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Disparities in Pre-Diabetes

This presentation by Dr. Winston Wong emphasizes the critical disparities seen in prediabetes management across different racial and ethnic groups. It highlights alarming statistics, such as the prevalence of end-stage renal disease and the disproportionate risks of cardiovascular disease faced by African Americans, Latinos, and other minorities. Dr. Wong explores the systemic factors contributing to these disparities, including increased healthcare costs, poor health literacy, and inadequate treatment intensification. He calls for immediate action to implement community-focused interventions aimed at reducing the burden of diabetes and improving health outcomes.

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Disparities in Pre-Diabetes

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  1. Disparities in Pre-Diabetes Winston Wong, MD, MSKaiser PermanenteMedical Director, Community BenefitDirector, Disparities Improvement and Quality InitiativesJuly 12, 2010

  2. A Family at Risk: America at Risk

  3. The Burden of diabetes • End stage renal disease prevalence: • 3.2 cases per 1000 people years among Caucasians • 4.5 cases among Latinos • 4.6 cases among Asian Americans • 6.8 cases among African Americans

  4. Prediabetes results in early CVD death • Prediabetes is associated with a 2 – 3X additional risk for cardiovascular disease • 75% of hospitalizations among diabetic patients are related to cardiovascular disease

  5. Why are individuals and communities at risk?

  6. Behind closed doors • African Americans are more likely to have worse control of HgbA1c, control of blood pressure and control of “high cholesterol” • Latinos are less likely to “self monitor blood glucose” • All non-white population groups were less likely than Caucasians to be “intensified” in treatment for poorly controlled for elevated HgbA1c

  7. Systems are at play • When patients burden of costs increase for management, adverse outcomes are more likely • Among African Americans, missed medications are associated with worsening diabetes, blood pressure and lipid control • Poor health literacy is associated with poorer outcomes

  8. What do we know that is effective?

  9. Environmental > Systems >Evidence Based Practice The burden of disease must be addressed NOW • Anti-Platelet Trialists • HOT • HOPE • EUROPA • 4S • HPS Yusuf, S. Lancet 360: July 6, 2002

  10. Steno-IICVD Events Combining ALL reduces CVD by nearly 50% over 8 years Hazard ratio .47, p=.008 NEJM 2003:348:383-93

  11. “A.L.L.” Community Intervention Focused intervention of low income, vulnerable populations in the community

  12. Excellent Enrollment Trends Across 5 Pilot Clinics NCHS: North County Health Services VCC: Vista Community clinic CHC: Comprehensive Health Center SDFC: San Diego Family Care LM: La Maestra

  13. Impact of ALL: Number of Cardiovascular Events Prevented Kaiser Permanente, Oakland California/ United States Lancet. 2002 Jul 6;360(9326):23-33. N Engl J Med. 2000 Jan 20;342(3):145-53.

  14. Disparities in Prediabetes management: bridge strategies Community engagement Sick-care Disease Management Chronic Condition Care Public Health

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