Table of Contents
Importance of Addressing Diabetes Disparities in Minorities
Diabetes is a significant health concern in the United States, particularly among racial and ethnic minorities, including Black and Hispanic populations. These groups experience a disproportionately higher prevalence of diabetes compared to their non-Hispanic white counterparts. According to the Centers for Disease Control and Prevention (CDC), the prevalence of diagnosed diabetes is 12.1% for Black adults and 11.7% for Hispanic adults, compared to 6.9% for non-Hispanic white adults (1). This disparity is alarming, as these minority groups are three times more likely to face complications and twice as likely to die from diabetes-related issues (2).
Several factors contribute to these alarming statistics. One primary reason is that medication adherence tends to be lower among Black and Hispanic adults, negatively impacted by social determinants of health (SDOH) such as socioeconomic status, education, and access to healthcare (3). Additionally, negative beliefs about diabetes and its management, including misconceptions regarding medications, further exacerbate the issue. A study indicated that many individuals from these communities harbor doubts about the effectiveness and safety of diabetes medications (4).
Addressing these disparities requires a comprehensive understanding of the multifaceted barriers that minority populations face in diabetes management. By identifying and targeting social determinants and health perceptions, effective interventions can be developed that not only improve health outcomes but also empower these communities to manage their diabetes more effectively.
Role of Pharmacists in Diabetes Management Interventions
Pharmacists are uniquely positioned to play a vital role in diabetes management, particularly through the provision of Medication Therapy Management (MTM). MTM is a service offered by pharmacists that focuses on optimizing medication use and improving therapeutic outcomes (5). Studies have shown that pharmacists delivering MTM can significantly enhance medication adherence and glycemic control among diabetes patients, particularly within minority populations (6).
For example, a longitudinal study demonstrated that patients receiving pharmacist-led MTM experienced a mean reduction in hemoglobin A1c (A1C) levels by 0.5% at six months (7). This is particularly relevant for Black and Hispanic adults with uncontrolled diabetes, who may struggle with medication adherence due to various barriers. Pharmacists can provide personalized support, education, and resources to help bridge the gap in diabetes care.
However, it is essential to recognize that pharmacists often face challenges in addressing the broader social determinants of health that influence medication adherence. Their capacity to assist patients in navigating these barriers can be limited due to time constraints and a lack of training in social determinants (8). Therefore, integrating the expertise of Community Health Workers (CHWs) alongside pharmacists may enhance the effectiveness of diabetes management interventions, addressing both medication adherence and the social factors that contribute to health disparities.
Community Health Workers: Bridging Gaps in Diabetes Care
Community Health Workers (CHWs) are invaluable assets in addressing the social determinants of health that affect diabetes management among minority populations. By working closely with patients, CHWs can provide education, support, and resources that empower individuals to take control of their health. Research shows that interventions involving CHWs have led to significant improvements in diabetes management among Black and Hispanic adults (9).
A recent study indicated that CHW involvement can reduce A1C levels by 0.5% to 0.9% (10). This is particularly critical given that Black and Hispanic adults face unique challenges that require tailored approaches to diabetes care. CHWs can help identify barriers to healthcare access, facilitate connections to community resources, and address health misperceptions that may impede effective diabetes management (11).
For instance, CHWs can offer guidance on nutrition, assist with navigating healthcare systems, and provide culturally relevant support that resonates with the communities they serve. This collaborative model, which combines the clinical expertise of pharmacists with the community-based focus of CHWs, represents a promising strategy for optimizing diabetes management interventions.
Optimizing Medication Therapy Management for Better Outcomes
To effectively manage diabetes in minority populations, it is crucial to optimize Medication Therapy Management (MTM) interventions. The Multiphase Optimization Strategy (MOST) provides a framework for identifying the most effective combination of intervention components (12). In the context of diabetes management, this can involve both pharmacist-led MTM and CHW support.
The effectiveness of MTM can be enhanced by tailoring it to address the specific needs of Black and Hispanic adults with uncontrolled diabetes. This includes providing culturally competent education, addressing health misconceptions, and integrating SDOH considerations into medication management practices. A recent protocol for a randomized mixed methods factorial trial aims to investigate the combined effects of MTM and CHW interventions on A1C levels among these populations (13).
By employing a 2 × 2 factorial design, researchers will be able to assess the main effects of MTM and CHWs, as well as their interactions, on diabetes outcomes. The primary outcome of interest is A1C levels, while secondary outcomes include medication adherence and psychosocial factors that may mediate the effects of the interventions (14).
