Date of Award

Summer 8-23-2025

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Food Science

First Advisor

Simone Camel

Abstract

Diabetes mellitus (DM) is a metabolic disease that affects 14.7% of adults in the United States (Centers for Disease Control and Prevention, 2023). Prevalence of diabetes increases with age, with rates for adults aged 65 and older reaching 29.2% (Centers for Disease Control and Prevention, 2023). Factors such as age, race, obesity, physical activity level, and genetics strongly increase the risk of developing type 2 diabetes (T2DM) (National Institute of Diabetes and Digestive and Kidney Disease, 2016). Diabetes requires complex and comprehensive management to reduce the risk of developing comorbidities (Al-Shabeeb et al., 2021). Factors such as education, familial support, socioeconomic status, attitude, and knowledge regarding the disease impact management ability (Duke et al., 2008; Borba et al., 2019). An inability to master diabetes management can lead to distress and burnout, causing an individual to neglect diabetes self-care behaviors (Jafari et al., 2024). As individuals age and become more familiar with their disease, standardized education techniques may not be as effective, especially if individuals are facing burnout. Interventions from Registered Dietitian Nutritionists (RDNs) and other diabetes healthcare professionals can alleviate the stress of diabetes management by improving diabetes health literacy (DHL) and self-efficacy and by providing needed support to individuals (Dobrow et al., 2017; Jafari et al., 2024; Marinic et al., 2017; Sbroma et al., 2017; Warner et al., 2018). While previous studies have examined the impact of other barriers on effective diabetes management, the influence of time since diagnosis on diabetes management has not been closely researched (Borba et al., 2019). This study aimed to assess the correlation between the duration of diabetes and self-management scores and HbA1c levels in adults diagnosed with diabetes. This study also aimed to determine the impact of RDN education interventions on self-management level and HbA1c levels. Respondents were recruited through social media and flyers that contained a link to an online survey. Flyers were advertised in primary care and diabetes specialist offices, community health centers, diabetes support group locations, free medical clinics, and diabetes outpatient facilities. Data collection lasted approximately four weeks. There were 238 respondents to the survey, and 216 responses were analyzed. Fifty-six percent of respondents were female, and 61.6% of respondents were white. Ninety-two percent of respondents were insured at the time of data collection, and 88.4% of respondents had health insurance coverage at the time of their diagnosis. Self-management level was determined using the Diabetes Self-Management Questionnaire (DSMQ-R). Participants’ responses were scored from 0 to 10 using the scoring guide. Respondents self-reported their most recent HbA1c level. Respondents were also asked if they had ever received education from an RDN, where they received the education, and how many times they received education. A Pearson’s correlation test was used to determine the correlations between the DSMQ-R score and continuous variables. The DSMQ-R total 20-item score was not correlated with years since diagnosis in this sample. Respondents with a higher total score on the DSMQ-R tool were more likely to be using intensive insulin therapy (r = -.198, p < .05). Age and years since diabetes diagnosis were positively correlated (r = .306, p = < .05). The average HbA1c level was 6.77% (SD = 1.10), with 64.8% of HbA1c responses being taken within the last three months. Sixty-five percent of respondents reported using intensive insulin therapy, while 33.8% reported using non-intensive insulin therapy. The average amount of RDN education sessions was 3.21 (SD = 2.68). The average DSMQ-R20 score was 4.60. Respondents were also mostly satisfied with their ability to afford and obtain prescribed diabetes medications (afford: M = 7.08, SD = 1.68; obtain: M = 7.22; SD = 1.71). When asked how they felt about managing their diabetes on a daily basis, 48.1% of respondents reported that they understand the need, but it can be challenging. A regression analysis was conducted to determine if variables could statistically significantly predict the DSMQ-R20 score. Age, cooperation with the diabetes team subscale, and eating behavior subscale were shown to be statistically significant (p < .034, p < .001, p < .001, respectively). In contrast, years with diabetes, RDN education sessions, and the use of intensive insulin therapy were not statistically significant. Independent samples t-tests were conducted to determine if there were differences in eAG, HbA1c, DSMQ-R total scores, and DSMQ-R subscales between respondents who had been seen by an RDN and those whom an RDN had not seen. It was found that respondents whom an RDN had not seen had a slightly higher DSMQ-R27 score compared to respondents who had been seen by an RDN, which contradicts published research (M = 5.07, SD = 1.06); t(121) = -2.45, p = .016. An independent samples t-test was conducted to determine if there were differences in DSMQ-R scores and RDN education sessions between respondents with low A1c levels (≤ 6.49) and those with high A1c levels (6.5-13.0). There was a significant difference in DSMQ-R20 scores for respondents with high A1c (M = 4.54, SD = 1.19) and low A1c (M = 5.43, SD = 1.95) levels; t(58) = 2.9, p = .005. These results suggest that A1c level does impact self-management scores in individuals using non-intensive insulin therapy. There was a significant difference in the cooperation with diabetes team subscale scores for high A1c (M = 4.55, SD = 1.75) and low A1c (M = 5.56, SD = 2.29) levels; t(65) = 2.71, p = .009. Respondents with an A1c ≤ 6.49 also had statistically significant higher eating behavior subscale scores (M = 5.89, SD = 1.81); t(174) = 4.03, p = < .001. The results of this study showed that the duration of diabetes is not correlated to self-management levels and HbA1c levels in this sample. Respondents who scored higher on the eating behavior subscale were less likely to be using intensive insulin therapy. In contrast, respondents who scored higher on the DSMQ-R tool were more likely to be using intensive insulin therapy. It was shown that respondents whom an RDN had not seen had a slightly higher DSMQ-R27 score compared to respondents whom an RDN had seen in this sample. These results suggest that respondents using intensive insulin therapy whom an RDN has seen have a slightly lower self-management score. Age and duration of diabetes were positively correlated with the eating behavior subscale. Respondents who have had diabetes for longer were shown to have a higher score on the eating behavior subscale. Respondents with a low HbA1c were found to have a statistically significant higher eating behavior score than respondents with a high HbA1c. These findings support the need for diet education to improve glycemic levels.

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