Older Blacks, Latinos Struggle With Diabetes Control
THURSDAY Sept. 27, 2007 -- Black Americans and Latinos with diabetes who take drugs to control their disease are less likely to have their blood sugar under control than whites, a new study finds.
Two factors appear to account for some of this difference in blood sugar control: adherence to medications and emotional responses to having diabetes, according to the study.
"A lot of diabetes outcomes depend on what patients do in their everyday life," said lead researcher Dr. Michele Heisler, an assistant professor of internal medicine at the University of Michigan Medical School.
Taking medication regularly, eating a healthy diet and exercising, and monitoring blood sugar levels are all critical, Heisler said. "In addition, people who have higher levels of emotional stress related to diabetes fare worse," she said.
For the study, Heisler's team collected data on 1,199 people aged 55 and older with diabetes who participated in the Health and Retirement Study. These people had their blood sugar measured using the A1C test, which gives an average blood sugar level for the past three months. The recommend A1C level for people with diabetes is under 7 percent. People without diabetes usually have an A1C level less than 6 percent.
When the researchers looked at diabetics taking medications to control their blood sugar, they found a significant difference in A1C levels for whites, blacks and Latinos. Whites had an average A1C reading of 7.22 percent, but for blacks it was 8.07 percent, and for Latinos it was 8.14 percent.
There was an even larger difference among the 286 people between 55 and 64 years old, making them too young for Medicare eligibility. The average A1C reading for whites was 7.46 percent, for blacks it was 8.96 percent and for Latinos it was 8.91 percent. There was less of a difference in A1C levels among those over 65, the researchers noted.
Heisler noted that these disparities are consistent with Medicare eligibility. "It appears that Medicare is working, it is making a difference," she said.
When the researchers looked at factors that contribute to good blood sugar control, the usual indicators -- such as education, income and access to health care -- didn't play a significant role, Heisler said.
One finding was particularly significant, Heisler said. "African-Americans reported that they didn't take their medications as prescribed," she said. "Medication adherence was one of the most important predictors of blood sugar control."
Heisler looks at this as an encouraging finding, because it's something that can be changed. "We have to do a better job with African-Americans to explain medications and why they are important," she said.
Diabetes-related distress was also an important contributor to poor blood sugar control, particularly among Latinos, Heisler said. "Latinos reported much higher levels of distress related to diabetes than whites," she said. "In general, we need to focus more on helping patients self-manage their diabetes."
Yet these factors, while significant, only explain about one-fifth of the disparity between whites and blacks and Latinos, Heisler said. Other factors could include the quality of health care, medication doses and environmental factors and overall stress, she said.
The findings were published in the Sept. 24 issue of the Archives of Internal Medicine.
Dr. Larry Deeb, president for medicine and science at the American Diabetes Association, thinks doctors need to be more aggressive in treating diabetes among blacks and Latinos.
Based on A1C levels, blacks and Latinos are at significantly greater risk than whites for the complications of diabetes, Deeb said. Those complications include blindness, heart attack, kidney failure and foot amputations. "But we don't have good answers as to why these disparities exist," he said.
Deeb said there could be bias among doctors when they treat blacks and Latinos. "Doctors need to know that people of color tend to have a higher A1C," he said. "It has to be explained. But don't try to explain it away with socioeconomics, don't try to explain it away based on self-management stuff.
"Explain it away by asking yourself, as a doctor: 'Is there something I can do to better control diabetes?'" he said.
For more on diabetes, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
Posted: September 2007
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