Abstract
Racial and ethnic minorities in the US have a higher prevalence, as well as suffer from more complications, lower quality care, and poorer outcomes for diabetes than their counterparts. Given the US health care system is in the midst of drastic transformation, with the passage of health care reform, and efforts in payment reform, and value-based purchasing, there is now support to provide more intensive, team-based care for those conditions that are complex, costly, and highly prevalent. Addressing and improving diabetes disparities, given they are prevalent and costly, will be an important area of focus in the years to come. The latest research demonstrates that community-based efforts, multifactorial approaches, and the deployment of health information technology can be successful in addressing diabetes disparities, and require support, attention, resources, and continued evaluation. Ultimately, these efforts should improve the quality of care for all persons with diabetes, especially those who are most vulnerable.
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Centers for Disease Control and Prevention. Diabetes Report Card. 2012.
Centers for Disease Control and Prevention. National Diabetes Fact Sheet. 2011.
Centers for Disease Control and Prevention. Diabetes Data Trends.
Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med. 1996;125(3):221–32. Lustman PJ, Anderson RJ, Freedland KE, et al. Depression and poor glycemic control:a meta-analytic review of the literature. Diabetes Care. 2000;23(7):934–42.
Lanting LC, Joung IM, Mackenbach JP, et al. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care. 2005;28:2280–8.
Harris MI, Eastman RC, Cowie CC, et al. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999;22:403–8.
Emanuele N, Sacks J, Klein R, et al. Ethnicity, race, and baseline retinopathy correlates in the veterans affairs diabetes trial. Diabetes Care. 2005;28:1954–8.
Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(5 Suppl):101S–56S.
Antonovsky A. Social class and the major cardiovascular diseases. J Chronic Dis. 1968;21:65–106.
Hinkle Jr LE. Whitney LH, Lehman EW, et al. Occupation, education, and coronary heart disease. Risk is influenced more by education and background than by occupational experiences, in the Bell System. Science. 1968;161:238–46.
Byrd WM. Race, biology, and health care: reassessing a relationship. J Health Care Poor Underserved. 1990;1:278–96.
Pincus T, Callahan LF. What explains the association between socioeconomic status and health: primarily medical access or mind-body variables? Advances. 1995;11:4–36.
Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socioeconomic status, stress and discrimination. J Health Psych. 1997;2:335–51.
Pincus T, Esther R, DeWalt DA, Callahan LF. Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med. 1998;129:406–11.
Flores G, Fuentes-Afflick E, Barbot O, et al. The health of Latino children: urgent priorities, unanswered questions, and a research agenda. JAMA. 2002;288:82–90.
Health Care Rx Access for All. Barriers to health care for racial and ethnic minorities: access, workforce diversity and cultural competence. A report prepared by the Department of Health and Human Services and The Health Resources and Services Administration for the Town Hall meeting on the Physician’s Initiative on race. Boston, MA. July, 1998.
Andrulis DP. Access to care is the centerpiece in the elimination of socioeconomic disparities in health. Ann Intern Med. 1998;129(5):412–6.
Medicine AC. o. P.-A. S. o. I. No health insurance? It’s enough to make you sick. 2000.
Boltri JM, Okosun IS, Davis-Smith M, Vogel RL. Hemoglobin A1c levels in diagnosed and undiagnosed Black, Hispanic, and persons with diabetes: results from NHANES 1999–2000. Ethn Dis. 2005;15:562–7.
Correa-de-Araujo R, McDermott K, Moy E. Gender differences across racial and ethnic groups in the quality of care for diabetes. Womens Health Issues. 2006;16:56–65.
Mainous 3rd AG, Diaz VA, Saxena S, Geesey ME. Heterogeneity in management of diabetes mellitus among Latino ethnic subgroups in the United States. J Am Board Fam Med. 2007;20:598–605.
Centers for Disease Control and Prevention. Racial disparities in diabetes mortality among persons aged 1–19 years–United States, 1979–2004. Morb Mortal Wkly Rep. 2007;56:1184–7.
Saydah S, Cowie C, Eberhardt MS, et al. Race and ethnic differences in glycemic control among adults with diagnosed diabetes in the United States. Ethn Dis. 2007;17:529–35.
Gary TL, McGuire M, McCauley J, Brancati FL. Racial comparisons of health care and glycemic control for African American and diabetic adults in an urban managed care organization. Dis Manag. 2004;7:25–34.
Heisler M, Faul JD, Hayward RA, et al. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med. 2007;167:1853–60.
Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. 2008.
Two Feathers J, Kieffer EC, Palmisano G, et al. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Am J Public Health. 2005;95:1552–60.
Gary TL, Batts-Turner M, Bone LR, et al. A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes. Control Clin Trials. 2004;25:53–66.
Thompson JR, Horton C, Flores C. Advancing diabetes self-management in the Mexican American population: a community health worker model in a primary care setting. Diabetes Educ. 2007;33 Suppl 6:159S–65S.
