Diabetes Mellitus Control among People of Haitian Descent

Diabetes mellitus is one of the major health concerns in the communities of the people of Haitian descent [1]. When uncontrolled, it is responsible for a substantial number of health complications such as diabetic retinopathy (ocular damage), coronary disease, congestive heart failure, neuropathy (nerve damage), ischemic stroke, nephropathy (kidney damage), peripheral vascular disease, and lower extremity ulcers.

In a longitudinal study conducted at the Boston Medical Center, the investigators sought to investigate if any differences existed in the frequency of these complications based on ethnicity [2]. 

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The study yielded the following results:

In total, 715 Haitians, 1,472 African Americans, and 466 non-Hispanic Whites, aged 20 years and older and diagnosed with diabetes, participated in this two-year longitudinal study. The data revealed a low percentage of Haitians (32%) who could communicate with their English-speaking providers. They were less likely to be obese with an average BMI of 24.0kg/m2 to 36.8kg/m2 and to smoke. However, they noticeably benefitted the least from the available services in primary health care and endocrinology.

Overall, these people of Haitian descent had a “higher risk of poor glycemic control” than the African Americans and the non-Hispanic Whites with an average A1C varying from 6.3mmHg to 10.1mmHg, even after controlling for other variables. Apart from their elevated A1C or glucose levels for the past three months, the people of Haitian origin were also at higher risk for uncontrolled blood pressure. In contrast, their risk for uncontrolled LDL cholesterol only exceeded that observed among the non-Hispanic Whites.

Contrary to expectations, the investigators discovered that “the rates of diagnosed and documented complications were lower in the Haitian group than in either comparison group”.

To explain this discrepancy, the investigators raised the possibility that these complications were not properly detected by the health professionals due to bias or discontinuity in patient care. Among the “patient-level factors”, they incriminated the “consumption of a traditional high-carbohydrate Haitian diet” as potential contributor of diabetes mismanagement in this category of patients.

As suggested in this article, targeting uncontrolled diabetes among the people of Haitian descent requires taking approaches that are culturally sensitive to optimize the chances of reduction of these health disparities in this ethnic population.


References

1. Allen, J. D., Mars, D. R., Tom. L., Apollon, G., Hilaire, D., Iralien, G., … Zamor, R. (2013). Health beliefs, attitudes and service utilization among Haitians. Journal of Health Care for the Poor and Underserved, 24(1), 106-119. doi: 10.1353/hpu.2013.0015

2. Vimalananda, V. G., Rosenzweig, J. L., Cabral, H. J., David, M. M., & Lasser, K. E. (2011). Comparison of diabetes control among Haitians, African Americans, and non-Hispanic whites in an urban safety-net hospital. Diabetes Care, 34(1), 58-60. doi: 10.2337/dc10-1387