Date of Award

11-3-2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

William V Tamborlane

Abstract

Over the past decade, great strides have been made in the treatment of type 1 diabetes mellitus. Although these advances have increased the proportion of young patients who are able to achieve strict metabolic control, there continues to be a disparity in the HbA1c levels of the African American and Hispanic American youth relative to Caucasian American youth, and in children of lower socioeconomic status (SES) relative to children of higher SES. Few studies have explored the underlying factors associated with this disparity and even fewer have analyzed how people of different ethnic backgrounds within lower socioeconomic groups deal with the diagnosis and its demands differently, particularly in the post-DCCT era of intensive diabetes management. To enhance understanding of these factors, a qualitative study was carried out to describe factors which influence the impact of type 1 diabetes mellitus in people of different ethnic backgrounds within lower income socioeconomic groups. Seven patients of African American, Hispanic, and Caucasian heritage respectively who are treated by the diabetes treatment team at the Yale Pediatric Diabetes Program were recruited to participate in the study. Semi-structured interviews were conducted to explore each familys perception of challenges in caring for their child and maintaining control of their childs diabetes, parent-child relationships around management of diabetes, and responsibilities of parents with children who have been diagnosed with diabetes. We also explored family support systems identified as being of assistance and aiding in minimizing the challenges in attaining successful diabetes treatment. After thorough analysis of the data, there were multiple identifiable differences in how people of different ethnic groups manage and cope with diabetes. Most notable themes included a disparity in the emotional response of different ethnicities after diagnosis, differences in treatment modalities and reasons for their use across ethnicities, support systems identified, and clinician-patient relationships. Although these differences are likely multifactorial, with components of socioeconomic status, family structure, and family experiences involved, it is evident that ethnicity itself is an important factor. Therefore it is important for health care providers to consider the various issues which can affect the familys ability to manage and cope with diabetes, however it is also important for them to refrain from using race or ethnicity in a stereotypical way which might negatively affect their decision making and relationship with the patient.

Comments

This is an Open Access Thesis.

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