Psychological functioning, support for self-management, and glycemic control among rural African American adults with diabetes mellitus type 2

Objective: To test a contextual-ecological model of factors relevant for glycemic control in an understudied and vulnerable population of persons with diabetes mellitus Type 2. Design: Rural African American adults (40-65 years old, n = 200) with Type 2 diabetes and 200 adult support persons whom the adults with diabetes nominated were interviewed in their homes. Adults with diabetes and support persons reported their own psychological functioning, which included depressive symptoms, self-esteem levels, and optimism levels as well as the quality of their relationship with one another. Adults with diabetes reported the extent and quality of the instrumental and emotional support they received from their support persons. Results: Structural equation modeling indicated that psychological functioning among the adults with diabetes and support persons was associated with the latter's provision of support for diabetes self-management. Support, in turn, was linked indirectly with glycemic control as assessed via glycosylated hemoglobin levels, through promotion of glucose monitoring. Conclusion: Targeting sources of support in patients' immediate social contexts is important to the improvement of self-care and deterring of morbidity among rural African Americans with Type 2 diabetes.