There is a wide variation in patient and family response to non-insulin dependent diabetes mellitus (NIDDM), both within and among ethnic groups, with subsequent variation in self care behavior and disease management over time. The investigators propose to add groups of African-Americans and Chinese Americans with NIDDM to a separately funded, parallel, longitudinal study of Hispanics and non-Hispanic whites with NIDDM, so that they can compare a comprehensive, integrated model of diabetes outcomes (behavioral and biologic) among the four largest ethnic groups with NIDDM who present for care in California. Using the family as an underlying framework, they propose to: (1) test and compare across ethnic groups an integrated model of predictors of diabetes outcomes, composed of the direct and interactive effects of three groups of variables--patient health beliefs and traits, provider beliefs and practice style, and family qualities and characteristics; (2) to use important summary composites from these groups of variables to establish an empirically-based typology of patient/family functioning in relation to diabetes management for African-Americans and Chinese-Americans; and (3) explain the links between the types of patient/family contexts and diabetes outcomes by ethnographic/ interpretive methods for these two additional ethnic groups. The proposed project broadens the perspective of diabetes research by: addressing ethnicity as a major area of study; including patient, family and provider characteristics in the same analysis; and utilizing both quantitative and qualitative methods of assessment. Furthermore, the resulting clinical typology will provide patient/family/ethnic profiling for use in studies to prevent the onset of NIDDM and to reduce complications in patients already diagnosed with NIDDM.
