Ethnic differences in outcomes of diabetes care and the role of self-management behavior

Patient Educ Couns. 2008 Jul;72(1):146-54. doi: 10.1016/j.pec.2008.03.008. Epub 2008 May 1.


Objective: Ethnic differences in outcomes of outpatient diabetic care and the role of self-management behavior and its determinants in explaining observed differences.

Methods: Face-to-face interviews were held with 102 Turkish or Moroccan, and 102 native Dutch diabetic patients to measure self-management behavior and determinants of self-management (as derived from the Attitudes-Social support self-Efficacy model, and Personal Models and Barriers). A medical record review was conducted to measure ethnic differences in outcomes of diabetes care. Data were analyzed using multiple linear regression.

Results: Outcomes differed significantly with ethnic minorities having higher levels of lipids (risk difference=RD=0.7%; CI: 0.3-1.2) and HbA1c (RD=0.9%; CI: 0.4-1.4) than native Dutch patients. Differences in self-management could not explain the ethnic differences in outcomes. Self-efficacy explained 18% of the ethnic differences in HbA1c. Beliefs about seriousness of diabetes and social support regarding diabetes management together explained 47% of the ethnic differences in lipids.

Conclusion: This study provides evidence for ethnic differences in outcomes of diabetes care. Self-efficacy is the most important determinant in explaining the differences in HbA1c.

Practice implications: For diabetes practice this suggests that strengthening patients' self-efficacy may improve the control of HbA1c and may result in a decrease of ethnic differences. The relationship between behavioral determinants like seriousness and social support and outcomes of diabetes care was differential by ethnic group, implying that caution is required when applying behavioral models to different ethnic groups.

Publication types

  • Comparative Study

MeSH terms

  • Attitude to Health / ethnology*
  • Body Mass Index
  • Cross-Cultural Comparison
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / ethnology*
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 1 / prevention & control
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / prevention & control
  • Emigrants and Immigrants / education
  • Emigrants and Immigrants / psychology
  • Female
  • Glycated Hemoglobin A
  • Health Behavior / ethnology*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hyperlipidemias / etiology
  • Linear Models
  • Male
  • Middle Aged
  • Models, Psychological
  • Morocco / ethnology
  • Netherlands
  • Residence Characteristics
  • Self Care / methods
  • Self Care / psychology*
  • Self Efficacy*
  • Social Support
  • Surveys and Questionnaires
  • Treatment Outcome
  • Turkey / ethnology


  • Glycated Hemoglobin A