Culturally-Specific Diabetes Care Reduces Disparities in Metabolic Control

Culturally-specific care for Asian Americans (AA) with diabetes may reduce their healthcare disparities and improve outcome. One-year outcomes of an integrated clinic for AA at a tertiary diabetes center previously showed more patients attaining A1C <7% and composite A1C, blood pressure (BP) and cholesterol (ABC) goal than whites in the general Adult Diabetes clinic. In a follow-up study to observe the clinical performance over 4 years, data for patients with T2DM who came during January 1, 2013 to December 31, 2016 were compared among AA in Asian Clinic (AAC, n=162), AA in general Adult Diabetes Clinic (AAD, n=118), and whites in Adult Diabetes Clinic (WAD, n=2846). There was no significant difference in baseline A1C. Patients in AAD were younger (P=0.0003) and diagnosed at an earlier age (P=0.04). Patients in AAC had the lowest BMI of 25.6 kg/m² (P<0.0001). The majority of patients in AAC use English as a second language and had lower income. After one year, 37% of patients in AAC achieved the ABC goal, compared to 31% in AAD (P=0.29) and 28% in WAD (P=0.03). Clinical outcomes in AAC were compromised in 2014-2015 in parallel to a transient reduction in Asian Clinic providers. The percentage of AAC patients achieving the ABC goal dropped to 29% (P=0.008) and 23% (P<0.001) in 2014 and 2015 respectively. With the restoration of adequate staffing in 2016, the percentage of AAC patients reaching the ABC goal in 2016 increased to 26%, which is comparable to AAD and WAD (P>0.85). Percentage of patients with A1C <7% was not significantly different among groups at the end of the study (P>0.25). Despite financial and language difficulties, staff providing clinical care tailored to the need of AA, the AAC was able to reduce healthcare disparity in metabolic outcomes in Asian Americans with diabetes over a long duration.