Diabetes Knowledge and Self-Management Among Tuberculosis Patients in Hawaii, 2013

BACKGROUND: Diabetes is increasing in Hawaii and complicates tuberculosis (TB) control efforts. Studies show that TB-diabetes patients are at increased risk for prolonged time to culture conversion, mortality during treatment for TB disease, and relapse after treatment completion. In Hawaii from 2009-2012, approximately one-third of TB patients aged 21 or older had diagnosed diabetes. This exploratory research addressed the following questions: 1) What is current diabetes knowledge and self-management among patients on Oahu being treated for TB disease? 2) How does diabetes knowledge relate to glucose control? 3) How does glucose control change during TB treatment?

METHODS: Adult TB-diabetes patients undergoing treatment for TB disease at a public clinic on Oahu were interviewed in-person from April to December 2013. Participant selection was based on availability and laboratory-confirmed diabetes. Open- and close-ended questions explored patients’ diabetes understanding and current self-management practices. Medical charts and EpiAnywhere (state electronic TB surveillance system) were reviewed to abstract clinical data and indicators of glucose control by hemoglobin A1c (HbA1c). Data were analyzed in SAS.

RESULTS: Twenty-eight TB-diabetes patients were interviewed and represented mostly individuals from the Philippines and the Pacific Islands with low socioeconomic status. Sixty percent of the sample was male, and the average age was 62±14 years. Patients’ diabetes knowledge based on a 5-point scale was moderate with a mean of 2.7±1.5. Over 50% of the sample understood that diabetes was related to blood sugar, knew their target HbA1c or random blood glucose levels, and correctly listed at least one complication of uncontrolled diabetes. However, the correlation between patients’ diabetes knowledge and self-management was weak (r=0.10, p=0.62). Only 36% of patients achieved the target HbA1c level of 7.0 during TB treatment. Less than half maintained recommended levels of exercise, checked their feet regularly, or received flu and pneumonia vaccinations. Patients frequently reported challenges of choosing local foods that were healthy and properly proportioned. Data suggest a moderate correlation between diabetes knowledge and years of education (r=0.46, p=0.01), but no other variables were associated. Lastly, average HbA1c showed an initial drop during the first 2 months of TB treatment, but steadily increased throughout the remainder of treatment.

CONCLUSIONS: Results suggest a disconnection between diabetes knowledge and self-management among patients undergoing treatment for TB disease on Oahu. This is exemplified by elevated HbA1c levels during TB treatment, regardless of diabetes knowledge. Study findings will be used to guide a clinic-based intervention among TB-diabetes patients.