A study was conducted to assess the utility of motivational interviewing techniques to improve management of type 2 diabetes among residents of an American Indian reservation. A convenience sample of participants was recruited at an Indian Health Service diabetes clinic (n = 26). Random blood glucose, A1C, and demographic variables for the 6 months before baseline were collected via chart review; data on random blood glucose, A1C, demographic variables, health-related behaviors, and psychological self-report instruments were collected at baseline and 3 months after intervention. The intervention consisted of two individual, 30-minute sessions of motivational interviewing (MI) delivered over 3 weeks.

Significant improvements in participants’ self-reported depressive symptoms, genetic/racial fatalism, treatment satisfaction, and social/vocational worry were observed. Stepwise regression revealed seven predictors of change in A1C from baseline to study end: completion of the study, total blood quantum, change in A1C from 6 months before baseline to baseline, and change in provider trust, treatment acceptance, depression, and reported hours of exercise per week from baseline to study completion. The final analysis had an R2 value of 0.896, accounting for 89.6% of the variance in A1C change. This pilot study provides preliminary support for the utility of MI techniques in diabetes care among American Indians.


Objective. This study sought to evaluate the details of self-management goal setting in a largely Hispanic population of patients with type 2 diabetes, to evaluate the impact of various factors on goal attainment and to assess the impact of self-management on glycemic control.

Setting. The intervention was conducted at Community Health Center, Inc., a large, multisite federally qualified health center in Connecticut caring for an ethnically and racially diverse population of medically underserved patients.

Methods. Patients with type 2 diabetes participated in a diabetes self-management program delivered by diabetes educators. We evaluated factors associated with successful goal attainment and the impact of goal setting on glycemic control.

Results. During a 3-year period, 488 patients participated in the self-management program and set a total of 2,133 goals. Hispanic patients and those with depression were as successful as others at setting and attaining goals. Goals focusing on medications and healthy eating were more often successfully attained. Successful goal attainment was independently associated with achieving or maintaining an A1C value of < 7.0%.

Conclusions. Underserved, largely Spanish-speaking patients successfully set and attained specific goals, with a preference for those focused on healthy eating and medication taking. This evaluation suggests an association between the successful achievement of individual goals and glycemic control.


Purpose. To determine whether the association between diabetes-specific family conflict and self-monitoring of blood glucose (SMBG) frequency is mediated by diabetes self-efficacy.

Methods. A total of 276 adolescents with type 1 diabetes (aged 15.6 ± 1.4 years; duration of diabetes 6.6 ± 1.8 years; A1C 8.9 ± 1.8%) completed measures of diabetes-specific family conflict and self-efficacy. Sociodemographic, family, and disease characteristics (including SMBG frequency and glycemic control) were obtained at the clinic visit.

Results. Multivariate analyses were used to test the mediational role of self-efficacy. The first model established that family conflict was associated with lower levels of self-efficacy. The second model established that increased family conflict was associated with lower SMBG frequency. In the third model, self-efficacy was added, and the effect of family conflict on SMBG frequency became less significant (P = 0.001 to P = 0.03). The indirect effect of family conflict on SMBG frequency through diabetes self-efficacy was significant (Sobel = 2.10, P = 0.035) and explained 22% of the association between family conflict and SMBG frequency.

Conclusions. Results confirm a partial mediational role of diabetes self-efficacy and suggest that a family environment characterized by conflict may also contain poorer self-efficacy in the adolescent. In these cross-sectional analyses, both variables contributed to less frequent SMBG. Future longitudinal research to confirm these relationships and potential avenues for intervention are discussed.

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