Tailored care by diabetes nurses is not enough to overcome disparities in the regulation of type 2 diabetes between Dutch natives and ethnic minority groups
DOI:
https://doi.org/10.57177/idn.v17.331Keywords:
Type 2 diabetes mellitus, Glycaemic control, glycated haemoglobin A1c (HbA1c), Ethnic (minority) groups, Ethnic disparitiesAbstract
Background: Differences in diabetes regulation between patients from different ethnic background have been described. This may be reduced by regular visits to a diabetes nurse (RVDN) with the same mother tongue. We explored whether equal access to diabetes-related care, including RVDN with the same mother tongue, may result in similar diabetes regulation among ethnic minorities and Dutch natives.
Methods: Patients with type 2 diabetes and an annual comprehensive diabetes evaluation were included in this study. For the analysis, we emphasized on the data of patients with RVDN and used descriptive statistics and nonparametric tests for between group comparisons.
Results: From a total of 983 patients, 581 patients had RVDN of whom 266 (46%) Dutch natives, 199 (34%) Turks/Moroccans, and 116 (20%) patients from other ethnicities. Within the group of patients with RVDN, Turks/Moroccans had higher median fasting plasma glucose levels as compared with Dutch natives and other ethnic minorities (8.4 vs 7.9 and 7.3 mmol/L, P < 0.001), and a higher HbA1c level was found for both the Turks/Moroccans and other ethnic minorities, as compared to Dutch natives (62 vs 55 mmol/mol, P < 0.001). In addition, only 22% of Turks/Moroccans and 26% of other minorities achieved the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD)-recommended HbA1c target ≤53 mmol/mol, compared to 39% in Dutch natives.
Conclusions: In patients with RVDN with the same mother tongue, we still found disparities in HbA1c levels between Dutch natives, Turks/Moroccans and other ethnic minorities. Other factors beyond Dutch language skills are likely to interfere.
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References
Rutten GE, de Grauw WJ, Nijpels G, Goudswaard AN, Uitewaal PJ, van der Does FE, et al. [NHG-guideline diabetes mellitus type 2]. Huisarts Wetenschap 2006; 49(3): 137–52.
van’t Riet E, Schram MT, Abbink EJ, Admiraal WM, Dijk-Schaap MW, Holleman F, et al. The diabetes pearl: diabetes biobanking in the Netherlands. BMC Public Health 2012; 12: 949. doi: 10.1186/1471-2458-12-949
Creamer J, Attridge M, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: an updated Cochrane review of randomized controlled trials. Diabet Med 2016; 33(2): 169–83. doi: 10.1111/dme.12865
Zeh P, Sandhu HK, Cannaby AM, Sturt JA. The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review. Diabet Med 2012; 29(10): 1237–52. doi: 10.1111/j.1464-5491.2012.03701.x
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 2. Classification and diagnosis of diabetes: standards of care in diabetes-2023. Diabetes Care 2023; 46(Suppl 1): S19–40. doi: 10.2337/dc23-S002
Ahdi M, Gerdes VE, Graaff R, Kuipers S, Smit AJ, Meesters EW. Skin autofluorescence and complications of diabetes: does ethnic background or skin color matter? Diabetes Technol Ther 2015; 17(2): 88–95. doi: 10.1089/dia.2013.0374
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9): 604–12. doi: 10.7326/0003-4819-150-9-200905050-00006
Senior PA, Bhopal R. Ethnicity as a variable in epidemiological research. BMJ 1994; 309(6950): 327–30. doi: 10.1136/bmj.309.6950.327
Schmidt CB, Potter van Loon BJ, Torensma B, Snoek FJ, Honig A. Ethnic minorities with diabetes differ in depressive and anxiety symptoms and diabetes-distress. J Diabetes Res 2017; 2017: 1204237. doi: 10.1155/2017/1204237
Dekker LH, van Dam RM, Snijder MB, Peters RJ, Dekker JM, de Vries JH, et al. Comparable dietary patterns describe dietary behavior across ethnic groups in the Netherlands, but different elements in the diet are associated with glycated hemoglobin and fasting glucose concentrations. J Nutr 2015; 145(8): 1884–91. doi: 10.3945/jn.114.207472
The Amsterdam Health Monitor Survey 2012. Amsterdam: Public Health Service of Amsterdam (GGD Amsterdam); 2013. Available from: http://www.ggd.amsterdam.nl/beleid-onderzoek/gezondheidsmonitors/amsterdamse/ [cited 24 June 2018].
Jansen YJ, Uitewaal PJ, Wijsman-Grootendorst A, Geelhoed-Duijvestijn PH. [Social and cultural problems in the compliance with life-style advice in diabetic patients of non-Dutch origin]. Ned Tijdschr Geneeskd 2011; 155: A3117.
Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Health literacy: a prescription to end confusion. National Academies Press (US), Washington, DC; 2004.
Dahhan N, Meijssen D, Chegary M, Bosman D, Wolf B. Ethnic diversity outpatient clinic in paediatrics. BMC Health Serv Res 2012; 12: 12. doi: 10.1186/1472-6963-12-12
Grimsby JL, Porneala BC, Vassy JL, Yang Q, Florez JC, Dupuis J, et al. Race-ethnic differences in the association of genetic loci with HbA1c levels and mortality in U.S. adults: the third National Health and Nutrition Examination Survey (NHANES III). BMC Med Genet 2012; 13: 30. doi: 10.1186/1471-2350-13-30
Herman WH. Are there clinical implications of racial differences in HbA1c? Yes, to not consider can do great harm! Diabetes Care 2016; 39(8): 1458–61. doi: 10.2337/dc15-2686
Maruthur NM, Gribble MO, Bennett WL, Bolen S, Wilson LM, Balakrishnan P, et al. The pharmacogenetics of type 2 diabetes: a systematic review. Diabetes Care 2014; 37(3): 876–86. doi: 10.2337/dc13-1276
Ahdi M, Gerards MC, Smits PHM, Meesters EW, Brandjes DPM, Nieuwdorp M, et al. Genetic glucocorticoid receptor variants differ between ethnic groups but do not explain variation in age of diabetes onset, metabolic and inflammation parameters in patients with type 2 diabetes. Front Endocrinol 2023; 14: 1200183. doi: 10.3389/fendo.2023.1200183
El Fakiri F, Bruijnzeels MA, Foets MM, Hoes AW. Different distribution of cardiovascular risk factors according to ethnicity: a study in a high risk population. J Immigr Minor Health 2008; 10(6): 559–65. doi: 10.1007/s10903-008-9144-4
Uitewaal PJ, Goudswaard AN, Ubink-Veltmaat LJ, Bruijnzeels MA, Hoes AW, Thomas S. Cardiovascular risk factors in Turkish immigrants with type 2 diabetes mellitus: comparison with Dutch patients. Eur J Epidemiol 2004; 19(10): 923–9. doi: 10.1007/s10654-004-5193-8
Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care 2005; 28(9): 2280–8. doi: 10.2337/diacare.28.9.2280
Uniken Venema HP, Garretsen HF, van der Maas PJ. Health of migrants and migrant health policy, the Netherlands as an example. Soc Sci Med 1995; 41(6): 809–18. doi: 10.1016/0277-9536(95)00065-F
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