This post is authored by Keith C. Ferdinand, MD, FACC, chair of the Minority Cardiometabolic Disease Alliance.
Over the last several decades, the U.S. has made substantial progress in overall cardiovascular health and reducing health disparities, but ongoing racial/ethnic, economic, and other social disparities in health are both unacceptable and correctable. Combating diabetes is an example of one such issue.
Diabetes is an urgent public health issue, especially for African Americans, Hispanics, American Indians and Alaskan Natives, and certain other minority populations. National data from 2007-2009 revealed that the prevalence of type 2 diabetes mellitus in non-Hispanic black adults was the greatest at 12.6 percent, with Hispanics closely following at 11.8 percent, followed by Asian Americans at 11.1 percent and non-Hispanic whites at 8.4 percent, respectively. Other groups with high rates of diabetes include American Indians, South Asians and Americans of Middle Eastern descent.
Race and ethnicity are not anthropologic or scientifically based designations, but instead sociocultural constructs of our society. Therefore, disparities in diabetes prevalence observed in racially and ethnically distinct subgroups of the U.S. population may not only be based on attributable, intrinsic factors (e.g., genetics, metabolism), but more prominently extrinsic factors (e.g., diet, environmental exposure, sociocultural issues). These social determinants of health are clearly major considerations in preventing and controlling diabetes and the associated cardiovascular morbidity and mortality and are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. For instance, steps to improve communication for patients who have English as a second language, and positive means to assist with culturally competent communication and care, include utilizing bilingual staff, an on-site professional medical interpreter, a telephonic medical interpreters, or professional interpreters, either on-site, telephonic, video. Using a patient’s bilingual minor relative is not recommended.
The ACC has taken innovative approaches to culturally competent diabetes care and CVD risk reduction. The purpose of CardioSmart.org is to provide comprehensive, thorough, and authoritative informational and educational resources as well as interactive management and compliance tools for heart disease patients and their families. It includes a Diabetes Education Center, with culturally appropriate and literacy level correct language on understanding diabetes. Novel tools include text messaging for adherence reminders and Spanish-language educational materials. In addition, the College’s credo initiative is dedicated to reducing racial/ethnic and other disparities in cardiovascular outcomes, while the new CardioMetabolic Health Alliance includes a focus on diabetes as a way of stemming the outbreak of cardiometabolic disease.