farming and healthy diet and exercise. A historical background of the Arizona Pimas will be provided, from their cultural traditions as irrigation engineers to their participation in federal subsidy programs and their current economic state. In-depth historical accounts will also be made for the history of water law in the Southwestern United States, including what drove white settlers’ demand for water west of the Mississippi over the course of two centuries, to the attempts to mitigate the severity of drought on Native American reservations through multiple legislative acts. Information regarding the Mexican Pima’s current economy, levels of physical activity and typical diet will be presented in comparison to the present health and economic conditions of the Arizona Pima.