221736 Are Self-management Factors Associated With Racial/Ethnic Disparities in HbA1c control?

Sunday, November 7, 2010

Jane N. Bolin, PhD, JD, RN , Health Policy & Management, Texas A&M HSC School of Rural Public Health, College Station, TX
Samuel N. Forjuoh, MD, DrPH, FGCP , Department of Family & Community Medicine, Scott and White, Texas A&M HSC College of Medicine, Temple, TX
Marcia G. Ory, PhD, MPH , Social & Behavioral Health, Texas A&M HSC School of Rural Public Health, College Station, TX
Chuck Huber, PhD , Epidemiology & Biostatistics, Texas A&M HSC School of Rural Public Health, College Station, TX
Darcy M. Moudouni, PhD , Health Policy & Management, Texas A&M HSC School of Rural Public Health, College Station, TX
Manisha Gupta, MD , Health Policy & Management, Texas A&M HSC School of Rural Public Health, College Station, TX
Janet Helduser, MS , Health Policy & Management, Texas A&M Health Science Center School Of Rural Public Health, College Station, TX
African Americans (AA) and Hispanics (H) experience higher rates of Type 2 diabetes (T2DM) and higher HbA1c levels (A1c) than Caucasians (C). Limited data exist to examine relationship(s) between A1c and the complex array of self-management behaviors in persons with T2DM including underserved/minority populations. Purpose of this study was to identify factors that may impact racial/ethnic disparities in A1c for adults with T2DM. Patients (n=300) with A1c ≥ 7.5% (within 6 mo) provided consent and participated in the survey. Questions included: demographics (race/ethnicity, age, gender, education, income); health-related quality of life (HRQL-4); physical activity (BRFSS); pain and fatigue (visual analog scales); diet, blood sugar testing, foot care (SDSCA). Participants comprised 16%AA, 18%H, 66%C; mean age of 55 yrs, A1c of 9.38, 56% females. Comparison of means revealed significantly (p<0.05) higher A1c for AA (10.01) and H (9.85), than for C (9.10). No significant differences were found by race/ethnicity for various self-care measures, including foot care, nutrition, blood sugar testing. A nutritional scale ( =0.71) and poor health scale (=0.72) were used in final regression analysis; however, no difference by race/ethnicity was found. Regression analysis adjusting for general health, blood sugar testing, nutrition and poor health scales indicated each additional year of age was significantly associated with 0.031 point decrease in A1c. While covariates were not statistically significant, they were consistent with anticipated A1c trends given adherence to diabetes self-management protocols. Health care behaviors encouraged in self-management may have implications for interventions to reduce health disparities in minority populations.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Epidemiology

Learning Objectives:
Examine the relationship between HbA1c and self-reported measures of health; Examine the relationship between HbA1c and physical activity, nutrition, and foot care in persons of varying race/ethnicities with Type 2 diabetes mellitus. List factors identified in a baseline sample of minority and nonminority persons identified with uncontrolled type 2 diabetes.

Keywords: Diabetes, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Co-PI of this NIH funded RCT research project. I also over see diabetes education education projects.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.