There is strong evidence that race/ethnicity and social determinants of health significantly impact outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships/associations will improve development of cost-effective, culturally tailored programs for patients with diabetes. This article reviews the current state of the literature on the impact of race/ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. The literature review shows that racial/ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure, and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support, and perceived stress, show consistent associations with self-care, quality of life, and glycemic control. Neighborhood factors, such as food insecurity, social cohesion, and neighborhood aesthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life. Health care professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined impact of race/ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high.

No abstract

Background The aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling. Methods 615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control. Results The final model (chi2(903) = 24088.91, p<0.0001, R2 = 0.93, RMSEA=0.05 and CFI=0.90) showed that higher diabetes distress was directly significantly related to a decreased self-care (r= −0.69, p<0.001) and increased HbA1c (r= 0.69, p<0.001). There was no significant direct association between depressive symptoms or fatalism, and glycemic control or self-care. There was, however, an indirect association between increased depressive symptoms and increased fatalism, explained through the direct association with diabetes distress in that higher depressive symptoms (0.76, p<0.001) and higher fatalism (0.11, p<0.001) were significantly associated with higher diabetes distress. Conclusion Diabetes distress serves as a pathway through which depressive symptoms and fatalism impact both glycemic control and self-care. In addition, pathways between diabetes distress and both self-care behaviors and glycemic control in patients with type 2 diabetes remained separate, suggesting the need to address both psychological and behavioral factors in standard diabetes care, rather than focusing on psychological care primarily through support for self-management and treatment of depression.

For decades, disparities in health have been well documented in the United States and regrettably, remain prevalent despite evidence and appeals for their elimination. Compared to the majority, racial and ethnic minorities continue to have poorer health status and health outcomes for most chronic conditions including diabetes, cardiovascular disease, cancer, and end-stage renal disease. Many factors, such as affordability, access, and diversity in the healthcare system, influence care and outcomes, creating challenges that make the task of eliminating health disparities and achieving health equity daunting and elusive. Novel strategies are needed to bring about much needed change in the complex and evolving United States health care system. Although not exhaustive, opportunities such as 1) developing standardized race measurements across health systems, 2) implementing effective interventions, 3) improving workforce diversity, 4) utilizing technological advances, and 5) adopting practices such as personalized medicine may serve as appropriate starting points for moving towards health equity. Over the past several decades, diversity in the U.S. population has increased significantly and is expected to increase exponentially in the near future. As the population becomes more diverse, it is important to recognize the possibilities of new and emerging disparities. It is imperative that steps are taken to eliminate the current gap in care and prevent new disparities from developing. Therefore, we present challenges and offer recommendations for facilitating the process of eliminating health disparities and achieving health equity across diverse populations.

Background: More than half of the U.S. population has experienced Adverse Childhood Experiences (ACE), which are linked to physical and mental health issues. This study examines the relationship between ACEs and life satisfaction, psychological well-being, and social wellbeing. Methods: Data of 6323 participants from three waves of the Midlife Development in the United States (MIDUS) (1995-1996, 2004-2006, and 2011-2014) were used. Repeated measures models were used to test the associations between ACEs and all three psychosocial scales. Generalized estimating equations (GEE) were used to account for multiple survey measures. Adjusting for demographics and survey wave, GEE models were run for each ACE construct. Results: After controlling for demographic covariables, those reporting an ACE had significantly lower levels of life satisfaction (β=−0.20, 95% CI −0.26-−0.15) compared to those without an ACE. Those reporting higher ACE counts were associated with lower life satisfaction compared to those with no ACE (β=−0.38, 95% CI −0.56-−0.20; β=−0.36, 95% CI −0.46-−0.27; and β= −0.13, 95% CI −0.19-−0.08 for ACE counts of 3, 2, and 1, respectively). Abuse (β=−0.41, 95% CI −0.48-−0.33) and household dysfunction (β=−0.18, 95% CI −0.25-−0.10) were associated with significantly lower life satisfaction. Overall, those exposed to ACEs had significantly lower sense of social well-being.