A qualitative review of studies of diabetes preventive care among minority patients in the United States, 1993-2003

Abstract

Objective: To review existing data to determine whether ethnic disparities exist for diabetes-related preventive care among adults in the United States.

Study design: Literature review.

Methods: We identified diabetes-related studies published between 1993 and 2003, using a reproducible search strategy. Studies were selected for review if there were ethnic comparisons or if data on a specific ethnic minority were reported. From these studies, we extracted data on commonly accepted diabetes-related preventive-care measures (testing for glycemia, eye examinations, foot examinations, lipid profile, influenza vaccination, nephropathy assessment, smoking-cessation counseling). The sources were US healthcare facilities, national survey samples, Veterans Affairs facilities, Medicare databases, and managed care data.

Results: Thirty-six studies met our search criteria. Data were extracted on glycemia testing (15 studies), eye examination rates (27 studies), foot examination rates (18 studies), lipid-profile assessment (15 studies), percentage of patients receiving influenza vaccinations (8 studies), nephropathy assessment (7 studies), and counseling referrals for smoking cessation (4 studies). The majority of the data indicated that the rates of diabetes monitoring are generally low regardless of the population being studied. The major ethnic differences reported were lower rates of eye examination, influenza vaccination, and lipid-profile testing among Hispanics and African Americans than among non-Hispanic whites.

Conclusions: Despite the availability of evidence-based guidelines, rates of diabetes preventive care are low, particularly for some measures in ethnic minority groups. Additional data are needed to further elucidate these disparities.