title: Diabetes care among Somali immigrants and refugees.
abstract: The risk for development of diabetes and associated complications among immigrants increases in the years after arrival to the United States. Somali immigrants and refugees represent the largest subset of African immigrants to the United States, yet little is known about the quality of their diabetes care. Therefore, adherence with diabetes quality indicators (Hemoglobin A1C <7%, LDL cholesterol <100 mg/dl, blood pressure <130/80 mm Hg) were compared between Somali and non-Somali patients with diabetes at a large academic primary care practice in the United States in 2008. Demographic and health-seeking behavior variables were assessed for association with adherence among the Somali population. A total of 5,843 non-Somali and 81 Somali patients with diabetes were identified. Somali patients with diabetes were less likely to meet the criteria for optimal glycemic control than non-Somali patients (40.6% vs. 53.9%; P=0.02). There was a similar, though statistically non-significant, trend towards lower rates of lipid control among Somali patients. There was no difference in achievement of optimal blood pressure between the two groups. There was a strong association between number of primary care visits during the study interval and achievement of all three diabetes care quality goals. This study demonstrates disparities in achievement of diabetes management quality goals among Somali patients compared with non-Somali patients, highlighting the need for additional system and practice changes to target this particularly vulnerable population.
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55904, USA. wieland.mark@mayo.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wieland
authors.forename: T Ben
authors.initials: TB
authors.lastname: Morrison
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Rahman
authors.forename: Rajeev
authors.initials: R
authors.lastname: Chaudhry
mesh_terms: D000328:Adult; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000032:analysis; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care; D012036:Refugees / Q000706:statistics & numerical data*; D012998:Somalia / Q000208:ethnology; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
references.citation: JAMA. 2004 Dec 15;292(23):2860-7
references.pmid: 15598917
references.citation: J Am Board Fam Med. 2007 Nov-Dec;20(6):598-605
references.pmid: 17954868
references.citation: Med Care Res Rev. 2009 Aug;66(4):355-408
references.pmid: 19179539
references.citation: CMAJ. 2010 May 18;182(8):781-9
references.pmid: 20403889
references.citation: J Public Health (Oxf). 2008 Mar;30(1):110
references.pmid: 18004012
references.citation: Health Serv Res. 2005 Apr;40(2):361-72
references.pmid: 15762896
references.citation: J Nerv Ment Dis. 2008 Feb;196(2):108-12
references.pmid: 18277218
references.citation: Arch Intern Med. 1975 Jun;135(6):811-7
references.pmid: 1130926
references.citation: Diabetes Care. 2008 Jan;31 Suppl 1:S12-54
references.pmid: 18165335
references.citation: Am J Prev Med. 2004 Nov;27(4):323-6
references.pmid: 15488363
references.citation: Am J Public Health. 2001 Mar;91(3):392-9
references.pmid: 11236403
references.citation: J Hum Hypertens. 1995 Apr;9(4):245-8
references.pmid: 7595906
references.citation: Prev Med. 2004 Dec;39(6):1068-76
references.pmid: 15539038
references.citation: Prev Chronic Dis. 2004 Apr;1(2):A03
references.pmid: 15663879
references.citation: J Gen Intern Med. 2000 Dec;15(12):878-80
references.pmid: 11119184
references.citation: JAMA. 2002 Jul 24-31;288(4):475-82
references.pmid: 12132978
references.citation: J Hum Nutr Diet. 2009 Apr;22(2):116-21
references.pmid: 19302117
references.citation: Diabetes Care. 2005 Sep;28(9):2280-8
references.pmid: 16123507
references.citation: J Gen Intern Med. 2011 Feb;26(2):170-6
references.pmid: 20878497
references.citation: Diabetes Care. 2009 Aug;32(8):1459-63
references.pmid: 19502546
references.citation: J Immigr Minor Health. 2009 Dec;11(6):460-7
references.pmid: 18379877