Approximately 20 million adults in the U.S. with diabetes are of low-income and minority populations. This population has an increased vulnerability to diabetes due living in high-stress environments, victimization from violent crimes, family history of domestic violence, personal histories of child physical and/or sexual abuse, and witnessing repetitive community violence. Common health disparities are often overlooked and access to appropriate medical care can be limited. Patient education for diabetes does not address how these previous traumatic experiences affect patients' ability to be compliant with their diabetes treatment plan.
While the effects of mental trauma on health disparities related to Type 2 Diabetes have focused largely on major depression, there is growing evidence that posttraumatic stress disorder (PTSD) is also associated with chronic disease and with poorer health outcomes. A potential contributing factor to the detrimental effects of PTSD and self-management for diabetes is an individual’s difficulty with regulating emotions and stress. Customized modifications of diabetes self-management could help increase patient engagement in both PTSD treatment and compliance with their own diabetes treatment plan. This study will be the first to examine effects of mental trauma as a contributor to the link between trauma exposure and diabetes self-care. The sample population consists of adults that are predominantly from ethnic minority groups (Latino and African American) and all are un-insured, lower socioeconomic families.
In this study, we will be able to look at electronic medical records of patients at two community clinics (Harvest Free Community Clinic and East Cooper Community Outreach (ECCO)) that are well-respected and trusted by this underserved and high needs population.
Individuals will be asked if they would be interested in participating in our survey study, which would involve completion of self report survey to gather information about each patient's emotion regulation, interpersonal violence and abuse history, PTSD symptoms, depression, daily diabetes self management activities, and positive/negative mood. Staff will also gather information from their electronic medical record (EMR) about their HbA1C, medications, other chronic conditions, BMI, and glucose levels. Most importantly, 10 of the participants will be asked to join in a group feedback session with the researchers to share from their perspective what their barriers are to managing their diabetes so that this information can be incorporated into appropriate health interventions.
While some studies may link the connection between PTSD and diabetes with biological changes in the stress regulating systems of the body (e.g., dysregulation of stress reacting hormones like cortisol), this study will determine whether the socio-emotional aspects related to health decision making behaviors may also lead to the development of type 2 diabetes and continue to contribute to poor management of diabetes.
Emotion regulation refers to how each individual handles intense emotions and/or stress (e.g., overeating, becoming more sedentary, impulsive poor choices, forgetfulness). By examining the role of emotion regulation in diabetes management, we can tailor diabetes self management to increase patient engagement in compliance with diabetes treatment plans as well as patient engagement in treatment for PTSD symptoms.
In addition to recruiting enough patients (100) to conduct analyses that are reliable and accurate, we are also relying on the input of patients from this victimized population, who can tell us first-hand what obstacles may be affecting their diabetes self management and can let us know what strategies will be most accepted in their community and how best to share this information with the community in need.
Results from the proposed study will provide pilot data for the NINR R21 application to develop proper modifications to PTSD treatment and/or customized diabetes self-care activities to prevent patient drop-out and/or noncompliance.
College of Nursing
Medical University of South Carolina