Healio
Healio
September 16, 2009
2 min read
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Multiple factors have led to disparities in health care for people with diabetes

Increased communication skills among minority patients are needed.

Guillermo Umpierrez, MD, urged health care professionals to look beyond blood glucose in ethnic minorities with type 2 diabetes during the Type 2 Diabetes Disparities in Ethnic Minorities meeting in New York City.

"Controlling blood glucose alone will not prevent cardiovascular complications in most of the patients with type 2 diabetes, and we must treat all comorbidities, including obesity, high blood pressure and lipids," said Umpierrez, of the department of medicine and division of endocrinology and metabolism at Emory University School of Medicine.

According to a recent CDC report, 23.6 million Americans were living with diabetes during 2007. Compared with whites (6.6%), the rate of diabetes was much higher in minority populations — 16.5% in American Indians, 11.8% in blacks, 10.4% in Hispanics and 7.5% in Asian-Americans. Nonwhites often have higher HbA1c levels, poorer blood pressure and LDL control and higher rates for end-stage renal disease.

Umpierrez said several factors have led to the diabetes epidemic in the United States, including:

  • Demographic changes (aging, increased growth of at-risk populations).
  • Behavioral elements (improper nutrition, decreasing physical activity, obesity).
  • Improved surveillance systems.
  • Limited ability to change behaviors.

"CV disease is the leading cause of mortality in patients with or without diabetes, and having diabetes multiplies the impact of CVD morbidity and mortality," he said. "In addition to improving glycemic control, physicians should make sure that BP and LDL levels are under control and that testing for the lipid profile has been ordered. Achieving a BP ,130/80 mmHg and LDL levels ,100 mg/dL appears to be equal to or more effective in reducing CV events than achieving glycemic control (HbA1C ,7%) in patients with type 2 diabetes."

The increased rate for obese and overweight minority adults and children in the United States is a major health problem, he added. NHANES III study data indicated that the proportion of overweight or obese black women was 77% vs. 57% in white women; the prevalence of overweight or obese Mexican-American men and women was approximately 73%.

Further, data from the National Longitudinal Survey of Youth indicated that the prevalence of overweight children has increased by 21.5% among blacks, 22% among Hispanics and 12% among whites. National health statistics have suggested that blacks with diabetes may receive similar access to basic medical services as their white counterparts; however, the incidence for complications and mortality from diabetes continues to increase at a rate that exceeds whites.

“The overall mortality rate is about 20% higher for black men and 40% higher for black women when compared with their white counterparts,” he said. “Minority populations are at increased risk for microvascular and macrovascular disease complications. Education is a must, especially for minority patients — there is a need for increased communication skills.” – by Jennifer Southall

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