title: Characterization of factors affecting attainment of glycemic control in Asian Americans with diabetes in a culturally specific program.
abstract: The purpose of this study is to examine the effectiveness of a culturally specific pilot clinic for Asian Americans (AA) in reaching glycemic target and to characterize factors affecting the attainment of glycemic control in comparison with white counterparts.
  
  
  
  This electronic health record review included all new AA patients with type 2 diabetes (n = 109) in a culturally specific program and a randomly selected sample of new white patients with type 2 diabetes (n = 218) in the adult clinic within the same time period and diabetes center.
  
  
  
  AA and whites had a comparable proportion of patients with A1C ≤7% (32.1%, 34.9%; P = .621) at baseline and after 12 months of care (48.6%, 56.0%; P = .210), with a similar A1C decline (-0.9% ± 1.6%, -0.8% ± 1.7%, P = .710) by 12 months. Factors associated with the lack of success in reaching target in AA but not in whites included older age, lower educational attainment, less likelihood of having health insurance, and a need for more educational visits. The percentage of AA reaching A1C ≤7%, as compared to whites, worsened among those with highest initial A1C when stratified by ascending quartiles (96.7% vs 85.2%, P = .101; 61.9% vs 58.9%, P = .813; 24.0% vs 37.7%, P = .230; 15.2% vs 35.4%, P = .044).
  
  
  
  While a culturally specific diabetes program in a specialty setting achieved a similar glycemic outcome for AA compared with whites, reasons for not reaching glycemic target differed. The findings suggest that the elimination of diabetes disparities requires not only culturally and linguistically specific programs, but must also identify and address the socio-environmental differences unique to each population.
authors.affiliation: Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Mr Le, Mrs Wong, Mrs Iftikar, Dr King, Dr Hsu)
authors.forename: Hung
authors.initials: H
authors.lastname: Le
authors.affiliation: Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Mr Le, Mrs Wong, Mrs Iftikar, Dr King, Dr Hsu)
authors.forename: Sophia
authors.initials: S
authors.lastname: Wong
authors.affiliation: Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Mr Le, Mrs Wong, Mrs Iftikar, Dr King, Dr Hsu)
authors.forename: Tracy
authors.initials: T
authors.lastname: Iftikar
authors.affiliation: Dianne Nunnally Hoppes Laboratory for Diabetes Complications, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Dr Keenan, Dr King)
authors.forename: Hillary
authors.initials: H
authors.lastname: Keenan
authors.affiliation: Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Mr Le, Mrs Wong, Mrs Iftikar, Dr King, Dr Hsu)|Dianne Nunnally Hoppes Laboratory for Diabetes Complications, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Dr Keenan, Dr King)
authors.forename: George L
authors.initials: GL
authors.lastname: King
authors.affiliation: Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts (Mr Le, Mrs Wong, Mrs Iftikar, Dr King, Dr Hsu)
authors.forename: William C
authors.initials: WC
authors.lastname: Hsu
mesh_terms: D000368:Aged; D001213:Asian / Q000523:psychology; D001786:Blood Glucose / Q000378:metabolism*; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology / Q000523:psychology; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D054625:Healthcare Disparities; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D015995:Prevalence; D011320:Primary Health Care; D015397:Program Evaluation; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000523:psychology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human