New and Unique Strategies Proposed for Older Americans with Diabetes

According to lead author Karen Fitzner, PhD, from the American Association of Diabetes Educators, diabetes rates among African-American men and women over age 65 are higher than for whites and Latinos, and although the older adult population in general is projected to have doubled in size to 71.5 million by 2030, the population of African-Americans over age 65, currently at 9%, is expected to reach 12% by 2050.

Compounding concerns about diabetes management is the fact that those who most need management and care tend to have the least access. To address the gap, some key initiatives are focusing on the use of health information technologies as well as multilevel diabetes education teams that strive to integrate the cultural values and needs of African-Americans.

Diabetes self-management education and training programs that are recognized as integral components in effective diabetes management have been central to these initiatives. Although the programs are covered by Medicare and some state Medicaid programs, health officials initially noticed relatively low turnout for management classes.

Groups including the American Association of Diabetes Educators recently stepped up efforts to expand the programs into more accessible community settings, such as churches, schools, libraries, senior centers, and other places, and the efforts have paid off with improved participation.

"Slowly, religious organizations, area agencies on aging, and other community-based entities across the country are beginning to create alliances with their respective medical communities to construct community referral networks that promote [diabetes self-management and training/education] beyond traditional medical settings," the authors write.

Healthcare officials are also increasingly turning to telemedicine as a cost-effective, nontraditional means for communicating disease management services to underserved populations. In some programs, telemedicine has allowed for home-based monitoring of blood pressure, blood glucose, and oximetry, and patients subsequently have reported improved disease understanding and satisfaction with telemedicine.

Implementation of geo-mapping is also on the rise to allow for improved identification of communities that can best benefit from such outreach strategies. The technique creates a visual picture of state or regional areas to better identify clustered concentrations of, for example, diabetes diagnoses and related chronic conditions.

Geo-mapping can include any type of demographic information, such as places where residents may have high rates of diabetes, but have limited access to fresh produce, healthcare, or safe walking paths. "The geo-mapping technique can help researchers identify areas that require specific attention because of identifiable disparities, and help policy makers identify interventions that would be most appropriate," the authors write.

They added that when implementing such strategies, researchers and healthcare providers should be diligent in tracking their data and reporting on progress in order to better identify which efforts are the most effective.

"Providers who use telehealth and other health information technologies must carefully measure and analyze their outcomes in relation to older African-Americans, and share the results," the authors said.

"Effective techniques are available to identify areas of need and should be incorporated into emerging models of health care. This multifaceted approach can help to ensure that people with diabetes benefit from effective, community-based diabetes self-management interventions."

Pop Health Manage. 2011;14:143-155