The epidemic of type 2 diabetes has had a disproportionate impact on African-Americans, who have increased risk of both the disorder and its complications. The risk of complications has been attributed to poor metabolic control, and our studies show that HbAlc levels are higher in African-Americans than in Non-Hispanic Whites. The mechanisms which underlie such disparities are poorly understood; socioecologic factors may play a role, but management by providers may also contribute - since we find that African-Americans receive lower dosages and less complex insulin regimens. (1) To identify socioecologic factors which contribute to poor control we will measure socioeconomic status and literacy, and assess health care access for African- Americans in a municipal diabetes clinic, and determine the impact of such factors on HbAIc levels both at presentation and after followup. (2) To determine whether diabetes control can be improved with an aggressive, physiologic regimen of insulin administration we will conduct a randomized, controlled trial comparing conventional regimens (beginning with 70/30 insulin twice daily) with a more physiologic regimen (insulin before meals and at bedtime), and assess HbAlc levels; potential adverse effects (hypoglycemia and weight gain); and patient acceptability, adherence, and satisfaction over one year of care. Information from these analyses will be critical to guide development of programs aimed at eliminating the health disparity of African-Armenians with diabetes.
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