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Reducing Health Care Disparities Affecting People with Diabetes



July 17th, 2010

Diabetes has been in the news this week what with a Food and Drug Administration (FDA) advisory panel ruling on the diabetes drug Avandia. So, today’s post focuses on a foundation-funded program to reduce disparities in care for people who have this chronic disease.

The Alliance to Reduce Disparities in Diabetes, which is funded by the Merck Company Foundation, has the goal of supporting multifaceted, community-based programs that address the key factors important in reducing disparities and improving health outcomes for people with diabetes, according to the alliance’s Web site.

The site gives some background on this whole problem of health disparities in diabetes. With 8 percent of the population in the United States “already diagnosed with diabetes and the costs associated with this disease skyrocketing, it is critical not only to understand how and why disparities exist, but also to invest in prevention and management initiatives that can address the special needs of underserved communities,” the alliance says. It points out that Type 2 (adult-onset) diabetes “disproportionately affects people of certain racial and ethnic groups, including African-Americans, American Indians, Asian Americans, Hispanics/Latinos and Pacific Islanders.” Lifestyle changes can prevent or delay diabetes, the alliance reports, and good management of diabetes once it is diagnosed “can significantly delay or prevent its numerous complications.” Thus, disparities in prevention and treatment among certain racial and ethnic groups can “contribute to the higher prevalence of diabetes and its complications among these populations.”

The alliance awarded grants to five organizations (University of Chicago, Chicago, Illinois; Camden Coalition of Healthcare Providers, Camden, New Jersey; Baylor Health Care System, Dallas, Texas; Wind River (American Indian) Reservation, Fort Washakie, Wyoming; and Healthy Memphis Common Table, Memphis, Tennessee) in February 2009. Each grantee is located in a community that “serves low-income and underserved [adult] populations with a high prevalence of type 2 diabetes.”

Also receiving a grant was the national program office for the alliance; the office is located at the Center for Managing Chronic Disease at the University of Michigan, in Ann Arbor. Noreen Clark of Michigan’s public health school directs the program. Its national advisory board includes José Escarce of the University of California, Los Angeles, and RAND, and Sara Rosenbaum of the George Washington University.

The Merck Company Foundation has committed $15 million for this diabetes and disparities effort through 2013.

The alliance is focusing on patients—educating and empowering them; clinicians—getting them to communicate better with diverse patients and be more aware of cultural beliefs; and systems—using disease management. Improving communication between patients and health care providers is very important, the alliance says.

In a December 2009 e-alert, Escarce, who chairs the alliance’s advisory board, pointed out two ways to help people.

1. Because patients of color with diabetes have a disproportionate share of complications directly linked to blood pressure and lipid control, improved access to care and treatment for controlling blood pressure, lipids, and blood sugar could narrow the health gap for underserved populations.

2. Because the obesity epidemic is disproportionately affecting people of color and is closely linked to the prevalence of Type 2 diabetes, providing proven interventions to decrease obesity and overweight in these groups could mitigate disparities in diabetes outcomes.

The alliance has produced a useful factsheet here titled “Disparities in Diabetes Prevention and Care.”

Related resources:

Chronic Care: Making the Case for Ongoing Care, Gerard Anderson of the Johns Hopkins Bloomberg School of Public Health, released February 2010 by the Robert Wood Johnson Foundation (RWJF). This is an update of the RWJF’s 2002 chartbook on this topic.

“The Economic Burden of Diabetes,” Timothy M. Dall, Yiduo Zhang, Yaozhu J. Chen, William W. Quick, Wenya G. Yang, and Jeanene Fogli, Health Affairs. This article was published online January 13, 2010 and in the February 2010 issue.

“Evaluating Interventions to Reduce Health Care Disparities: An RWJF Program,” Amy E. Schlotthauer, Amy Badler, Scott C. Cook, Debra J. Pérez, and Marshall H. Chinn, GrantWatch section, Health Affairs, March/April 2008. Read about an RWJF program called Finding Answers: Disparities Research for Change. The program awards funding for “evaluation of health care interventions that hold promise” for reducing disparities and improving care for minority patients with one or more of these conditions: cardiovascular disease, depression, and diabetes. A list of diabetes interventions evaluated under this program, based at the University of Chicago, can be found here.

Improving Diabetes Prevention and Management, a priority area of the New York State Health Foundation. As its name indicates, the foundation funds in New York State.

Medtronic Foundation’s Patient Link program. According to this corporate foundation’s Web site, “Patients with chronic conditions often seek information and a means to act.” Through this program’s grants, the foundation partners “with national and international patient organizations that educate, support and advocate on behalf of patients and their families to improve the lives of people with chronic diseases.”

Monthly Update on Health Disparities, Henry J. Kaiser Family Foundation, May 2010.

“The $174 Billion Question: How to Reduce Diabetes and Obesity,” Alliance for Health Reform briefing in Washington, D.C., Friday, July 23, 2010, 12:15 p.m. until 2 p.m. Cosponsored by the United Health Foundation. Click here for more information and to register for this event.

Racial and Ethnic Health Care Equity, a program of the Aetna Foundation.

News article:

“FDA Panel’s Vote on Avandia Reveals Mixed Opinions on Diabetes Drug’s Safety,” Rob Stein, Washington Post, July 15, 2010.

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