Race and ethnic differences in glycemic control among adults with diagnosed diabetes in the United States

National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD 20782, USA.
Ethnicity & disease (Impact Factor: 0.92). 01/2007; 17(3):529-35.
Source: PubMed

ABSTRACT Control of blood glucose levels reduces vascular complications among people with diabetes, but less than half of the adults with diabetes in the United States are achieving good glycemic control. This study examines 1999-2002 national data on the association between race/ethnicity and glycemic control among adults with previously diagnosed diabetes.
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002, a cross-sectional survey of a nationally representative sample of the non-institutionalized civilian US population. Participants were non-pregnant adults, 20 years or older, with a previous diagnosis of diabetes, and who had participated in both the interview and examination in NHANES 1999-2002 (N=843). Glycemic control was determined by levels of glycosylated hemoglobin (A1C). We compared glycemic control by race/ethnicity and potential confounders including measures of socioeconomic status, obesity, healthcare access and diabetes treatment.
Overall, 44% of adults with previously diagnosed diabetes had good glycemic control (A1C levels < 7%). Mexican Americans and non-Hispanic Blacks were less likely to achieve good control (35.4% and 36.9%, respectively) compared with non-Hispanic Whites (48.6%). After multivariable adjustment for measures of socioeconomic status, obesity, healthcare access and utilization and diabetes treatment, differences in glycemic control by race/ethnicity remained.
Glycemic control is low among all racial/ethnic groups, but is lower among non-Hispanic Blacks and Mexican Americans. These results provide guidance for public health workers and health professionals in targeting programs to improve glycemic control among adults with diagnosed diabetes in the United States.

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    • "Mexican-Americans in the United States bear a disproportionate burden of diabetes (Wong et al. 2002; Centers for Disease Control and Prevention 2011). They are almost twice as likely to have diabetes compared to non-Hispanic whites and less likely to achieve optimal glycemic control (National Institute of Diabetes and Digestive and Kidney Diseases 2008; Saydah et al. 2007). In managing diabetes, Latinos report barriers such as high healthcare costs, lack of health insurance, fear of deportation, lack of necessary resources to engage in appropriate lifestyle modifications, conflicting cultural norms, and language barriers (Fernandez et al. 2004; Gary et al. 2003; Cusi and Ocampo 2011). "
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    ABSTRACT: Churches provide an innovative and underutilized setting for diabetes self-management programs for Latinos. This study sought to formulate a conceptual framework for designing church-based programs that are tailored to the needs of the Latino community and that utilize church strengths and resources. To inform this model, we conducted six focus groups with mostly Mexican-American Catholic adults with diabetes and their family members (N = 37) and found that participants were interested in church-based diabetes programs that emphasized information sharing, skills building, and social networking. Our model demonstrates that many of these requested components can be integrated into the current structure and function of the church. However, additional mechanisms to facilitate access to medical care may be necessary to support community members' diabetes care.
    Journal of Religion and Health 04/2012; 53(1). DOI:10.1007/s10943-012-9601-1 · 1.02 Impact Factor
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    • "Over 7% of adults in the United States have been diagnosed with diabetes, and diabetes-related care now accounts for 11% of all U.S. health care expenditures (American Diabetes Association [ADA], 2005). Type 2 diabetes disproportionately affects African Americans, who are almost twice as likely to have the disease, are less likely to have good glycemic control, and have a higher incidence of diabetes complications when compared to Caucasian Americans (ADA, 2005; Saydah, Cowie, Eberhardt, De Rekeneire, & Narayan, 2007). Diabetes poses a particular burden for African American women over the age of 60 years, 20% of whom are diagnosed with diabetes (ADA, 2005). "
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    ABSTRACT: Type 2 diabetes affects one in five African American women older than 60 years. These women face distinct challenges in managing diabetes self-care. Therefore, tailored self-care interventions for this population need to be developed and tested. The effectiveness of a tailored, four-visit, in-home symptom-focused diabetes intervention with and without booster telephone calls was compared with an attentional control focused on skills training for weight management and diet. African American women (n = 180; >55 years old, Type 2 diabetes mellitus >1 year, HbA1c >7%) were randomly assigned to the intervention or attentional control condition. Half the intervention participants were assigned to also receive a telephone-delivered booster intervention. Participants were evaluated at baseline and 3, 6, and 9 months. : Baseline HbA1 was 8.3 in the intervention group (n = 60), 8.29 in the intervention with booster group (n = 55), and 8.44 in the attentional control condition (n = 59). HbA1c declined significantly in the whole sample (0.57%) with no differences between study arms. Participants in the booster arm decreased HbA1c by 0.76%. Symptom distress, perceived quality of life, impact of diabetes, and self-care activities also improved significantly for the whole sample with no significant differences between study arms. Parsimonious interventions of four in-person visits yielded clinically significant decreases in HbA1c. Although the weight and diet program was intended as an attentional control, the positive effects suggest it met a need in this population. Because the contents of both the intervention and the attentional control were effective despite different approaches, a revised symptom-focused intervention that incorporates weight and diet skills training may offer even better results.
    Nursing research 10/2009; 58(6):410-8. DOI:10.1097/NNR.0b013e3181bee597 · 1.50 Impact Factor
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    ABSTRACT: Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, (1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) .7%), borderline (HbA1c 7- 8.9%), and poor (HbA1c .9%) glycemic control and potentially new risk factors (e.g. work characteristics), and (2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with glycemic control; and (3) using prospective data, assess the relationship between mortality risk and glycemic control in US adults with type 2 diabetes. Data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys were used. HbA1c values were used to create dichotomous glycemic control indicators. Binary logistic regression models were used to assess relationships between risk factors, employment status and glycemic control. Multinomial logistic regression analyses were conducted to assess relationships between glycemic control and HRQOL variables. Zero-inflated Poisson regression models were used to assess relationships between missed work days and glycemic control. Cox-proportional hazard models were used to assess effects of glycemic control on mortality risk. Using STATA software, analyses were weighted to account for complex survey design and non-response. Multivariable models adjusted for socio-demographics, body mass index, among other variables. Results revealed that being a farm worker and working over 40 hours/week were risk factors for suboptimal glycemic control. Having greater days of poor mental was associated with suboptimal, borderline, and poor glycemic control. Having greater days of inactivity was associated with poor glycemic control while having greater days of poor physical health was associated with borderline glycemic control. There were no statistically significant relationships between glycemic control, self-reported general health, employment, and missed work. Finally, having an HbA1c value less than 6.5% was protective against mortality. The findings suggest that work-related factors are important in a person's ability to reach optimal diabetes management levels. Poor glycemic control appears to have significant detrimental effects on HRQOL.
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