Healthcare disparities in diabetes management facing African American and Latino minority populations exist across the board for all ages and diabetes types. Not only do they exist, those disparities lessen the quality of life in diabetes minority populations and shorten them.
I attended sessions on this topic at the recent ADA Virtual Scientific Sessions and what I learned about minority disparities in diabetes care made me incredibly angry. Things have to change.
And I found hope where I didn’t think I'd find any, thanks to the dedication and hard work of the Presenters implementing change and fixing what’s broken. Here are my key takeaways from the first of these sessions.
Community and Family Based Strategies to Improve T1 Diabetes Management in African American and Latino School Aged Children
Dr. Ashley M. Butler - Texas Children’s Hospital/Baylor College of Medicine
Dr. Butler’s research focused on the inordinate amounts of social risk plaguing African and Hispanic children with diabetes in the US, resulting in elevated blood sugars & poor glycemic control at one year post diagnosis of T1D. Early intervention and support for T1 minority youth is paramount in preventing diabetes complications before they occur. If early intervention doesn’t happen, the diabetes burden to children with diabetes and their families is devastating.
Employment Challenges: Minority parents work environments are often more restrictive and less flexible re: daily communication with their T1D child’s school , tracking blood sugar via an app and having 504 plans in place.
Minority parents aren’t always aware of the laws that place their children at an advantage to have access to resources in school settings.
Social integration can cause additional challenges. Minorities are less likely to integrate or be involved within the diabetes community and less likely to interact with other families living with diabetes.
According to Dr. Butler, Tailored Community Outreach can be used linking families to community based resources and events with culturally inclusive language and imagery.
Social needs screening and in-home behavioral interventions by multidisciplinary HC teams utilizing their areas of expertise and innovation to work together to guide families and create community outreach events.
Providing low-intensity social/behavioral support resources for families with limited time that include links to personalized resources, video conferences and other computer-based interventions.
Disparities in Delivery of Care in Diabetes Strategies for Underserved/Underrepresented Young Adults Living with Diabetes - Hispanic and African Americans
Shivani Agarwal - Albert Einstein College of Medicine
Diabetes or not, young adults are developmentally unique and vulnerable, no matter their minority status.
Young adults with diabetes face multiple transitions. Transitioning from diabetes children’s services to adult services, increased glucose and increased A1Cs - along with the added dynamics of being a teenager and the need for independence.
Add ethnic minority status to the all of the above and the vulnerabilities increase exponentially.
Minority young adults are the largest growing diabetes population in the world, with Black, Hispanic, Indigenous, and other youths of color being diagnosed with both t1 and t2 at much higher rates.
Roadblocks and Obstacles
Being a minority teen with diabetes can itself be a roadblock.
According to the data, non-Hispanic Black teens and Hispanic teens struggle more with lower socioeconomic status, higher A1cs, trauma from unaddressed childhood events, lower health literacy, and drastically lower diabetes technology use than their White diabetes counterparts.
Racial diabetes technology disparities are real and exist in the US and internationally among both youths and adults with diabetes.
As diabetes tech options improve, the gaps will continue to grow if healthcare professionals aren’t cognizant and halt their own biases and figure out solutions now.
Dr. Agarwal referred to the Closed-Loop trial in the UK that examined provider perceptions re: who they felt were “appropriate” candidates for closed loop technologies. YEP, race and implicit bias were both factors.
The providers were honest and admitted they didn't offer tech to their underserved populations because “they didn't think they could handle it.”
HCPs must become culturally competent, with training in cultural demographics and norms of their patients. The need to effectively learn to communicate and engage with young adults with diabetes and their families re: diabetes tech and diabetes support. And incorporate motivational interviewing techniques like "show N tell”, and offer continuing diabetes education and guided orientation to help young adults transition from peds to adult diabetes practices.
Lastly, healthcare providers need to know where the young adults with diabetes they engage with are coming from.
Addressing Latino Diabetes Disparities Through Multi-Level Interventions
Dr. Arshiya Baig - University of Chicago
Dr. Baig began her talk by stating that the US Latino population is growing, currently encompassing 16% of the population and projected to be 1/3 by 2050.
US Hispanics countries of origin vary, with the largest population of Hispanics being Mexican Americans, who are also experiencing an increase in diabetes diagnoses in the US.
19% of Mexican Americans in the US currently live with diabetes and only one-third of Hispanics achieve “optimal glycemic control.”
Hispanics with diabetes are twice as likely to develop retinopathy than non-Hispanic Whites and are 40% more at risk when it comes to developing kidney disease.
Dr. Arshiya Baig flipped the barriers by utilizing community-engaged research methods in South Lawndale (Little Village), a community that is 83% Latino and 76% Mexican.
Not only did she and her team engage with the community, they worked alongside them, utilizing community resources — designing and implementing culturally informed, supportive behavioral intervention programs.
They formed a Community Advisory Board (CAB) who worked in tandem with diabetes and healthcare professionals and created a church-based diabetes education program, led by trained lay leaders.
The resulting 8-week church based type 2 diabetes self-management diabetes intervention class called: Imaginate Una Buana Salud aka, Picture of Good Health. 100 participants attended eight weekly 90 minute classes focusing on support, diabetes education and patient navigation resources that were made available to the whole community. At the 6 month follow up, people in the class were eating better and exercising more.
The CAB (Community Advisory Board) also helped in creating a Cultural Competency Training program for providers called Local Patients, Local Stories.
As a result, HCPs became more aware of barriers including their own personal biases and stereotypes. This changed the cadence of the healthcare professionals practice — resulting in more patient centered approaches, streamlined care coordination of care, better quality of care, and better patient outcomes.
As I said at the beginning of this post, things have to change. These sessions helped me learn more so I can help make things different and I hope this post did the same for you.