A Patient-Centered Strategy to Reduce Diabetes Disparities in Chinese Americans

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Project Summary/Abstract The number of adults with diagnosed diabetes in the US increased 61% from 1991 to 2001 and will double by 2050. Diabetes is the sixth most common cause of death, causing cardiovascular and kidney disease, blindness, and lower limb amputations. Improved disease management can reduce morbidity and mortality from diabetes. Unfortunately, diabetes patients, especially immigrants and minorities, often do not receive recommended levels of care, indicating a critical need for developing culturally-appropriate and effective strategies that can be incorporated into existing medical practices. Diabetes has emerged as a new epidemic across the US and diabetes rates are growing faster among Asian Americans and Pacific Islanders than in any other racial/ethnic group. In particular, diabetes rates for Chinese are higher in the US than in native countries, and rates have been demonstrated to increase with acculturation. Approximately 15% of Chinese are diagnosed with diabetes, ~ 2.5 times higher than in the general U.S. population (5.9%). Also, Chinese American diabetes rates are 5 to 7 times higher than in their native countries.However, there continues to be a lack of support for national, community and academic efforts to collect Chinese diabetes data. This may be related to the relative lack of political influence and the model minority myth among Chinese Americans. This proposed project is a community-academic collaboration between Asian Health Services (AHS), the Association of Asian Pacific Community Health Organizations, and the University of Calilfornia, Berkeley that includes a Chinese American community advisory board consisting of Chinese diabetics, family members, providers, and advocates that are engaged in all phases of the project. It will assess whether a multi-level pilot team care intervention, incorporating culturally and linguistically-proficient clinical care, family education, and community promotion, is feasible, effective, and affordable for improving diabetes care and outcomes compared with usual care model among underserved Chinese Americans at AHS. 74% of patients at AHS are Chinese, 67% of patients are at or below 100% federal poverty level and 86% are best served in a language other than English. Data will be analyzed using qualitative and quantitative techniques. A particular strength of this project is that it will build on an existing collaborative, the Diabetes Care Initiative, that was started by Chinese patients and providers at AHS, a safety net federally qualified health center, in Alameda County, California. This community-based collaborative seeks to increase patient-centered care and to promote healthy dietary and physical activity behaviors in Chinese diabetics. Ultimately, it aims to promote healthy behaviors among Chinese diabetics, their family members, and the community at-large to prevent adverse diabetes outcomes and prevent new diabetes cases in Alameda County and beyond. Project Narrative This project was started up by Chinese diabetes patients and doctors at a clinic, because diabetes has become a big issue for Chinese people. The clinic's patients, their families, and doctors will work with local researchers to find ways to improve diabetes care in the clinic and to help educate patients and their families.