Rates of type 2 diabetes mellitus (T2DM) have grown significantly in the last decade. Older adults, especially older adult ethnic minorities, are exceptionally vulnerable to diabetes and many experience difficulties adhering to self-management recommendations related to diet, exercise, glucose testing and medication.1,2 The proposed 36-month study investigates the subjective construction of diabetes among male and female African-American and non-Hispanic white older adults, age e50, with T2DM, living in Baltimore City (n=80). Using the McGill Illness Narrative Interview (MINI), a semi-structured ethnographic interview guide, we will explore participants'perceptions of their diabetes and their understandings of diabetes management. This study takes an innovative approach to diabetes understanding and management as it employs a social constructionist perspective, that is, this study seeks to identify what people themselves think about their diabetes and how local social, cultural, and material contexts inform participants'conceptions of their diabetes and their approach to managing their illness. This study also is unique as the sample will be drawn from NIH's intramural Healthy Aging in Neighborhoods of Diversity across the Lifespan Study (HANDLS), a community-based, fixed- cohort, epidemiological study (n=3722) of cardiovascular and cerebrovascular disease risk in Baltimore. By obtaining our sample from the community-based HANDLS study we will be able to capture persons who normally may not be included in a clinic-based study, i.e., persons not seeking treatment for their diabetes. We will employ code-based and case-based analytic strategies in order to examine how diabetes understandings, management, and social contexts vary across and within race and gender categories, and with respect to diabetes duration and control. We argue that greater understanding of this subjective experience of diabetes is needed in order to more effectively help patients to negotiate the beliefs and contexts that play a role in self-management.
Public Health Relevance The prevalence of diabetes continues to increase at epidemic proportions while adherence to self-management programs remains challenging, especially for older adults in urban contexts. This study of older adults'subjective understandings of their diabetes will provide rich, detailed insight to the construction of diabetes and diabetes management among older adult urban residents, and the ethnic and gender variation in these constructions. This study will offer health care providers a better understanding of the ways in which subjective beliefs and experiences must be taken into account when working conjointly with patients to develop self- management plans.