Differences in diabetes self-care activities by race/ethnicity

Introduction: Previous research indicates disparities in optimal diabetes control (ODC) status by race/ethnicity. Moreover, specific risk factors for not achieving ODC differ significantly by race/ethnicity. Given observed patterns in our clinic data, we hypothesized that there are distinct patterns of diabetes self-care activities and clinical care activities by race/ethnicity. We examined self-care activities and adequacy of self-care by race/ethnicity and whether diabetes clinical care is associated with better self-care. Methods: We used data from the 2011 BRFSS for adults residing in 14 states that implemented the diabetes module and who reported they had diabetes (n=14,790 unweighted). Outcomes included self-care activities (daily foot checks, daily blood glucose monitoring, non-smoking, physical activity, 5 fruits/vegetables daily) and a composite adequacy of self-care (high, moderate, low). We used cross-tabulations with design-based f-tests to examine differences by race/ethnicity. Multinomial logistic regression was used to estimate the odds of moderate and high self-care compared with low self-care by race/ethnicity adjusting for background characteristics. Finally, we stratified by race/ethnicity and examined predictors of adequate self-care within each group. Results: Of adults with diabetes, 63% did daily foot checks, 61% daily glucose monitoring, 84% were non-smokers, 36% had sufficient physical activity, and 12% ate 5 daily fruits and vegetables. Overall, 19% had high, 65% had moderate, and 16% had low adequacy of self-care. Hispanic and American Indians had significantly higher odds of high self-care versus low self-care compared with non-Hispanic whites. Older ages, being married, and college education were significant predictors of adequate self-care. Clinical care for diabetes management also played a role; 52% of adults received diabetes self-management education (DSME) and 53% had 3 or more provider visits for diabetes. Those who received DSME had 1.6 times higher odds of moderate versus low self-care and three times higher odds of high versus low self-care compared to those with no DSME. Regular provider visits also increased the odds of adequate self-care. Differences in predictors of self-care adequacy by race/ethnicity were noted. Discussion: Adequacy of diabetes self-care differed by race/ethnicity but not in the way we hypothesized. Hispanics and American Indians have high prevalence of diabetes-related disparities, but our findings indicate these groups are more (not less) likely to engage in high-levels of diabetes self-care suggesting something beyond individual behavior is causing their poor diabetes outcomes. Additionally, although self-care takes place outside the clinical setting, regular provider visits and receiving DSME are the strongest predictors of adequate diabetes self-care.