Disparities/Minority Health

More comprehensive American Indian and Alaska Native diabetes education programs are linked to better diabetes care

American Indians and Alaska Natives have two to three times higher rates of diabetes and are four times more likely to die from the disease than the general U.S. population. Thus, diabetes education is important for these individuals to self-manage their disease. Yet, few diabetes education programs serving these groups met national standards in 2001, according to a new study. It also found that more comprehensive programs were associated with better quality diabetes care.

The researchers reviewed 88 Indian Health Service (IHS)-funded diabetes care programs in 2001. Most were clinic-based (70 percent); the rest were hospital-based. All completed a checklist of criteria from the IHS Integrated Diabetes Education Recognition Program (IDERP) on how well programs implemented each of the 10 national standards for diabetes self-management education. Programs were then categorized as Level 1 (developmental), Level 2 (educational), or Level 3 (integrated).

Patients receiving care from Level 2 and Level 3 programs had higher completion rates of all 15 diabetes quality-of-care indicators compared with those in programs at or below Level 1. This difference was significant for annual testing of LDL cholesterol, HDL cholesterol, triglycerides, and hemoglobin A1c (a measure of average blood-sugar level) after adjustment for patient and program factors. Yet, only 9 of the 86 programs had fulfilled enough criteria to qualify for at least Level 2 IDERP recognition. The remaining 77 programs qualified at Level 1 or less. Programs were often understaffed and unable to complete the extensive documentation process required by the IDERP, according to the authors. They note that, since the study, with additional IHS funding toward staff and training, the number of IDERP-recognized programs grew to 37 in 2009. The study was supported in part by the Agency for Healthcare Research and Quality (HS10854).

See "Relation between the level of American Indian and Alaska Native diabetes education program services and quality-of-care indicators," by Yvette Roubideaux, M.D., M.P.H, Carolyn Noonan, M.S., Jack H. Goldberg, Ph.D., and others, in the November 2008 American Journal of Public Health 98(11), pp. 2079-2084.

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