Barriers to Achieving Optimal Glycemic Control in a Multi-Ethnic Society: A US Focus

Abstract

The increasing prevalence of diabetes is particularly apparent in certain ethnic groups, such as African and Hispanic Americans. These groups generally also have poorer glycemic control and outcomes. To better understand the issues surrounding these problems and possible methods to overcome them we performed a literature review from the past 15 years on barriers to glycemic control with a focus on US data. The literature reveals that barriers may be inherent (eg, genetic, cultural, and language/communication) or acquired (eg, those associated with changes in lifestyle and socioeconomic factors). Healthcare interventions that take into consideration cultural and population-specific characteristics can reduce the prevalence and severity of diabetes and its resulting complications. Implementing such strategies will require suitable education for patients and providers, the availability of culturally-sensitive, patient-centered healthcare teams, the creation of collaborative relationships between providers and patients, better use of community resources, and assistance for patients to make informed decisions about available treatment options. There is also evidence suggesting that at the same level of glucose control Hispanics and African Americans have the same degree of complications as whites; therefore, good control is essential for the future well-being of all patients. Addressing these issues may help to decrease the ethnic disparities that currently exist in diabetes care.

Diabetes Knowledge, Attitudes and Behaviors Among Somali and Latino Immigrants

“…Those who reported barriers in self-monitoring of blood glucose identified forgetfulness, lack of testing supplies, inability to do it independently, and pain associated with the testing, as barriers. These barriers are similar to those identified by our referent Latino group, and other non-immigrant patients [58,59]. Notwithstanding that the two groups who participated in this study arrived from different continents with very different linguistic and cultural experiences, their knowledge, attitudes, perceptions and behavior related to diabetes were very similar.…”

“…Notwithstanding that the two groups who participated in this study arrived from different continents with very different linguistic and cultural experiences, their knowledge, attitudes, perceptions and behavior related to diabetes were very similar. While certain experiences of people living with diabetes in the U.S. may be universal [58], participants in this study share a common lived experience of low socio-economic position, immigration and limited English proficiency. The systemic barriers associated with these shared circumstances likely supersede cultural contributions to health behaviors in these populations [31].…”

Chronic kidney disease (CKD) treatment burden among low-income primary care patients

“…16 These social determinants of health have a deleterious impact on an individual’s ability to manage a chronic illness that requires consistent self-monitoring, adherence to regular medical care, and dietary and lifestyle changes. 17–21 …”

Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system

“…1–3 According to a 2004–2006 national survey, the age-adjusted prevalence of diabetes was 11.8% among non-Hispanic blacks and 10.4% among Latinos/Hispanic Americans compared to 6.6% for non-Hispanic whites. 4 …”