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Limited health care access impairs blood sugar control among low-income urban blacks with type 2 diabetes

Controlling blood sugar (glycemic) levels to near normal (less than 7 percent) is the key to minimizing complications from diabetes such as serious eye, kidney, and cardiovascular problems. A new study, supported in part by the Agency for Healthcare Research and Quality (HS09722), looked at the clinical, socioeconomic, and health care access factors of low-income urban blacks with type 2 diabetes and found that health care access most affected their glycated hemoglobin (HbA1c) levels. Among those with diabetes, the average HbA1c was 8.7 percent for patients who had no trouble getting medical care compared with 9.4 percent for those who did have trouble; 8.9 percent for patients who had no trouble obtaining medication compared with 9.2 percent for those who had trouble doing so; and 8.6 percent for patients who regularly used a doctor's office or clinic compared with 9.5 percent among those who relied only on acute care facilities and 10.3 percent for those who had gone nowhere for care.

The study authors advise that approaches to improve diabetes outcomes should target barriers to health care access, develop programs to help high-risk groups maintain a regular place of health care, and educate high-risk groups to obtain periodic health evaluations. They did not find a direct association between HbA1c and factors such as health insurance, education, employment, race, or other socioeconomic characteristics. However, they note such factors are likely to affect patients' access to medical care and thus have an indirect impact on glycemic control.

The researchers examined whether differences in health care access affected HbA1c levels in 605 predominantly low-income black patients initially treated at a municipal diabetes clinic in 2001 and 2002. They administered a 26-question survey about sociodemographic characteristics and access to health care. They also examined clinical or disease-related variables. Overall, 47 percent reported difficulty getting medical care and trouble obtaining medications during the 12 months prior to their initial visit to the diabetes clinic. Only 56 percent used a regular source of care such as doctor's office or clinic.

See "Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes," by Mary K. Rhee, M.D., Curtiss B. Cook, M.D., Virginia G. Dunbar, B.S., and others, in the November 2005 Journal of Health Care for the Poor and Underserved 16, pp. 734-746.

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