African-American and Hispanic patients with diabete are less likely to get eye exams

African-American and Hispanic patients with diabete are less likely than white patients to get eye exams, flu shots or cholesterol tests as part of their diabetes prevention care, according to a new review of recent studies in the latest issue of American Journal of Managed Care.

Three studies also showed significantly lower rates of flu vaccination -- between 8 percent and 29 percent lower -- in black populations compared to white populations, according to Julienne Kirk, Pharm. D., C.D.E., of Wake Forest University School of Medicine and colleagues.

Six studies that compared cholesterol test rates found that minority populations received fewer such tests than white groups, with the differences ranging from 3.4 percent to 19 percent among the studies.

Five of 36 studies reported a lower rate of eye exams -- as large as an 8 percent difference in some cases -- among minority patients compared to white patients, Kirk and colleagues found.

Although these studies indicate minority patients may receive less preventive care than white patients in some areas, "the majority of the data indicated that the rates of diabetes monitoring are generally low regardless of the population studied," Kirk says.

Good evidence suggests that regular preventive care for diabetic or pre-diabetic patients can help patients avoid complications from their disease. The American Diabetes Association, the American Heart Association and many others have published clinical guidelines for the care of diabetic patients that include measures such as regular foot and eye exams, cholesterol tests and blood glucose monitoring.

"Despite the availability of such guidelines and quality of care measures, there is an overall lack of adherence to these guidelines by health care providers," Kirk says.

To find out if there were differences in how ethnic minorities received preventive diabetes care, Kirk and colleagues analyzed 36 studies published between 1993 and 2003. Patient information in the studies came from Veterans Affairs clinics, Medicare databases, national surveys, managed care databases and hospital records.

The researchers did not find any consistent significant differences between ethnic groups for preventive care measures like foot exams and smoking-cessation counseling.

Although the study did not specifically examine reasons why ethnic minorities might have different rates of preventive care, Kirk notes that socioeconomic factors, language differences and "potential bias in healthcare delivered by providers" might all contribute to lower care rates among minority patients.