Medical Mistrust, Diabetes Self-Management, and Glycemic Control in an Indigent Population With Type 2 Diabetes
- Leonard E. Egede, MD, MS1,2 and
- Yvonne Michel, PHD3
- 1Department of Medicine, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
- 2Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- 3College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Address correspondence and reprint requests to Leonard E. Egede MD, MS, Division of General Internal Medicine, Medical University of South Carolina, 135 Cannon St., Suite 403, Charleston, SC 29425. E-mail: egedel{at}musc.edu
Diabetes is a chronic debilitating condition associated with significant morbidity, mortality, and health care costs (1). Morbidity and mortality are higher in blacks than in whites (1). Medical mistrust by black patients has been hypothesized as a contributory factor (2); however, the evidence is inconclusive (3). The purposes of this study were to determine whether there are racial or ethnic differences in medical mistrust and ascertain the association among medical mistrust, self-management, glycemic control, and health-related quality of life (HRQOL) in an indigent population with type 2 diabetes. We hypothesized that blacks would be less trusting of the medical system and that self-management, glycemic control, and HRQOL would be significantly correlated with medical mistrust in this population.
RESEARCH DESIGN AND METHODS
We used billing records to identify all patients with type 2 diabetes in an indigent clinic of an academic medical center. Patients were contacted by telephone and invited to participate in the study. Over a 12-month period, consenting subjects completed validated surveys to assess trust in the medical care system, diabetes knowledge, diabetes self-management, perceived control of diabetes, and HRQOL. Response rate was 60% and did not differ by race or ethnicity. We only had data on race or ethnicity for responders and nonresponders, and there was no significant difference. Our institutional review board approved the study.
Trust was measured with the 15-item Medical Mistrust Index (MMI) (4). MMI measures distrust …
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