Perception of risk of developing diabetes in offspring of type 2 diabetic patients

Are Malaysian Type 2 Diabetes patients willing to be trained to speak to their offspring about risk of diabetes and preventive measures?

Background

Offspring of type 2 diabetes patients have an absolute risk of 20–40% of developing the condition. Type 2 diabetes patients should be encouraged to speak to their offspring regarding diabetes risk and prevention strategies. The Health Belief Model conceptualises that the higher the perceived risk, the more likely an individual will modify their behaviour. The objectives of this study were to i) determine the distribution of type 2 diabetes patients regarding their willingness to accept training to speak to their offspring, ii) determine the distribution of type 2 diabetes patients regarding their willingness to accept training based on the HBM and iii) to determine the factors associated with their willingness to accept training.

Methods

This was a cross-sectional study amongst type 2 diabetes patients attending two primary care clinics in Malaysia. Sociodemographic data and knowledge of diabetes risk factors were collected. The adapted, translated and validated Diabetes Mellitus in the Offspring Questionnaire-Malay version (DMOQ-Malay) was self-administered. Statistical analysis included descriptive statistics, univariate and multiple logistic regression (MLogR).

Results

A total of 425 participants were recruited. Of these, 61.6% were willing to accept training. In MLogR, six variables were found to be significantly associated with willingness to accept training. These were i) positive family history [Adj. OR 2.06 (95% CI: 1.27, 3.35)], ii) having the correct knowledge that being overweight is a risk factor [Adj. OR 1.49 (95%CI: 1.01, 2.29)], iii) correctly identifying age ≥ 40 years old as a risk factor [Adj. OR 1.88 (95%CI: 1.22, 2.90)], iv) agreeing that speaking to their offspring would help them to prevent type 2 diabetes [Adj. OR 4.34 (95%: 1.07, 17.73)], v) being neutral with the statement ‘I do not have much contact with my offspring’ [Adj. OR: 0.31 (95% CI: 0.12, 0.810] and vi) being neutral with the statement ‘my offspring are not open to advice from me’ [Adj. OR: 0.63 (95% CI: 0.31, 0.84].

Conclusion

The majority of type 2 diabetes patients were willing to accept training to speak to their offspring to prevent diabetes. A training module should be designed to enhance their knowledge, attitude and skills to become family health educators.

Health beliefs among individuals at increased familial risk for type 2 diabetes: implications for prevention

AIM

To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes.

METHODS

Data analyses were based on the Family Healthware™ Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978).

RESULTS

After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups.

CONCLUSIONS

Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders.

Factorial structure of the perception of risk factors for type 2 diabetes scale: exploratory and confirmatory factor analyses

RATIONALE, AIMS AND OBJECTIVES

The extent to which individuals' perceptions of risk for type 2 diabetes are related to their actual risks and health-promoting behaviours is not well known. Yet perception of risk for type 2 diabetes may influence the likelihood that individual would engage in preventive behaviours. The purpose of this study was to evaluate the psychometric properties of the perception of risk factors for type 2 diabetes (PRF-T2DM).

METHODS

A descriptive, correlational, methodological design was used to conduct this study. The sample consisted of 629 adults from 42 states of the United States. A demographic questionnaire, the PRF-T2DM, the health-promoting lifestyle profile II and the depressive cognition scale were used to collect the data. Data analyses consisted of descriptive statistics, scale and item analyses, Pearson's correlation analysis, and exploratory and confirmatory factor analyses.

RESULTS

The PRF-T2DM has a Cronbach's alpha of 0.81. Both extracted factors had Cronbach's alphas of 0.74 and 0.80, respectively. Most inter-item and item-to-total correlation coefficients for factor 1 and factor 2 met the recommended criteria of r=0.30 to r=0.70. The PRF-T2DM achieved all minimum recommended criteria for model fit (χ(2) /d.f.=2.33, goodness of fit index=0.95, adjusted goodness of fit index=0.93, comparative fit index=0.94, root mean square error of approximation=0.05, root mean residual=0.05 and the P value for test of close fit=0.33).

CONCLUSIONS

All statistical estimates and measures of model fit were above the standard recommended criteria. The scale has potential uses in research and clinical practice. Further development and psychometric evaluation of the PRF-T2DM is warranted.

Knowledge about type 2 diabetes risk and prevention of African-American and Hispanic adults and adolescents with family history of type 2 diabetes

PURPOSE

The purpose of this study was to assess type 2 diabetes knowledge, perceptions, risk factor awareness, and prevention practices among African American and Hispanic families with a history of diabetes.

METHODS

Ninth and tenth grade Houston area students who had a parent who spoke English or Spanish and had a family history of type 2 diabetes were recruited. Student interviews took place during lunch. Parents were interviewed via telephone. Open-ended questions in the interview guide assessed knowledge of diabetes and risk factors, diabetes prevention practices, and perceived risk. Students reported dietary behaviors. Responses were recorded.

RESULTS

Interviews were conducted with 39 parents (95% female, 49% African-American, 51% Hispanic) and 21 ninth and tenth grade adolescents (71% female, 43% African-American, 57% Hispanic). The majority were overweight. Approximately one-half of both groups reported some knowledge of diabetes. The majority (74%) of parents correctly identified family history as a risk factor, but few adolescents responded correctly. Being overweight was identified as a risk factor by 26% of the parents and 10% of the adolescents. Losing weight was not acknowledged as a way to reduce diabetes risk. Sweetened beverage consumption consisted of 2 cans/day and 43% reported to have skipped breakfast.

