Glucose control in diabetes: the impact of racial differences on monitoring and outcomes

Abstract

Purpose Type 2 diabetes is the seventh leading cause of death in the US and is projected to increase in prevalence globally. Minorities are disproportionately affected by diabetes and data suggest that clinical outcomes consistently fall below American Diabetes Association recommendations. The purpose of this systematic review was to examine ethnic differences in self-monitoring and outcomes in adults with type 2 diabetes. Methods Medline was searched for articles published between January 1990 through January 2012 using a reproducible strategy. Inclusion criteria included: (1) published in English, (2) targeted African Americans, Hispanic or Asian adults, ages 18+ years with type 2 diabetes, (3) cross-sectional, cohort, or intervention study, and (4) measured change in glycemic control, BP, lipids, or quality of life by race. Results Twenty-two papers met the inclusion criteria and were reviewed. Overall, significant racial differences and barriers were found in published studies in diabetes management as it pertains to self-monitoring and outcomes. African Americans tend to consistently exhibit worse outcomes and control when compared to other minority populations and non-Hispanic Whites. Conclusions Significant racial differences and barriers exist in diabetes management as it pertains to self-monitoring and outcomes when compared to non-Hispanic Whites. Explanatory and intervention studies are needed to determine the mechanisms and mediators of these differences and strategies to reduce these disparities. In addition, more research is needed to investigate the impact of racial differences in self-monitoring and outcomes on quality of life.

Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes

“…(10) Despite varying research designs, sample sizes, source data, and study limitations, members within minority populations (African Americans, Hispanic, and Asian Americans) were found to have significantly higher HbA1c levels compared to non-Hispanic Whites. (10) Additionally, regardless of the study population and the measured outcome (i.e., HbA1c threshold of <7% vs. <9%), differences in glycemic control by race and ethnicity were observed, and these differences were clinically significant indicated by a difference in HbA1c by a minimum of 0.5 between groups. (10) Finally, a persistent racial gap in glycemic control between African Americans and non-Hispanic Whites was continually observed in the populations assessed during the systematic review.…”

1. Promoting Health and Reducing Disparities in Populations

“…For example, children with type 1 diabetes from racial/ethnic minority populations with lower socioeconomic status are at risk for poor metabolic control and poor emotional functioning (47). Significant racial differences and barriers exist in self-monitoring and outcomes (48).…”

Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes

“…A recent study (4) in the 26 states and District of Columbia that expanded Medicaid under the Affordable Care Act found that diabetes diagnoses increased by 23% in 2014 compared with the previous year. Hispanic individuals in the U.S. experience higher rates of type 2 diabetes and, once diagnosed, exhibit poorer glycemic control than non-Hispanic white individuals (3,5). …”