Table 1: Proposed Intervention Components
| Intervention Component | Description |
|---|---|
| Pharmacist-led MTM | Comprehensive medication review and assessment to optimize diabetes management. |
| Community Health Worker Support | Address SDOH barriers and enhance understanding of diabetes and medication. |
Evaluating the Impact of Social Determinants on Diabetes Control
The impact of social determinants of health on diabetes control cannot be overstated. Factors such as socioeconomic status, access to healthcare, and social support networks play a crucial role in influencing health outcomes among Black and Hispanic adults with diabetes (15). By understanding these determinants, healthcare providers can develop targeted strategies to minimize their adverse effects.
Research indicates that addressing SDOH can have a significant impact on improving diabetes outcomes. For example, a study found that reducing food insecurity among minority populations led to improved A1C levels and overall health (16). Furthermore, interventions that provide resources for transportation, medication access, and diabetes education have shown promise in enhancing diabetes management and adherence (17).
To effectively address these disparities, it is essential to integrate SDOH assessments into diabetes management interventions. This can involve incorporating screening tools for SDOH during healthcare visits and utilizing the expertise of CHWs to connect patients with community resources that can alleviate barriers to care (18). By adopting a holistic approach that considers both medical and social factors, healthcare providers can better support minority populations in managing their diabetes.
Conclusion
In summary, effective diabetes management among minorities requires a multifaceted approach that addresses both medical and social determinants of health. Pharmacists and Community Health Workers play critical roles in this process, providing the necessary support and resources to empower patients. By optimizing Medication Therapy Management and incorporating SDOH considerations into diabetes care, healthcare providers can significantly improve health outcomes for Black and Hispanic adults living with diabetes.
FAQ
What is the role of pharmacists in diabetes management?
Pharmacists provide Medication Therapy Management (MTM), which includes comprehensive medication reviews, personalized support, and education to help optimize diabetes management.
How can Community Health Workers assist in diabetes care?
Community Health Workers (CHWs) address social determinants of health, provide education, support, and resources, and help individuals navigate healthcare systems to improve diabetes management.
What are social determinants of health (SDOH)?
Social determinants of health are conditions in which people are born, grow, live, work, and age, which can significantly influence health outcomes and access to care.
Why is optimizing Medication Therapy Management (MTM) important?
Optimizing MTM is essential for enhancing medication adherence and glycemic control, particularly among minority populations who may face unique barriers to effective diabetes management.
How can addressing SDOH improve diabetes outcomes?
By identifying and addressing social determinants of health, healthcare providers can reduce barriers to access, empower patients, and ultimately improve diabetes control and health outcomes.
References
- Centers for Disease Control and Prevention. (2021). Diabetes and African Americans
- Centers for Disease Control and Prevention. (2021). Diabetes and Hispanic Americans
- Heisler, M., Faul, J. D., Hayward, R. A., Langa, K. M., & Blaum, C. (2007). Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Archives of Internal Medicine, 167(17), 1853–1860. doi:10.1001/archinte.167.17.1853
- Mann, D. M., Ponieman, D., Leventhal, H., & Halm, E. A. (2009). Misconceptions about diabetes and its management among low-income minorities with diabetes. Diabetes Care, 32(3), 591–593. doi:10.2337/dc08-1837
- American Pharmacists Association. (2008). Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association, 48(3), 341–353. doi:10.1331/JAPhA.2008.08514
- Spencer, M. S., Kieffer, E. C., Sinco, B., & Funnell, M. M. (2011). Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. American Journal of Public Health, 101(12), 2253–2260. doi:10.2105/AJPH.2010.300106
- Shiyanbola, O. O., & Brown, C. M. (2018). “I did not want to take that medicine”: African-Americans’ reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence. Patient Preference and Adherence, 12, 409–421. doi:10.2147/PPA.S152146
- Collins, L. M. (2018). Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: The Multiphase Optimization Strategy (MOST). Springer, Cham, Switzerland.
- Shiyanbola, O. O., Maurer, M. A., & Ward, E. C. (2022). A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans. Pilot and Feasibility Studies, 8(1), 240. doi:10.1186/s40814-022-01198-7
- Shiyanbola, O. O., Maurer, M. A., Mott, M., Schwerer, L., Sarkarati, N., & Sharp, L. K. (2020). Protocol for partnering with peers intervention to improve medication adherence among African Americans with Type 2 Diabetes. medRxiv. doi:10.1101/2020.06.04.20122895
- Shiyanbola, O. O., & Maurer, M. A. (2024). Optimizing diabetes management interventions for Black and Hispanic adults using the multiphase optimization strategy: Protocol for a randomized mixed methods factorial trial. Contemporary Clinical Trials, 319, 107804. doi:10.1016/j.cct.2024.107804
