Disparities in self-monitoring of blood glucose among low-income ethnic minority populations with diabetes

Income appears to play a crucial role in how often diabetes patients on insulin check their daily blood glucose levels, and low-income minorities check less often than others, a new research study finds.

The study, which appears in the latest issue of the journal Ethnicity & Disease, shows that Hispanics and African-Americans with insulin-treated diabetes performed daily self-monitoring of blood glucose less frequently than whites, and that Hispanics receive less diabetes education.

"We were surprised to see such large differences in self-monitoring between low-income Hispanics and low-income whites," said lead author Deborah Levine, M.D., at Ohio State University College of Medicine. "We were also surprised to find such significant disparities in glucose monitoring among low-income minorities," when comparing Hispanics with African-Americans.

Levine and her colleagues evaluated blood glucose self-monitoring of at least once a day among 16,630 adults with insulin-treated diabetes. Data came from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an ongoing system of health surveys of U.S. adults through telephone interviews.

For those adults earning more than $20,000 per year, Hispanics and African-Americans reported similar but lower self-monitoring rates than whites did -78 percent for Hispanics, 77 percent for African-Americans and 85 percent for whites.

However, among adults earning less than $20,000, Hispanics performed blood glucose self-monitoring substantially less than did African-Americans or whites - 65 percent for Hispanics, 79 percent for African-Americans, and 85 percent for whites. The researchers found that these differences held after adjusting for factors such as age, education, health insurance and health status.

Levine and her colleagues also found the number of patients who had received diabetes education varied significantly among ethnic groups - 49 percent for Hispanics, 64 percent, for African-Americans and 62 percent for whites. Hispanics with limited English proficiency reported the lowest participation in diabetes education and blood glucose self-monitoring.

"Proper diabetes education plays a critical role in self-monitoring blood glucose, which is a vital component of diabetes disease management," said Levine.

Evette Joy Ludman, Ph.D., of Seattle-based Group Health Cooperative, is an expert in the area of self-care of chronic diseases, and agreed that income level and patient education play a major role in how well minority patients manage their condition.

"Low income, low English proficiency and nonparticipation in self-management education are factors often associated with poorer self-care in people living with many types of chronic conditions," Ludman said. "Creative solutions are being researched and implemented, however. Some of the most intriguing I've seen combine outreach and peer support by community members, such as the 'promotora' model in Spanish speaking communities."

A promotora is an outreach worker in a Hispanic community who is responsible for raising awareness of health and educational issues.

Ethnicity & Disease is a quarterly medical journal studying the ethnic patterns of disease. For more information, contact [email protected] or visit http://www.ishib.org/ED_index.asp

Levine DA, et al. Disparities in self-monitoring of blood glucose among low-income ethnic minority populations with diabetes, United States. Ethnicity & Disease 19(2), 2009.

By Glenda Fauntleroy, Health Behavior News Service