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Low-income Hispanic patients less likely to monitor blood glucose
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Compared with whites, black and Hispanic adults with insulin-treated diabetes are less likely to self-monitor their blood glucose, and the problem is worse among Hispanics with low incomes, according to data presented at the American Heart Association’s 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.
Deborah A. Levine, MD, MPH, assistant professor at Ohio State University’s College of Medicine, and her colleagues at the University of Alabama at Birmingham analyzed self-monitoring of blood glucose (one or more times daily) in 16,630 adults with insulin-treated diabetes aged >19 years by race/ethnicity and income.
Compared with those reporting a higher income, those reporting an income <$20,000 were more likely to be 65 years of age, women, less educated or uninsured, according to the data. At incomes ≥$20,000, fewer Hispanics (78%) and blacks (77%) reported daily self-monitoring of blood glucose than whites (85%) (P<.001). However, among those with income <$20,000, rate of daily self-monitoring of blood glucose decreased for Hispanics (65%), but did not change for blacks or whites.
In the study, receipt of diabetes education and diabetes-related provider visits were both independently associated with performing self-monitoring of blood glucose in both income groups.
"Clinicians should ensure that all adults with insulin-treated diabetes, particularly Hispanic, black and low-income adults, receive high-quality, culturally appropriate diabetes education and have diabetes-related provider visits each year," Levine told Endocrine Today.
In the <$20,000 income group only, receipt of diabetes education varied by race/ethnicity: Hispanics 49%, blacks 64%, whites 62% (P<.001).
"Poverty significantly worsened disparities in self-monitoring of blood glucose and receipt of diabetes education among the Hispanic but not the black or white populations. Strategies to improve self-monitoring of blood glucose education and resources for low-income Hispanics with diabetes likely will reduce this ethnic disparity," Levine said. – by Stacey L. Adams
For more information:
- Levine DA, Allison JJ, Cherrington A, et al. #P289. Presented at: American Heart Association’s 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention; March 11-15, 2008; Colorado Springs.
As a practicing endocrinologist with patients across a broad socio-economic spectrum, this result is not surprising to me. It is hard to disagree with the authors’ conclusion that strategies to improve self-monitoring of blood glucose education and resources for any low-income or under-insured population with diabetes would likely reduce disparity. However, I also think that race and income level represent surrogate markers for other barriers to not only the health care system, but also to self-care; these may be social, economic and behavioral.
It is not uncommon for people in the low-income range to work more hours because of lower wage rates, to work in settings which are unsympathetic to diabetes self-care measures or, indeed, for people to feel the need to hide their disease status for fear of losing their jobs. Low socio-economic status can be a consequence of undiagnosed mental illness. Inadequate services in the individual's own language can represent an additional barrier to care for foreign language speakers in some parts of the country. All of these may be contributors to the findings in this study. It would be important to know more about the population studied, and it would not be surprising to see regional variation, were this study to be replicated in different parts of the country.
– Robert Cohen, MD
Associate Professor of Medicine
University of
Cincinnati College of Medicine