Behavioral and psychosocial correlates of fasting blood glucose in a resource-constrained diabetes clinic in the Dominican Republic: an exploratory network analysis.

OBJECTIVE

Examine the associations between demographic, behavioral, and psychosocial characteristics and fasting blood glucose among adults with type 2 diabetes (T2D) at a regional diabetes clinic in the Dominican Republic (DR).

METHODS

This cross-sectional study enrolled 65 adults with T2D who received care from a non-profit regional diabetes clinic in the DR. Participants completed interviewer-administered questionnaires to assess sleep quality, perceived stress, diet quality, health-related quality-of-life, and physical activity (PA). Fasting blood glucose was measured using capillary testing by a clinic nurse. A complete-case network analysis was conducted to examine conditional associations among study variables.

RESULTS

Only 15 participants (23%) had fasting blood glucose within the 80-130 mg•dL-1 target range for people with T2D, with significantly higher levels among men (243 ± 93 vs. 170 ± 64 mg•dL-1, p<0.001). Participants reported poor sleep quality (98%), moderate-to-high stress (97%), and low consumption of fruits and vegetables. Although 95% of participants met or exceeded recommended PA volume, activity was primarily from occupational and household tasks performed at light-to-moderate intensity. PA was the most connected variable within the network, and was inversely related to fasting blood glucose.

CONCLUSIONS

In this resource-constrained DR clinic sample, poor fasting blood glucose coexisted with substantial sleep, stress, and diet deficiencies, despite substantial low-to-moderate-intensity PA. The network findings support diabetes self-management interventions to improve physical activity, sleep hygiene, stress reduction, and diet education, to improve glycemic control in low- and middle-income countries. Future prospective network analyses may identify context-specific behavioral targets for improving glycemic control in similar populations.