McCloskey J. Promotores as partners in a community-based diabetes intervention program targeting Hispanics. Fam Commun Health. 2009;32:48–57.
• Long JA, Jahnle EC, Richardson DM, et al. Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Ann Intern Med. 2012;156:416–24. This article describes the use of peer mentors and financial incentives, separately, in helping improve glycemic control. The 2 interventions demonstrated that peer mentoring has a positive effect in reducing hemoglobin A1c levels, whereas financial incentives do not.
Joshu CE, Rangel L, Garcia O, et al. Integration of a promotora-led self-management program into a system of care. Diabetes Educ. 2007;33 Suppl 6:151S–8S.
• Spencer MS, Rosland AM, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101:2253–60. This article describes the use of a community health worker in providing multiple culturally appropriate services (including education and monitoring) to help improve patient behaviors and consequently improve glycemic control.
Philis-Tsimikas A, Walker C. Improved care for diabetes in underserved populations. J Ambul Care Manag. 2001;24:39–43.
Davidson MB. Effect of nurse-directed diabetes care in a minority population. Diabetes Care. 2003;26:2281–7.
Fanning EL, Selwyn BJ, Larme AC, DeFronzo RA. Improving efficacy of diabetes management using treatment algorithms in a mainly Hispanic population. Diabetes Care. 2004;27:1638–46.
• Peek ME, Wilkes AE, Roberson TS, et al. Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes. Health Aff (Millwood). 2012;31:177–86. This article describes an intervention that combines elements of institutional health system change, patient education, provider training, and community involvement in a multi-pronged approach to improve diabetes care/control in an African American population.
Davidson MB, Blanco-Castellanos M, Duran P. Integrating nurse-directed diabetes management into a primary care setting. Am J Manag Care. 2010;16:652–6.
Hayrinen K, Saranto K, Nykanen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform. 2008;77:291–304.
Jaana M, Pare G. Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract. 2007;13:242–53.
Mathur A, Kvedar JC, Watson AJ. Connected health: a new framework for evaluation of communication technology use in care improvement strategies for type 2 diabetes. Curr Diabetes Rev. 2007;3:229–34.
Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15:231–40.
Wireless substitution. Early release of estimates based on data from the National Health Interview Survey, July-December 2006. National Center for Health Statistics; 2009. http://www.cdc.gov/nchs/nhis.htm. Accessed February 19, 2010.
Baig AA, Wilkes AE, Davis AM, et al. The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients. Med Care Res Rev. 2010;67(5 Suppl):163S–97S.
Patient Protection and Affordable Care Act §3022 and §10307, Pub L No. 111–148, 124 Stat 119.
•• Carter EL, Nunlee-Bland G, Callender C, Carter EL, Nunlee-Bland G, Callender C. A patient-centric, provider-assisted diabetes telehealth self-management intervention for urban minorities. Perspect Health Inf Manag. 2011;8:1–9. This article describes the use of an online diabetes self-management program in effectively lowering hemoglobin A1c in an African American population..
Social Security Act §1848(o)(1)(A)(i) [42 U.S.C. §1395w–4 et seq. (as added by ARRA §4101(a))].
The American Recovery and Reinvestment Act (ARRA). P.L.111–5, 123 Stat. 115 (2009).
Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009;360:1477–9.
Medicare and Medicaid programs. Electronic health record incentive program. Final rule. Fed Regist. 2010;75:44313–588.
Lopez L, Green AR, Tan-McGrory A, et al. Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities. J Comm J Qual Patient Saf. 2011;37:437–45.
VanLare JM, Conway PH. Value-based purchasing–national programs to move from volume to value. N Engl J Med. 2012;367:292–5.
Thorpe KE. Analysis & commentary: the Affordable Care Act lays the groundwork for a national diabetes prevention and treatment strategy. Health Aff (Millwood). 2012;31:61–6.
Green AR, Tan-McGrory A, Cervantes M, et al. Leveraging quality improvement to achieve equity in health care. J Comm J Qual Patient Saf. 2010;36:435–42.
McPheeters ML, Kripalani S, Peterson NB, et al. Quality improvement interventions to address health disparities. Closing the quality gap: revisiting the state of the science. Evidence Report No. 208. (Prepared by the Vanderbilt University Evidence-based Practice Center under Contract No. 290-2007-10065.) AHRQ Publication No. 12-E009-EF. Rockville, MD: Agency for Healthcare Research and Quality. August 2012. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.
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Betancourt, J.R., Duong, J.V. & Bondaryk, M.R. Strategies to Reduce Diabetes Disparities: An Update. Curr Diab Rep 12, 762–768 (2012). https://doi.org/10.1007/s11892-012-0324-1
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DOI: https://doi.org/10.1007/s11892-012-0324-1