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DIABETES

Ethnic Disparities: Control of Glycemia, Blood Pressure, and LDL Cholesterol Among US Adults with Type 2 Diabetes

Associate Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC

Ronny A Bell, PhD

Associate Professor, Department of Public Health Sciences, Wake Forest University School of Medicine

Alain G Bertoni, MD MPH

Assistant Professor, Department of Public Health Sciences and Internal Medicine, Wake Forest University School of Medicine

Thomas A Arcury, PhD

Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine

Sara A Quandt, PhD

Professor, Department of Public Health Sciences, Wake Forest University School of Medicine

David C Goff Jr., MD PhD

Professor, Wake Forest University School of Medicine

K M Venkat Narayan, MD MPH MBA

Acting Chief, Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA

Reprints: Dr. Kirk, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, fax 336/716-9126, jkirk{at}wfubmc.edu

OBJECTIVE: To examine ethnic disparities in the quality of diabetes care among adults with diabetes in the US through a systematic qualitative review.

DATA SOURCES: Material published in the English language was searched from 1993 through June 2003 using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center.

STUDY SELECTION AND DATA EXTRACTION: Studies of patients with diabetes in which at least 50% of study participants were ethnic minorities and studies that made ethnic group comparisons were eligible. Research on individuals having prediabetes, those <18 years of age, or women with gestational diabetes were excluded. Reviewers used a reproducible search strategy. A standardized abstraction and grading of articles for publication source and content were used. Data on glycemia, blood pressure, and low-density lipoprotein cholesterol (LDL-C) were extracted in patients with diabetes. A total of 390 studies were reviewed, with 78 meeting inclusion criteria.

DATA SYNTHESIS: Ethnic minorities had poorer outcomes of care than non-Hispanic whites. These disparities were most pronounced for glycemic control and least evident for LDL-C control. Most studies showed blood pressure to be poorly controlled among ethnic minorities.

CONCLUSIONS: Control of risk factors for diabetes (glycemia, blood pressure, LDL-C) is challenging and requires routine assessment. These findings indicate that additional efforts are needed to promote diabetes quality of care among minority populations.

Key Words: diabetes, ethnicity, quality-of-care measures

Published Online, August 2, 2005. www.theannals.com, DOI 10.1345/aph.1E685

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