Sept. 24, 2007 -- Why is diabetes worse for African-Americans and Latinos than it is for white Americans? A new study offers answers -- but raises more questions.
University of Michigan researcher Michele Heisler, MD, MPA, and colleagues sent detailed questionnaires -- and home blood-sugar-control test kits -- to 1,901 African-American, Latino, and white diabetes patients aged 55 or older.
The blood tests confirmed what previous studies have shown: average hemoglobin A1cvalues (a measure of blood sugar control in diabetes) are much higher for African-American and Latino patients than for white patients. This disparity holds up even when researchers compare people with the same incomes and with the same access to health care.
Elevated hemoglobin A1c is a sign of poorly controlled diabetes.
Heisler and colleagues asked a lot of questions previous researchers had not. They probed the patients' emotional responses to having diabetes. They asked about all sorts of things that might affect how well the patients were able to control their blood sugar.
The bottom line:
- African-American patients are less likely than white patients to take diabetes medications as prescribed.
- Latino patients are more likely than white patients to experience diabetes-specific emotional distress.
- Socioeconomic, clinical, health care, and self-management issues account for 14% of the difference in blood-sugar control between African-Americans and white Americans.
- These factors account for 19% of the difference in blood-sugar control between Latino and white Americans.
- Overall, these factors fail to account for nearly 80% of the diabetes disparity between white and minority Americans.
Heisler says the findings give doctors something to focus on.
"While we were taken aback to see that diabetes control still varies so much by race and ethnicity, we're encouraged that two of the crucial factors are modifiable," Heisler says in a news release. "We need to tailor specific interventions to address the barriers to achieving good diabetes control that African American and Latino adults with diabetes disproportionately face."
The researchers now have turned their attention to two new studies. One is testing whether nurse-led group sessions can help patients break down their long-term diabetes goals into concrete, day-to-day steps. This study also pairs patients with a "diabetes buddy" to provide mutual coaching and support during weekly phone calls.
The second study is training Veterans Administration pharmacists to reach out to diabetes patients who are having trouble refilling their diabetes prescriptions.
The Heisler study appears in the Sept. 24 issue of Archives of Internal Medicine.