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Racial Disparities vs. Glycemic Control

Aug 25, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Brianna Belton, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

How racial disparities can affect diabetes care: rushed communication between provider and patient is associated with reduced glycemic control in black patients. 

Racial disparities significantly impact the quality of care that individual patients receive based on their racial/ethnic groups. These disparities can negatively impact the health of patients and reduce their quality of life. Although racial disparities are being recognized and being corrected, these disparities have not yet been eliminated.  

Racial minorities have unequal experiences with diabetes and its complications. Minorities with diabetes experience higher prevalence rates, decreased glycemic control, and higher rates of complications. Several studies have demonstrated the existence of racial and ethnic disparities. This is shown through the differences in the quality of care received and the associated health outcomes. This includes life expectancy, worse prognosis, premature death, and poor overall health, all being associated with racial disparities in health. Overall, it can be said that health outcomes have improved over time with emerging drugs, technology, and information. Still, the large racial gap has also been consistent and persistent over this time.  

A crosssectional study was conducted to include Non-Hispanic Blacks (NHB) and Non-Hispanic Whites (NHW) with type 2 diabetes to determine the association between HbA1c, patient race and the patient-provider relationship provided by the Interpersonal Processes of Care Survey (IPC). The IPC includes seven domains: hurried communication, elicited concerns and responses, explained results and medications, patient-centered decision making, compassionate and respectful, discriminated, and rude office staff. Adjusted linear regression was used to determine this association between HbA1c, patient race, and the IPC domains. 

The study included a total of 106 NHW and 115 NHB. The mean age was 64.4, and 55% of the participants were female. The average HbA1c was 7.3%. Adjusted linear regression models displayed no significant association overall. However, for the domains’ hurried communication’ and ‘explained results and medications,’ there was a significant difference in HbA1c. The Hb1Ac was 0.45% lower [95% CI -1 to 0.1; p=0.48] among NHB who reported no hurried communication versus NHB who reported hurried communication; and 0.64% lower [95% CI -1.19 to -0.08; p=0.01] among NHB who reported that their providers explained their results and medications versus NHB who reported that their providers thoroughly explained everything. This relationship was not displayed among the NHW. Therefore, it was concluded that interventions that aim to improve the communication between the patient and provider might reduce racial disparities in glycemic control.  

Although it is stated that the relationship between race, hurried communication, and glycemic control was statistically significant (p=0.48), it is essential to note that although there was a decrease in HbA1c in NHB who reported no hurried communication, the results reported displayed no statistical significance. Based on the pvalue of 0.48, the suggestion is that the hurried communication did not significantly impact NHB. However, based on the title, I would have expected the results to display that hurried communication was statistically significant in optimizing glycemic control. Despite these results, enough time should still be taken to counsel the patient thoroughly 

This study reaffirmed that racial disparities exist, and it is essential to continue to recognize their existence and fight to eliminate them. The nation is expanding, and with this expansion, diversity is increasing. Although it is a challenging and complex issue to address, it must be done.  

Another study completed in June 2020, Intensive Lifestyle Intervention Does Not Reduce Racial and Ethnic Disparities in Achievement of Optimal Glycemic Control, did attempt to reduce racial and ethnic disparities in adults with type 2 diabetes and overweight/obesity. An intensive lifestyle intervention for weight loss (ILI) was implemented over eight years to determine the effect ILI would have on reducing racial/ethnic disparities to achieve optimal glycemic control (HbA1c <7%). Over this period, the racial/ethnic disparities were persistent and not reduced by lifestyle intervention. Significantly fewer Hispanics and African Americans achieved optimal glycemic control (p<0.001), relative to non-Hispanic whites, which suggests both African Americans and Hispanics showed more significant disparities. This study further solidifies the complexity of the issue of racial disparity and the need for more research. 

While there is an overwhelming amount of studies documenting that racial disparities exist, more studies are needed to focus on ways to eliminate these disparities instead of highlighting their existence. Areas of future study might include identifying the disparities between provider race and ethnicity versus that of the patient, as well as certain biases and stereotypes already present in the lives of both the provider and the patient. 

Practice Pearls: 

  • All patients should receive thorough counseling and instructions to ensure their understanding of their disease state and how to manage it properly. 
  • Recognize that racial disparities exist and that they can have a significant impact on patient outcomes. 
  • There are a plethora of studies that demonstrate the existence of racial disparities, but not enough on their elimination. 

 

Hayes, JF, Bertoni, A, Pilla SJ, Wing, RR. “1991-P: Intensive Lifestyle Intervention Does Not Reduce Racial and Ethnic Disparities in Achievement of Optimal Glycemic Control.” ADA, vol. 69 no. Supplement 1, 2020, doi: 10.2337/db20-1991-P 

Peek ME, Cargill A, Huang ES. Diabetes Health Disparities: A Systematic Review of Health Care Interventions. Med Care Res Rev 2007, vol. 64, no. Supplement 5, doi:10.1177/1077558707305409. 

Reid, Hadley, et al. “52-LB: Provider Communication in Black Patients with T2DM Is Associated with Glycemic Control.” Diabetes, vol. 69, no. Supplement 1, 2020, doi:10.2337/db20-52-lb.  

 

Brianna Belton, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences 

 

 

See more about how racial disparities can affect diabetes care.