Understanding Type 2 Diabetes
A quality improvement (QI) project can be undertaken to understand type 2 diabetes in one’s patients of color.
The QI project can include prevalence in the practice, common comorbidities, A1c levels, emergency department and hospitalization, and the status of other performance measures/best practices including foot exams, etc. In addition, the QI project might analyze medications used in the patient population and adherence rates.
Example of how disparities in type 2 diabetes outcomes can be addressed
The Office of Minority Health tracks epidemiologic data on type 2 diabetes based on race. Most recently available data reveal the following:
- In 2018, non-Hispanic Black patients were twice as likely as non-Hispanic whites to die from diabetes
- Black adults are 60% more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician
- In 2017, non-Hispanic Black patients were 3.2 times more likely to be diagnosed with end stage renal disease as compared to non-Hispanic whites
- In 2017, non-Hispanic Black patients were 2.3 times more likely to be hospitalized for lower limb amputations as compared to non-Hispanic whites
Based on these data, community and health leaders alike may be able to make the case for developing focus groups that seek to understand the drivers of barriers that perpetuate disparities in type 2 diabetes health outcomes in Black communities. As a result, they may be able to intervene around specific social, political, and/or systemic determinants of health and reduce disparities in a certain region.
Death Rates
| Age-adjusted diabetes death rates per 100,000 (2018) | ||||||
| Non-Hispanic Black | Non-Hispanic White | Non-Hispanic Black / Non-Hispanic White Ratio | ||||
| Male | 47.6 | 24.3 | 2.0 | |||
| Female | 33.1 | 14.3 | 2.3 | |||
| Total | 39.3 | 18.9 | 2.1 | |||
“Town hall sessions are needed because diabetes has gotten worse for our community!” – Rev. Dr. Terris King, Pastor, Liberty Grace Church of God
Additional Tactics to Improve Type 2 Diabetes Health Outcomes
There are many tactics the medical staff, beyond the physician, can use to inform and influence patients that will improve their health outcomes. Here are some key approaches:
Patient education
Use patient education tools to encourage changes in lifestyle, physical activity, weight management, etc.
Patient surveys
A nurse, medical assistant, patient navigator, or patient educator can survey patients via email before their appointment to understand the barriers they face in their type 2 diabetes self-management practices and the tools they need to be successful
Health equity strategies
Medical systems and practices may employ health equity strategies from the American Diabetes Association (ADA)’s Health Equity Bill of Rights for advancing health equity
Build trust through communication
- Provide culturally appropriate and responsive patient education tools and patient advocate groups like DiabetesSisters
- Start a patient education program in your practice
Proactive Activities to Improve Type 2 Diabetes Outcomes
- Email patients at regular intervals to remind them of type 2 diabetes management and care appointments. Remind them that they will be asked to remove their shoes to examine their feet
- Designate personnel (clinical or community navigator) to help patients navigate the social determinants of health as barriers present (eg, transportation, housing, food insecurity, financial barriers, etc.)
- Show empathy and respect for patient concerns regarding their fears of developing illness and/or fears of death if diagnosed
- Keep patients informed of where resources are located through zip code trackers like this Medicine Assistance Programs finder tool from the ADA