Current Diabetes Reviews, 2006, 2, 285-293 285 1573-3998/06 $50.00+.00 © 2006 Bentham Science Publishers Ltd. Barriers to Achieving Optimal Glycemic Control in a Multi-Ethnic Society: A US Focus Samuel Dagogo-Jack*, 1 Martha M. Funnell 2 and Jaime Davidson 3 1 Division of Endocrinology, Diabetes and Metabolism, University of Tennessee College of Medicine, Memphis, Tennessee, USA 2 Michigan Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan, USA 3 Endocrine and Diabetes Associates of Texas, University of Texas, Southwestern Medical School, Dallas, Texas, USA Abstract: The increasing prevalence of diabetes is particularly apparent in certain ethnic groups, such as African and Hispanic Americans. These groups generally also have poorer glycemic control and outcomes. To better understand the issues surrounding these problems and possible methods to overcome them we performed a literature review from the past 15 years on barriers to glycemic control with a focus on US data. The literature reveals that barriers may be inherent (eg, genetic, cultural, and language/communication) or acquired (eg, those associated with changes in lifestyle and socioeconomic factors). Healthcare interventions that take into consideration cultural and population-specific characteristics can reduce the prevalence and severity of diabetes and its resulting complications. Implementing such strategies will require suitable education for patients and providers, the availability of culturally-sensitive, patient-centered healthcare teams, the creation of collaborative relationships between providers and patients, better use of community resources, and assistance for patients to make informed decisions about available treatment options. There is also evidence suggesting that at the same level of glucose control Hispanics and African Americans have the same degree of complications as whites; therefore, good control is essential for the future well-being of all patients. Addressing these issues may help to decrease the ethnic disparities that currently exist in diabetes care. Keywords: Barriers, Ethnic, Glycemic control, Insulin, Type 2 diabetes. INTRODUCTION Between 1990 and 2000, the total minority population (e.g. Hispanics, African Americans, Asians, Pacific Islanders, American Indians, and Alaskan natives) of the United States increased by 36% [1]. As the United States grows in diversity, healthcare providers are increasingly challenged to understand and address the linguistic and cultural needs of a diverse population. Many ethnic minority populations have a higher incidence of type 2 diabetes and greater rate of under- diagnosis than whites, Fig. (1) [2-6]. Using data from the National Health Interview Survey (1984–2000), Narayan and colleagues [7] estimated lifetime risk of developing diabetes mellitus for individuals born in the USA in 2000. Their estimate was that 33% of males and 39% of females would develop diabetes in their lifetime. The highest estimated lifetime risk was among Hispanics (males, 45%; females, 53%). Certain ethnic groups also have much higher rates of diabetes-related complications and death [8-11]. Genetic predisposition to type 2 diabetes and some of its complications contribute to the ethnic disparities in the prevalence and outcome of type 2 diabetes [2,12-14]. However, the focus of the present review is the barriers to *Address correspondence to this author at the Division of Endocrinology, Diabetes and Metabolism, University of Tennessee College of Medicine, 951 Court Ave RM 335M, Memphis, TN 38163, USA; Tel: +1 (901) 448- 1246; Fax: +1 (901) 448-5332; E-mail: sdagogojack@utmem.edu optimal glycemic control, since glycemic burden is the driving force for many of the long-term complications of diabetes [15,16]. By reviewing issues surrounding poor Fig. (1). Mean glycosylated hemoglobin (A1C) for adults aged ≥20 years with normal fasting glucose, impaired fasting glucose, undiagnosed diabetes, and diagnosed diabetes, according to race or ethnicity. Reprinted with permission from The American Diabetes Association. Harris et al. Diabetes Care. 1999;22: 403-408. Copyright © 1999 American Diabetes Association [4].