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Haitian Americans show poorer diabetes control

NEW YORK (Reuters Health) - Diabetics of Haitian descent may have a tougher time controlling their blood sugar than their African-American and white counterparts, a study at one U.S. hospital suggests.

The study, published in the journal Diabetes Care, looked at blood-sugar control among more than 2,600 diabetes patients who received primary-care treatment at Boston Medical Center -- a “safety net” hospital that serves a large percentage of low-income patients.

Researchers found that the 715 patients of Haitian descent generally had less control over their blood-sugar levels, as reflected by measurement of a substance in the blood called hemoglobin A1C. Hemoglobin A1C levels are linked with a person’s average blood sugar levels over the previous two to three months.

On average, Haitian patients’ A1C was 8.2 percent, versus 7.7 percent among African American patients, and 7.5 percent among white patients.

In general, people with diabetes are advised to keep their A1C levels at or below 7 percent. Blood-sugar control is key to lowering the risk of long-term diabetes complications like heart disease, kidney failure, vision loss and nerve damage throughout the body.

Moreover, nearly 25 percent of Haitians had an A1C level above 9 percent, which is considered poor blood-sugar control. That compared with 18 percent of African Americans and 15 percent of whites.

The reasons for the discrepancy aren’t clear, according to Dr. Varsha Vimalananda, of Boston Medical Center, and colleagues.

When the researchers accounted for factors like insurance coverage, doctor visits in the past two years and whether patients spoke English, Haitian patients were still much more likely than African Americans and whites to have an A1C level above 9 percent.

This suggests that other factors are at work, according to Vimalananda’s team. One possibility, they write, is the high carbohydrate content of the traditional Haitian diet; another is that culture gaps between doctors and Haitian patients may in some cases hinder communication.

Surprisingly, however, the researchers found that despite Haitian patients’ poorer blood-sugar control, their risk of diabetes complications was lower than that of African-American and white patients.

The Haitians had only about one-third of the risk of complications such as heart disease or clogged arteries in the legs. And they were roughly half as likely to have problems such as nerve or kidney damage.

Again, the reasons are unclear. It’s possible that the Haitians had had diabetes for a shorter period, so that long-term complications wouldn’t yet be apparent.

SOURCE: Diabetes Care, online October 26, 2010.