Study: High-risk minority groups not being screened for diabetes

Even for patients with insurance, screening is below desired levels

 MADISON, Wis. -- Although people from certain ethnic groups are at high risk for getting diabetes and should be screened, a new study suggests that such screenings are not being done as often as they should.

Dr. Ann Sheehy, a hospitalist and clinical assistant professor of internal medicine at the University of Wisconsin School of Medicine and Public Health, was lead author of the findings, which will appear in the June edition of Diabetes Care.

The American Diabetes Association (ADA) says that African-Americans, Latinos, Native Americans, Asian-Americans, and Pacific Islanders should be screened through fasting blood tests. The research gathered data from more than 15,000 patients between 2003 and 2007.  All patients were insured and eligible for diabetes screening based on a number of ADA risk factors: 45 years or older, high blood pressure, high cholesterol levels, polycystic ovarian syndrome, obesity, heart disease, history of pre-diabetes, and ethnicity.

Sheehy and her colleagues at the University of Wisconsin Health Innovation Program say according to information obtained from the doctor visits of those in the study, more than 40 percent of minority patients should have been screened for diabetes based on their ethnic background, but were not.

"I believe there is a lack of awareness that minority status is an independent risk factor not only for having diabetes, but for complications with diabetes," she said.  "Minorities get diabetes more often and tend to do worse when they have diabetes.  I don't think providers are necessarily aware of this.  There has also not been enough public and provider education about the increased risks minority patients face not only in getting diabetes but also to have complications with the disease. We hope the information learned in this study will help us care for these patients better."

Sheehy said the research proves that increased screening efforts are needed for minority populations.

"Studies have previously shown that minority preventive care is less optimal due to a lack of health care insurance or lack of clinic visits," she said.  "In this study, we wanted to look at the effect of minority status alone without the confounding effects of lack of insurance or lack of visits.  That's why we only included patients with insurance and mandated at least one visit per year.  So, we were really able to focus on the fact that insurance status and access to care were not factors in our findings. In fact, the minority patients in this study actually had significantly more primary-care visits than our non- minority patients, so access to health care was clearly not a factor in our findings."

Sheehy said it is possible primary-care providers recommended diabetes screening for minorities, but those patients did not follow through on what needed to be done.

"Although we were unable to test for this possibility in the current study, it may be that minorities had unique barriers that prevented them from being able to return for fasting labs as frequently as other patients," she said.  "Historically, a patient would come to clinic, the doctor ordered lab work to be done, and since diabetes screening used to require fasting, the patient would have to return another day after an overnight fast to get this done."

Sheehy says new standards endorsed last year by the ADA that allow a non-fasting test to be done at the same time as the clinic visit may lead to increased diabetes screenings for minorities.

For more information on diabetes programs offered at UW Health, visit


MADISON, Wis. - Feb 25, 2010 - Whooping cough is becoming more common in infants - and a big part of the solution is for women to get a booster vaccination before they become pregnant or right after they give birth.

Also known as pertussis, whooping cough is a contagious bacterial disease of the upper respiratory system. It can lead to uncontrollable coughing and breathing difficulties and can cause permanent disability and even death in infants.

Dr. Jim Conway, an infectious disease specialist and associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health, says that, until they can be vaccinated, infants are totally dependent on the antibodies they get from their mother during pregnancy.

"The baby's primary protection for the first couple of months of life is what they get from mom," Conway says. "So, it is important for moms to get vaccinated, so they can give some immunity to the baby."

But Conway says this rule doesn't apply only to the mother.

"Anyone who has contact with infants should also receive the vaccination so that they don't expose the infant," he says.  "The mother is one part of it, and should receive vaccine either before pregnancy or immediately after delivering.  In addition, all family members should get it."

Dr. Greg DeMuri, also an infectious-disease specialist and associate professor at UW, says there have been greater efforts to get new moms immunized.

"Many women who have given birth have not had a pertussis booster since kindergarten," he says. "Some hospitals are implementing vaccination programs on their labor and delivery units."

The booster vaccine not only protects against whooping cough, but also against tetanus and diphtheria. Infants get their first immunizations in three doses, beginning at two months of age. After that first series, children should receive shots between 15 and 18 months; four to six years; and when they reach age 11 or 12.

Immunizations don't end at childhood, and adults should check with their physicians during routine visits and annual physicals to see if they are due for booster shots to guard against tetanus, an infection often connected to puncture wounds from rusty nails, fish hooks, or open wounds infected by dirt. If left untreated, tetanus may cause muscle contractions and other complications requiring hospitalization.

"Tetanus is a soil microbe, so as long as there is soil, there will be tetanus, and people will be at risk of tetanus contaminating a wound," says DeMuri. "It's completely preventable by vaccination. Adolescents and adults should receive regular boosters every 10 years."

Conway says about 30 to 40 cases are diagnosed annually, and most of them are in the western part of the country and involve people over 40 years old.

"They stop paying attention to their health, think they are super human and don't need the vaccine," he says. "Also, it's not routine practice to administer these vaccines in other countries, and some immigrants may not be protected. Older adults who get tetanus usually survive, but it's an unpleasant condition in which all of your muscles are spasmodic."

Conway says people who get puncture wounds or infected lacerations should get a shot as soon as possible if they are not sure of their vaccination history. However, a product called tetanus immunoglobulin can be given to patients who wait too long and put themselves at greater risk.

"If someone stepped on a nail three or four days ago, and they haven't had a tetanus booster for more than 10 years, tetanus immunoglobulin can provide instant immunity and the antibodies needed to fight off tetanus," he says.