Older blacks, Latinos still lag behind whites
in controlling blood sugar
Despite decades of advances in diabetes care, blacks and Latinos are still far less likely than whites to have their blood sugar under control, even with the help of medication, a new nationally representative study finds. That puts them at a higher risk of blindness, heart attack, kidney failure, foot amputation and other long-term diabetes complications.
The comprehensive study of middle-aged and older adults, published in the Archives of Internal Medicine, was performed by a team from the University and the VA Ann Arbor Healthcare System.
It is based on recent data from the Health and Retirement Study, a decades-long effort to assess the health of adults over age 50 through regular completion of intensive questionnaires and health examinations.
"The ability to obtain such an important clinical marker on a large national sample is a major step forward in using population surveys to understand health disparities in the older population," says David Weir, director of the study and a research professor at the Institute for Social Research.
The study documents the persistence of strong racial and ethnic disparities in diabetes control that contribute to the much greater impact of diabetes on adult blacks and Latinos. The results suggest that diabetes will continue to disproportionately kill and disable these two ethnic groups for decades to come.
Most notably, two factors were found to account for a sizable portion of the racial and ethnic difference in glucose control: how well patients persist in taking their diabetes medicines regularly and how they respond emotionally to their diagnosis. Medication adherence was a strong factor among black respondents, and Latinos reported much higher levels of distress related to their diabetes than other groups.
"While we were taken aback to see that diabetes control still varies so much by race and ethnicity, we're encouraged that two of the crucial factors are modifiable," says Dr. Michele Heisler, assistant professor of internal medicine and a research scientist at the VA Ann Arbor's Center for Clinical Practice Management Research. "To improve diabetes outcomes, we must do better at supporting all patients in managing their disease through treatment and lifestyle change."
Differences in income and education level two factors long hypothesized as key determinants of worse diabetes outcomes did not explain the glucose control differences, researchers found.
"Medication adherence was one of the strongest predictors of glucose control across the board," Heisler says. "By targeting barriers to medication adherence such as patient-doctor communication about medications, patient trust in health systems, patient confidence that medication actually helps, cost barriers, and other barriers that African-Americans disproportionately face we can make a difference."
In addition to Heisler and Weir, the study is co-authored by U-M and VA researchers Jessica Faul, Dr. Rodney Hayward, Dr. Kenneth Langa and Dr. Caroline Blaum.