Diabetes mellitus was the seventh leading cause of death in 2010 (Centers for Diseases and Control and Prevention [CDC], 2014). Diabetes is a severe chronic disease in which the pancreas does not produce enough insulin to manage the body’s blood sugar, glucose (World Health Organization [WHO], 2013). Causes of diabetes include hereditability, race, (African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American) increased stress, poor diet, obesity, and lack of physical activity (American Diabetes Association [ADA], 2014; CDC, 2014; Diabetes Prevention Program Research Group, 2009, Grant, Moore, & Florez, 2009).
People with diabetes who have uncontrolled blood glucose are at a higher risk of developing other health concerns such as hyperglycemia, hypoglycemia, high blood pressure, cardiovascular disease (CVD), stroke, kidney disease, heart disease, blindness, amputations and even death (ADA, 2014). Type 2 diabetes (T2DM) accounts for about 90% of people with diabetes and is preventable, but can be caused by obesity, poor diet, and lack of exercise (CDC, 2014; WHO, 2013). In 2010, a reported 69,071 death certificates listed T2DM as the primary cause of death. In addition, during that same year about 234,051 deaths in the US listed T2DM as one of the contributing causes of death (CDC, 2014). Later in 2012, about 29.1 million people in the United States reported having T2DM and about 8.1 million (27.8%) were undiagnosed and untreated by providers (CDC, 2014). Given the number of complications that T2DM causes, diabetes is a major public health concern.
Unfortunately, the prevalence rate of T2DM continues to increase in the country (Boyle, Thompson, Gregg, Barker, & Williamson, 2010) and unfortunately, there is no known cure for T2DM. However, T2DM can be managed and controlled (CDC, 2014). The standard treatment for managing T2DM includes healthy dietary habits, regular physical activity, and medication adherence, and monitoring blood glucose levels (ADA, 2014; CDC, 2014). However, researchers have found that adherence to T2DM treatment are reported to be low, which could be explained by the T2DM distress experienced at onset (Skovlund & Peyrot, 2005). One of the ways that diabetes is diagnosed is by using glycated hemoglobin or HbA1c. Glycated hemoglobin (HbA1c) is the golden standard measurement that medical doctors use for capturing a summary of what a person’s blood sugar levels have been over a period of 8-12 weeks and is also used to diagnose diabetes (ADA, 2014; Consensus Committee, 2007). Diabetes is diagnosed when a patient has a HbA1c of 6.5 or higher, which means that the patient will need to monitor his or her blood sugar. Blood glucose monitoring requires purchasing a blood glucose meter, test strips, and using a lancing device to draw blood before each meal and an hour or two after beginning the meal (ADA, 2014).
Providers that were interviewed in the Diabetes Attitudes, Wishes, and Needs (DAWN) study report that individuals diagnosed with T2DM patients sometimes experience a range of negative emotions such as anger, anxiety, shock, guilt, depression, and helplessness (Skovlund & Peyrot, 2005). The DAWN study reveals that T2DM distress can impact a patient’s ability to manage blood glucose and adhere to lifestyle changes such as medication, physical activity, and diet restrictions (Pyykkönen et al., 2010). The lack of adherence and additional stress can combine with other barriers such as the cost of medical care, cost, health literacy, and stress from uncontrolled blood glucose, etc. (Nagelkerk, Reick, & Meengs, 2006).
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