CONCLUSIONS

Overall, there was a lack of knowledge about risk and prevention of type 2 diabetes among African American and Hispanic families at risk. From a public health perspective, there is a critical need for innovative prevention programs targeting families at risk for diabetes.

Family history and parents' beliefs about consequences of childhood overweight and their influence on children's health behaviors

OBJECTIVES

The aims of this study were to examine factors related to 1) parental perception of health risks for overweight children and 2) parents' self-efficacy for influencing their children's dietary and physical activity behaviors, especially in relation to family history (FH) of diabetes and cardiovascular disease (CVD).

METHODS

A consecutive sample of parents was surveyed at 7 primary care practices about FH, perceptions of childhood obesity-related health risks, health beliefs, and perceptions. Generalized estimated equation models clustering on practice were developed to examine associations with perceptions and self-efficacy.

RESULTS

Analyses included 386 parents of children aged 2 to 17 years. Sixty-seven percent had FH of CVD and 33% had FH of diabetes. Children were 57% white, 23% Hispanic, 12% African American, and 8% other race/ethnicity; 17% were overweight and 18% were obese. Parents whose child had FH of diabetes more often perceived higher risk of diabetes for overweight children than those with neither FH risk (adjusted odds ratio [OR] 1.4, 95% confidence interval [95% CI], 1.2-1.7), as did those with FH of CVD (adjusted OR 2.0, 95% CI, 1.6-2.5) and those with an obese child. Parents with less than college education or having African American and female children perceived risk less often. Parents had high self-efficacy for influencing their child if they had a strong belief in parental modeling and their child was aged <12 years.

CONCLUSIONS

Family history of diabetes and CVD and other factors are associated with parents' perceptions of health risks for overweight children. Strategies to use FH to motivate families with overweight children toward behavior change are needed.

Preventive advice given by patients with type 2 diabetes to their offspring

BACKGROUND

Patients' advice-giving behaviour could be a useful preventive strategy for type 2 diabetes.

AIM

To investigate the conditions under which patients offer advice to their offspring and to assess the factors that facilitate advice giving.

DESIGN OF STUDY

Cross-sectional observational study.

SETTING

A general hospital with a diabetes clinic in a metropolitan suburb in Japan.

METHOD

Parents with type 2 diabetes (n = 221) who had offspring aged 20-49 years inclusive without diabetes completed a self-administered questionnaire containing items relating to advice-giving behaviour, demographic characteristics, risk perception, and their disease status.

RESULTS

A total of 184 (83.3%) patients responded that parental advice-giving behaviour is needed for their offspring, while 138 (62.4%) actually advised their offspring. Multiple logistic regression analysis showed that patients who were female (odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.03 to 3.65, P = 0.041), living with their offspring (OR =1.92, 95% CI = 1.04 to 3.57, P = 0.038), had complications (OR = 2.74, 95% CI = 1.25 to 6.00, P = 0.029), or perceived that their offspring had a high risk of developing diabetes (OR =1.45, 95% CI = 1.09 to 1.93, P = 0.011) were most likely to advise their offspring.

CONCLUSION

Patients with type 2 diabetes recognised the need to give advice about preventive behaviour to their offspring but were not necessarily engaging in advice-giving behaviour. Advice-giving behaviour was affected by the parents' own disease status, their perception of their offspring's risk of developing diabetes, and the relationship between the patients and their offspring.

Individualized pharmacokinetic risk assessment for development of diabetes in high risk population

AIM

The objective of this study is to propose a non-parametric pharmacokinetic prediction model that addresses the individualized risk of developing type-2 diabetes in subjects with family history of type-2 diabetes.

METHOD

All selected 191 healthy subjects had both parents as type-2 diabetic. Glucose was administered intravenously (0.5 g/kg body weight) and 13 blood samples taken at specified times were analyzed for plasma insulin and glucose concentrations. All subjects were followed for an average of 13-14 years for diabetic or normal (non-diabetic) outcome.

RESULTS

The new logistic regression model predicts the development of diabetes based on body mass index and only one blood sample at 90 min analyzed for insulin concentration. Our model correctly identified 4.5 times more subjects (54% versus 11.6%) predicted to develop diabetes and more than twice the subjects (99% versus 46.4%) predicted not to develop diabetes compared to current non-pharmacokinetic probability estimates for development of type-2 diabetes.

CONCLUSION

Our model can be useful for individualized prediction of development of type-2 diabetes in subjects with family history of type-2 diabetes. This improved prediction may be an important mediating factor for better perception of risk and may result in an improved intervention.

Family history of diabetes as a potential public health tool

Given the substantial morbidity and mortality associated with type 2 diabetes, it is important that public health seek ways to delay or prevent the onset of this condition. Risk factors for type 2 diabetes are well established and include underlying genetic susceptibility. Despite this knowledge, as well as significant advances in understanding the human genome, the prevalence of type 2 diabetes continues to rise at an alarming rate. Because type 2 diabetes is a complex condition involving a combination of genetic and environmental factors, DNA testing for susceptibility genes is not yet warranted. However, because family history reflects genetic susceptibility in addition to other factors, it may be a useful public health tool for disease prevention. When evaluating family history as a public health tool, several important issues need to be considered, including the analytic and clinical validity and the clinical utility of using family history as a screening tool. These issues as well as a review of the epidemiologic evidence evaluating family history as a risk factor will be reviewed.Overall, a family history approach appears to be a promising new public health tool to fight the growing epidemic of diabetes in the United States. Adequate levels of funding to further evaluate this approach and to develop appropriate tools should be made available for research activities focused on this important area.