Journal of General Internal Medicine

, Volume 28, Issue 10, pp 1340–1349 | Cite as

Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project

  • Sherrie H. Kaplan
  • John Billimek
  • Dara H. Sorkin
  • Quyen Ngo-Metzger
  • Sheldon Greenfield
Original Research



Despite numerous efforts to change healthcare delivery, the profile of disparities in diabetes care and outcomes has not changed substantially over the past decade.


To understand potential contributors to disparities in diabetes care and glycemic control.


Cross sectional analysis.


Seven outpatient clinics affiliated with an academic medical center.


Adult patients with type 2 diabetes who were Mexican American, Vietnamese American or non-Hispanic white (n = 1,484).


Glycemic control was measured as hemoglobin A1c (HbA1c) level. Patient, provider and system characteristics included demographic characteristics; access to care; quality of process of care including clinical inertia; quality of interpersonal care; illness burden; mastery (diabetes management confidence, passivity); and adherence to treatment.


Unadjusted HbA1c values were significantly higher for Mexican American patients (n = 782) (mean = 8.3 % [SD:2.1]) compared with non-Hispanic whites (n = 389) (mean = 7.1 % [SD:1.4]). There were no significant differences in HbA1c values between Vietnamese American and non-Hispanic white patients. There were no statistically significant group differences in glycemic control after adjustment for multiple measures of access, and quality of process and interpersonal care. Disease management mastery and adherence to treatment were related to glycemic control for all patients, independent of race/ethnicity.


Generalizability to other minorities or to patients with poorer access to care may be limited.


The complex interplay among patient, physician and system characteristics contributed to disparities in HbA1c between Mexican American and non-Hispanic white patients. In contrast, Vietnamese American patients achieved HbA1c levels comparable to non-Hispanic whites and adjustment for numerous characteristics failed to identify confounders that could have masked disparities in this subgroup. Disease management mastery appeared to be an important contributor to glycemic control for all patient subgroups.


Glycemic Control Diabetes Care Diabetes Registry Illness Burden Interpersonal Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.




This work was supported by The Robert Wood Johnson Foundation (Grants # 1051084 and #59758), Princeton, New Jersey, The NovoNordisk Foundation, Corporate Diabetes Programmes, Novo Nordisk, Bagsvaerd, Denmark, and the National Institute of Diabetes, Digestive and Kidney Diseases (R18DK69846 and K01DK078939), Building 31. Rm 9A06, 31 Center Drive, MSC 2560 Bethesda, MD 20892–2560, USA.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Sherrie H. Kaplan
    • 1
  • John Billimek
    • 1
  • Dara H. Sorkin
    • 1
  • Quyen Ngo-Metzger
    • 1
  • Sheldon Greenfield
    • 1
  1. 1.Health Policy Research Institute and Department of Medicine, School of MedicineUniversity of California, IrvineIrvineUSA

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