The Use of Cultural Competency in Decreasing Diabetes Outcomes Disparities in a Community Health Care Setting

Abstract

In the United States, the prevalence of diabetes in the Latnix population is roughly 70% higher than in non-Latinx whites. Along with this, many studies have shown that the rate of complications, both macro- and microvascular, in this population is also disproportionately higher. Given that complication rates mirror glycemic control, as evidenced by studies such as the DCCT and UKPDS, the increased rate of poor glycemic control is likely one of the most important factors contributing to this. Most efforts at controlling diabetes in a population have aimed at a heterogeneous cohort in terms of race and ethnicity, yet poor control disproportionately affects the Latinx groups. North Shore Community Health Center is a Federally Qualified Health Center located around the communities of Salem, Peabody, and Gloucester, MA. These areas are ethnically diverse, and the vast majority of the Latinx population are Dominican. In fact, roughly 50% of the clinic population is Latinx. After prioritizing glycemic control as a goal for 2019, we utilized a population health strategy to identify patients with A1c >9% (poor control as defined by UDS measurements). These patients were given an appointment with the only endocrinologist in the clinic, who, through a Dominican Spanish translator and using joint decision making, decided on appropriate medication. They were then followed at least weekly at first by a nurse who also was Dominican and lived in the community. She counseled patients on culturally-appropriate diet recommendations, activity, screening, monitoring, and provided access to other specialties (e.g. podiatry, ophthalmology) as needed. The rate of A1c >9% in the clinic had been 35–40% prior 2019. At the end of 2019, the rate was 27%, with a disproportionaltly lower rate in the Latinx population (23%). Our conclusion is that a culturally sensitive diabetes program will eliminate these health disparities