title: Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes.
abstract: BACKGROUND
  There is strong evidence that race, ethnicity and social determinants of health significantly influence outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships or associations would improve development of cost-effective, culturally tailored programs for patients with diabetes.
  
  
  METHODS
  This article reviews the current state of the literature on the influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature.
  
  
  RESULTS
  The literature review shows that racial or ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure (BP) and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support and perceived stress, show consistent associations with self-care, quality of life and glycemic control. Neighborhood factors, such as food insecurity, social cohesion and neighborhood esthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life.
  
  
  CONCLUSIONS
  Healthcare professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high.
authors.affiliation: Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Joni
authors.initials: J
authors.lastname: Strom Williams
authors.affiliation: Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D003920:Diabetes Mellitus / Q000191:economics / Q000208:ethnology* / Q000628:therapy; D005006:Ethnicity / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology*; D006801:Humans; D044469:Racial Groups / Q000208:ethnology*; D064890:Social Determinants of Health / Q000208:ethnology*; D016896:Treatment Outcome
keywords: Diabetes; Health disparities; Neighborhood factors; Psychosocial factors; Social determinants of health