Diabetes management in urban African Americans: review of a public hospital experience.
OBJECTIVE
To review characteristics of an urban (primarily African American) diabetes patient population and discuss experience with treatment strategies, we summarize key retrospective and prospective analyses conducted during 15 years.


RESULTS
Severe socioeconomic and personal barriers to diabetes care were often seen in the population. An atypical presentation of diabetic ketoacidosis was observed and extensively studied. A structured diabetes care delivery program was implemented more than three decades ago. A better understanding of how to provide simpler but effective dietary education and factors that affect lipid levels were elucidated. The phenomenon of clinical inertia was described, and methods were developed to facilitate the intensification of diabetes therapy and improve glycemic control.


CONCLUSIONS
Structured diabetes care can be successfully introduced into a public health system and effective diabetes management can be provided to an under-served population that can result in improved metabolic outcomes. Lessons learned on diabetes management in this population can be extended to similar clinical settings.
Ziemer
David C
DC
Department of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA.
El-Kebbi
Imad M
IM
Umpierrez
Guillermo E
GE
Rhee
Mary K
MK
Phillips
Lawrence S
LS
Cook
Curtiss B
CB
D001741:Black or African American / Q000706:statistics & numerical data*; D000553:Ambulatory Care / Q000458:organization & administration*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000458:organization & administration*
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