Minority, low-income diabetics least likely to monitor their blood glucose

Mar 17 2008

Black and Hispanic adults with insulin-treated diabetes are less likely than whites to monitor their blood glucose, according to a new study presented at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

The disparities were greatest for low-income Hispanics, said Deborah A. Levine, M.D., M.P.H., lead author of the study.

“Minority and financially vulnerable adults with insulin-treated diabetes appear to have lower reported rates of self-monitoring of blood glucose (SMBG) — a vital disease management component,” said Levine, assistant professor in general internal medicine at the Ohio State University College of Medicine in Columbus.

“Efforts to improve diabetes control, including the collection and use of SMBG data in Hispanic and black populations with diabetes (particularly those on insulin), are warranted given that Hispanics and blacks have a higher frequency of diabetes-related complications compared to whites. We need to better understand income's role in racial and ethnic disparities in SMBG to offer effective programs and policies to improve SMBG by minorities.”

In the study, Levine and colleagues focused on adults with insulin-treated diabetes, the group with the strongest evidence and recommendations for SMBG. Their analysis included recent data from a nationally representative, population-based survey, including 16,630 adults 19 years and older with insulin-treated diabetes.

Researchers examined SMBG at least daily among Hispanics, blacks and whites by annual household income of less than $20,000 versus $20,000 or more ($20,000 was the approximate federal poverty threshold for a family of two adults and two children in 2005).

They found that lower proportions of Hispanics and blacks reported daily SMBG than whites at every income level.

At incomes of $20,000 and higher, SMBG rates were:

• 78 percent for Hispanics
• 77 percent for blacks
• 85 percent for whites

Among those with incomes of less than $20,000, SMBG rates were:

• 65 percent for Hispanics
• 79 percent for blacks
• 85 percent for whites

In the income group of less than $20,000, 49 percent of Hispanics received diabetes education, versus 64 percent of blacks and 62 percent of whites.

“Receipt of diabetes education varied significantly by race/ethnicity only in the less-than-$20,000 income group,” Levine said. “At incomes of $20,000 or more, both Hispanics and blacks had 40 percent lower odds of daily SMBG compared to whites.

“At incomes of less than $20,000, however, the odds of daily SMBG decreased by 70 percent for Hispanics compared to whites, but did not change for blacks. Importantly, demographic characteristics, health insurance, health status and diabetes measures — including receipt of diabetes education, disease duration or end-organ damage — did not fully explain these racial and ethnic differences in SMBG.”

The findings suggest that although Hispanics and blacks performed SMBG less than whites, poverty significantly worsened disparities in SMBG and receipt of diabetes education among Hispanics, researchers said.

“Income must be explicitly considered when assessing SMBG performance and designing SMBG interventions for Hispanics with insulin-treated diabetes,” Levine said.

In 2005, 15.1 million adults 20 years and older (7.6 million males and 7.5 million females) had physician-diagnosed diabetes, according to the American Heart Association's Heart Disease and Stroke Statistics – 2008 Update. This represents about 7.3 percent of the adult population. Non-Hispanic white males accounted for 6.7 percent of the cases and females accounted for 5.6 percent; non-Hispanic black males accounted for 10.7 percent and females accounted for 13.2 percent; Mexican-American males accounted for 11 percent and females accounted for 10.9 percent.