Vol. 15 •Issue 2
• Page 18
Men's Health Report
Diabetes in Minority Men
by Joseph D. Tariman, NP
One of the major problems in the United States health care system today is disparity.
For example, the prevalence of diagnosed diabetes is twice as high in non-Hispanic blacks and Mexican Americans as in non-Hispanic whites. The prevalence of diagnosed diabetes is similar in men and women, but the prevalence of undiagnosed diabetes and impaired fasting glucose is significantly higher in men.1
Specifically, the prevalence of diabetes is 1.7 times greater among Hispanic men (Mexican Americans make up the largest Hispanic and Latino group) than in non-Hispanic men. Non-Hispanic blacks are 1.8 times as likely to have diabetes as non-Hispanic whites. A similar trend of disparity is occurring among American Indians, Alaska Natives, Asian Americans, Hawaiians and Pacific Islanders.2
Minority populations have higher morbidity and mortality due to diabetes. In particular, the prevalence of coronary artery disease is two times higher in men with diabetes than men without diabetes (similarly matched controls).3
Coronary artery disease is more prevalent among South Asian men with diabetes (9%) than in white men (1%).4 In both genders, the prevalence of blindness due to diabetes is twice as high among African-Americans as among whites.
Compared with Caucasians, the incidence of kidney disease is six times higher in Native Americans, four to six times higher in Mexican Americans, and four times higher in African-Americans.5 Lastly, diabetes mortality is significantly higher in African-Americans than their white counterparts, regardless of gender.6
In the United Kingdom, diabetes complications such as renal disease (microalbuminuria, proteinuria and end-stage renal failure), eye disease (cataract, retinal vein occlusions) and vascular disease (peripheral vascular disease, stroke) occur more frequently among African Caribbeans and Indo-Asians compared with whites.7 This trend is true for men and women.
Approaches to Management
African-Americans and Hispanics are much less likely than non-Hispanic whites to be screened and treated for cardiovascular risk factors, including diabetes.4 Although minority populations bear a disproportionate burden of diabetes, few studies have been conducted to test the effectiveness of culturally competent diabetes self-management.8,9
Therefore, policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the spectrum of health literacy.10 Furthermore, little is known about how to effectively promote self-management by minority men with diabetes.
Nurse practitioners are in an excellent position to improve diabetes management in minority men by using culturally competent diabetes self-management education interventions, with emphasis on the following:11,12
understanding of educational issues among minority populations
increased cultural awareness specific to each subset of minority populations
understanding of compliance issues with pharmacologic therapy
appropriateness of lifestyle changes and instructions, including diet and physical activity.
Nurse practitioners can play vital roles in conducting research, particularly how to effectively promote self-management of disease. They can also be effective by promoting research participation among minority men who have diabetes.
References
1. Cowie CC, et al. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National health and nutrition examination survey 1999-2002. Diabetes Care. 2006;29(6):1263-1268.
2. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics. Bethesda, Md.: National Institue of Health; 2005.
3. Davidson MB. Effect of nurse-directed diabetes care in a minority population. Diabetes Care. 2003;26(8):2281-2287.
4. Ferdinand KC. Managing cardiovascular risk in minority patients. J Natl Med Assoc. 2005;97(4):459-466.
5. American Diabetes Association. Diabetes 2001 Vital Statistics. Alexandria, Va.: American Diabetes Association; 2001.
6. Gu K, et al. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971-1993. Diabetes Care. 1998;21(7):1138-1145.
7. Burden ML, et al. Diabetes in African Caribbean and Indo-Asian ethnic minority people. J R Coll Physicians Lond. 2000;34(4):343-346.
8. von Goeler DS, et al. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educ. 2003;29(4):663-672.
9. Rosal MC, et al. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005;29(3):225-235.
10. Sarkar U, et al. Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care. 2006;29(4):823-829.
11. Two Feathers J, et al. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Am J Public Health. 2005;95(9):1552-1560.
12. Brown SA, et al. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2002;25(2):259-268.
Joseph Tariman is an adult nurse practitioner who owns JD Tariman Consulting and lives in Chicago. This column was developed with the Men's Health Network. Learn more at www.menshealthnetwork.org.
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