Glycemic Relapse in Uninsured Asian- Americans/Pacific Islanders with Diabetes

Chen Yen Wang

doi:10.4172/2167-1168.1000139

Abstract

Abstract Purpose: The purpose of this study is to examine the rate of glycemic relapse in uninsured Asian-Americans and Pacific Islanders attending the diabetes clinic of a community health center in Honolulu, Hawaii. Methods: Target study population was patients who came to the diabetes clinic between November 1, 2011 and February 29, 2012. Their medical charts between January 2009 and February 2012 were reviewed for retrieving levels of HbA1C, LDL (low-density lipid), Triglyceride, and blood pressure. Changes in these outcomes were compared with baseline. Percent of patients with glycemic relapse was calculated. Through a ‘talk story’ session, the management team members gathered their perspectives in educating Asian-Americans and Pacific Islanders with diabetes. Findings: Medical records of 111 patients (60 females and 51 males) with diabetes were reviewed. Average age ranged from 22 year-old to 81 year-old with mean of 58.91 (SD=9.63) year-old. Levels of HbA1C and LDL were computed at 3 ± 1 months, 6 ± 1 months, 9 ± 1 months, and 12 ± 1 months. Compared with the initial visit, means in HbA1C and in LDL at 3-month and/or 6-month follow-up visits significantly decreased. Conclusions: The diabetes management team provided group and individual diabetes education and counseling, culturally tailored diabetes education sessions, and empowerment of diabetes self management through demonstrations and explanations. There is a need to search the intervals of reinforcement program to prevent glycemic relapse. The team also provided medical care and preventative care taking into account complementary and alternative health care practices of the different ethnic groups. Health literacy was a key barrier to optimal diabetes self management in the Asian-Americans and Pacific Islanders. Community health workers played essential roles in facilitating diabetes management.

Highlights

Several studies have discovered that patients with HbA1c levels greater than 7% have a higher risk of developing medical complications than those having an HbA1c less than 7% [1,2,3,4]. 10-year follow-up of the intensive glucose control indicated lower rates of retinopathy, nephropathy, neuropathy, and macrovascular disease [5]
Following outcome analyses were based on 111 patients (60 females and 51 males) had been diagnosed with diabetes
Sharing of insulin and other medications among family members and friends with diabetes was one challenge; but language barrier seem to be the major challenge in managing diabetes among the Asian-Americans and Pacific Island patients

Summary

Introduction

Several studies have discovered that patients with HbA1c levels greater than 7% have a higher risk of developing medical complications than those having an HbA1c less than 7% [1,2,3,4]. 10-year follow-up of the intensive glucose control indicated lower rates of retinopathy, nephropathy, neuropathy, and macrovascular disease [5]. Several studies have discovered that patients with HbA1c levels greater than 7% have a higher risk of developing medical complications than those having an HbA1c less than 7% [1,2,3,4]. Inadequate adherence to medication and/or diabetes regimens has been associated with increased healthcare utilization, costs, and risk for diabetes related medical complications.. The United Kingdom Prospective Diabetes Study found the probability of glycemic relapse after one year of intervention to be 38% for type 2 diabetes and 56% for type 1 diabetes [8]. After three years of intervention the probability of relapse was 70% and 86% for type 2 and type 1 diabetes, respectively. Glycemic relapse is defined as an HbA1c greater than 8%, and an increase of 1% from the baseline (initial visit) measurement

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