title: Glycemic control among Latinos with type 2 diabetes: the role of social-environmental support resources.
abstract: OBJECTIVE
  Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources.
  
  
  METHODS
  Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with Type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression.
  
  
  RESULTS
  Participants who perceived greater support resources for disease-management reported better diabetes self-management (β = .40, p < .001) and less depression (β = -.19, p < .01). In turn, better diabetes self-management and less depression were associated with tighter glycemic control (HbA1c; β = -.17, p < .05 and β = .15, p < .05, respectively). Once the indirect effects via diabetes self-management (95% CI [-.25; -.03]) and depression (95% CI [-.14; -.01]) were statistically controlled, the direct pathway from support resources to HbA1c was markedly reduced (p = .57).
  
  
  CONCLUSIONS
  These findings demonstrate the important connection that support resources for disease management can have with diabetes self-management, emotional well-being, and glycemic control among Latinos. Thus, programs targeting diabetes self-management and glycemic control in this population should consider culturally relevant, multilevel influences on health outcomes.
authors.affiliation: San Diego State University/University of California, San Diego, CA 92123, USA. abrewer@projects.sdsu.edu
authors.forename: Addie L
authors.initials: AL
authors.lastname: Fortmann
authors.forename: Linda C
authors.initials: LC
authors.lastname: Gallo
authors.forename: Athena
authors.initials: A
authors.lastname: Philis-Tsimikas
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D003863:Depression / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D012648:Self Care / Q000523:psychology; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human