A culturally tailored diabetes program can help Asian Americans with type 2
A culturally tailored diabetes program can help Asian Americans with type 2 diabetes achieve glycemic control that is comparable to that observed in white patients, researchers reported at the 71st Scientific Sessions of the American Diabetes Association (ADA).
The study also found that Asian Americans with diabetes who are older and have higher baseline hemoglobin (Hb)A1C values have more difficulty achieving glucose targets.
Hung Le, a summer intern at the Joslin Diabetes Center in Boston, Massachusetts, reviewed results in 327 adult type 2 patients: 109 self-identified Asian American patients seen at a clinic that is culturally tailored to Asian Americans and 218 self-identified white patients seen at the adult diabetes clinic at the same institution between January 1, 2004 and September 30, 2009.
Le pointed out:
“Ethnic disparities in diabetes control and outcome have been widely documented in the primary care setting but cannot be readily remedied by referral to subspecialists.”
To date, there is no clear-cut agreement on an effective solution for this public health issue, he said. For the Asian American population, many of whom are first- generation immigrants, previous studies have suggested that linguistic and cultural barriers and a lack of culturally appropriate educational materials are responsible for suboptimal diabetes control and quality of care.
Other studies have shown that when access to health care is readily available, social factors such as economic or educational background became more important contributors to outcomes.
In response to these challenges, some neighborhoods that are heavily populated with minority patients have introduced ethnic-specific clinics, however it is not clear whether this approach is effective or sufficient to overcome ethnic disparities in diabetes care, Le commented.
For the study, clinical data were obtained from patients’ clinical electronic medical records and socio-demographic data were obtained from 2000 census tract data.
The primary outcome was the proportion of patients reaching HbA1C ?7% after 12 months of care. The HbA1C value for the final outcome was obtained during a visit 9 to15 months after their initial visit.
Asian American and white patients were similar in initial HbA1C (8.2±0.9, 7.9±1.8%; p=0.19) and percentage of patients with HbA1C ?7% (32.1%, 34.9%; p>0.5) at baseline and after 12 months of care (48.6%, 56.0%; p>0.5).
The absolute HbA1C reduction was 0.85% in Asian Americans and 0.78% in whites (p=0.71), suggesting that a culturally tailored program can help Asian Americans achieve better glucose control.
However, when stratified according to initial HbA1C from lowest to highest quartile, 96.7, 61.9, 24.0, and 15.2% of Asian American patients and 85.2, 58.9, 37.7, and 35.4% of white patients within each quartile achieved their glucose target at 12 months, pointing to the fact that Asian American patients compared to white patients have more difficulty reaching clinical targets if they present with a higher HbA1C level.
Given these challenges, more resources are needed to develop a stratified treatment approach for patients at increased risk of treatment failure, Le said.