Older Blacks and Latinos Still Lag Whites in Controlling Diabetes

Despite decades of advances in diabetes care, African Americans and Latinos are still far less likely than whites to have their blood sugar under control, even with the help of medications, a new nationally representative study finds. That puts them at a much higher risk of blindness, heart attack, kidney failure, foot amputation and other long-term diabetes complications.

The comprehensive new national study of middle-aged and older adults, published in the Sept. 24 issue of the Archives of Internal Medicine, was performed by a team from the University of Michigan and the VA Ann Arbor Healthcare System.

The study documents the persistence of strong racial and ethnic disparities in diabetes control, which have been observed for decades and contribute to the much greater impact of diabetes on those two ethnic groups. The results suggest that diabetes will continue to kill and disable black and Latino adults disproportionately for decades to come.

But the study delves deeper into the reasons behind this difference in blood sugar levels, using complex statistical analysis to find factors that do - and don’t - play a role. For instance, diabetes control was worse among black and Latinos under age 65.

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 having diabetes. Fortunately, these factors are likely to change in response to specific outreach efforts — including some now underway by the U-M researchers. The study also hints that more factors are at work.

“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 Michele Heisler, M.D., MPA, an assistant professor of Internal Medicine at the U-M Medical School 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. But we need to tailor specific interventions to address the barriers to achieving good diabetes control that African American and Latino adults with diabetes disproportionately face.”

The study is based on very recent data from the Health and Retirement Study, a decades-long national effort to assess the health of adults over age 50 through regular completion of intensive questionnaires and health examinations.

Funded by the National Institute on Aging, and based at the U-M Institute for Social Research, the HRS began assessing the blood sugar levels of participants in 2003. In the older age groups where Type II diabetes is mostly found, the new study is larger than the other major source of population-wide data on this issue, the National Health and Nutrition Examination Survey (NHANES) run by the Centers for Disease Control and Prevention.