Health Care Interventions to Improve the Quality of Diabetes Care in African Americans: A systematic review and meta-analysis

• Autores: Ignacio Ricci-Cabello, Isabel Ruiz Pérez, Adela Nevot-Cordero, Miguel Rodríguez Barranco, Luis Sordo del Castillo, Daniela C. Gonçalves
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 36, Nº. 3, 2013, págs. 760-768
• Idioma: inglés
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• Resumen

  • Type 2 diabetes is a serious, costly, and potentially preventable public health problem in the U.S., and both the prevalence and incidence of diabetes have increased rapidly since the mid-1990s (1). Currently, >7% of adults in the U.S. have been diagnosed with type 2 diabetes, and diabetes-related care accounts for 11% of all U.S. health care expenditures (2).

    African Americans bear a disproportionate burden from diabetes and its complications. Compared with Caucasians, African Americans are almost twice as likely to suffer from type 2 diabetes and to experience diabetes-related blindness and lower-limb amputations, and two to six times more likely to have kidney disease (3). Furthermore, these disparities are enhanced when in tandem with other axes of inequality, such as geographic region, age, or sex (4).

    Health inequalities in diabetes care can be conceptualized as differences in the quality of diabetes self-management (DSM) and of the medical care received. African Americans with diabetes experience more difficulties in DSM than Caucasians (5,6). Several reasons contribute to the observed differences, namely that African Americans often present cultural beliefs about their medical care and difficulties with language or low health literacy, which interfere with the success of DSM activities. Additionally, racial disparities in health services access and delivery are also thought to contribute to the observed differences, as African Americans are less likely to have routine glycosylated hemoglobin (HbA1c) testing, lipid panels, and retinopathy screening than their Caucasian counterparts (7,8).

    In the past decade, there has been a surge in the development and implementation of quality improvement interventions led by the health care sector, which aim to decrease the burden of social inequalities in diabetes care. According to the Chin et al. (9) conceptual framework, those interventions can be classified as targeted to the patients, �