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Changes in the delivery of care are needed to reduce the burden of diabetes among ethnic minorities

Critical changes are needed in the delivery of care for patients with type 2 diabetes to improve the overall quality of diabetes care and reduce its disproportionate burden on ethnic minorities, concludes a new study. Researchers Leonard E. Egede, M.D., M.S., of the Medical University of South Carolina, and Samuel Dagogo-Jack, M.D., F.R.C.P., of the University of Tennessee Health Sciences Center, suggest that health providers and health systems must shift from acute care to a chronic disease care model, involve the patient in the day-to-day management of the disease, and include collaboration between the patient and doctor on how to achieve care goals.

Studies have shown that when blood glucose levels are controlled to a similar degree (below 6.5 percent) among different racial and ethnic groups, complication rates from diabetes are also similar. Sometimes insulin is needed in addition to oral medication to achieve blood glucose control; however, because diabetes remains undiagnosed much longer in minority populations than whites, clinicians may want to consider early use of combination drug therapy for minority patients, suggest the researchers.

Medication to control blood glucose levels is most effective if it is initiated as part of a comprehensive chronic disease management plan that encourages patients to manage their disease and partner with the doctor to achieve blood glucose targets. The program should include self-monitoring of blood glucose levels, patient education, and counseling about proper diet and sufficient exercise. Aggressive control of hypertension, cholesterol levels, and obesity should also be a part of routine diabetes management practices, note the researchers. Their study was supported in part by the Agency for Healthcare Research and quality (HS11418).

More details are in "Epidemiology of type 2 diabetes: Focus on ethnic minorities," by Drs. Egede and Dagogo-Jack, in the September 2005 Medical Clinics of North America 89, pp. 949-975.

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