Diabetes: Exploring racial inequities

The National Diabetes Statistics Statement released by the Centers for Disease Control and Prevention (CDC) this year reveals stark racial disparities in the prevalence and incidence of diabetes across the United States.

The 2020 National Diabetes Statistics report examines trends in diabetes incidence - that's, new cases of the problem - and prevalence - meaning existing cases of diabetes over the U.S. from 2008-2018.

The report makes no distinction between type 1 and type 2 diabetes, though it will probably be worth noting that approximately 90-95% of adults with diabetes have type 2 diabetes.

Overall, the number of adults newly identified as having diabetes decreased found in this decade. But, of the new cases, non-Hispanic Black adults and persons of Hispanic descent produced up the best proportion.

Of the existing diagnosed cases, diabetes was most prevalent among American Indians/Alaska Natives (AI/AN), in line with the report.

In this post, we explore these disparities in further detail, search for possible explanations, and examine the implications for health equity.

2020 Diabetes record: A racial breakdown

Based on the new CDC article, more than 1 in 10 persons in the U.S., round 34.2 million, live with diabetes, 34.1 million of whom are adults.

Of the, the paper estimates that 26.9 million possess a medical diagnosis of the condition.

The “Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic [Black Americans] (11.7%),” notes the article.

Non-Hispanic Asian Americans used, with a prevalence of 9.2%, and non-Hispanic white Americans, with 7.5%. AI/AN women had an increased prevalence of diabetes than AI/AN men.

In terms of incidence, or fresh cases, the most recent report recorded 1.5 million new cases of diabetes among U.S. adults in 2018. Of the, non-Hispanic Black adults possessed an incidence of 8.2 per 1,000 people, while those of Hispanic origin accounted for 9.7 per 1,000.

In comparison, the incidence for non-Hispanic white adults was 5.0 per 1,000 people.

These race-related health disparities are not latest. A 2012 editorial by the American Diabetes Association observed that “18.7% of most African Americans ≥ 20 years of age, have diagnosed or undiagnosed diabetes, in comparison to 7.1% of non-Hispanic white Americans.”

The risk of growing diabetes was “77% bigger among African Americans than among non-Hispanic white Americans.”

Going further back again to 2006, “African Americans with diabetes had been 1.5 times much more likely to be hospitalized and 2.3 times much more likely to die from diabetes than non-Hispanic whites” that year, in line with the same editorial.

The authors also quoted a mature 2003 report, where the Institute of Medicine discovered that “African Americans, Hispanics, and Native Americans experience a 50-100% higher burden of illness and mortality from diabetes than white Americans.”

At the time, practically 16.1% of AI/AN were coping with diabetes, the highest prevalence of the health of all U.S. racial and ethnic groups.

Diabetes and modifiable risk factors

What are the reason why behind these disparities? Studies indicate common risk factors - that tend to be more common amongst minority ethnic groups in America, particularly among Dark Americans - such as for example abdominal fat, high blood circulation pressure, and having overweight or obesity.

These factors are believed modifiable. This means persons might help reduce their results through dietary changes and way of living choices such as doing exercises and a healthful diet plan.

However, it is crucial to acknowledge the socioeconomic and systemic barriers that tend to be in the form of certain groups implementing these alterations.

Residential segregation, stress, and cardiometabolic health

At MNT, we've explored a few of these barriers. Residential segregation is usually one of them, as experts repeatedly tell us.

For example, living in poorer neighborhoods without close usage of supermarkets and food markets, or moving into unsafe or over-policed areas where exercising outdoors can pose a risk to one’s safety are only some of the things to consider when discussing the “modifiable” risk factors for conditions such as diabetes.

Furthermore, the strain induced simply by racial discrimination or by residing in poor conditions contributes drastically to cardiometabolic risk. As Dr. Donald Warne, president and CEO of American Indian Health Management and Policy, comments, “You will find a direct biochemical connection between moving into poverty and the strain that people happen to be under and blood sugar control.”

“If you are within an impoverished community and you don’t have healthy selections for food and […] safe and sound places to exercise, you are tremendously disempowered with regards to an illness like diabetes.”

- Dr. Donald Warne

Harvard University professor David R. Williams echoes the same sentiment, pointing out that the stressors that African Americans and other minority groups happen to be more subjected to may raise blood pressure and also have implications for cardiometabolic health.

“Minorities experience higher degrees of stress […] and greater clustering of stress,” Prof. Williams says. “In addition to the traditional stressors, minorities experience the stress of racial discrimination that has been shown to have negative effects on physical and mental health.”

So, explaining the higher incidence of diabetes among these groups exclusively through biological risk factors is only telling half the report, ignoring the deeper complexities of how social and cultural factors affect a person’s biology and wellness.

The importance of early lifestyle and maternal health

The most comprehensive overviews of racial wellness disparities found in endocrine disorders was published found in the Journal of Clinical Endocrinology & Metabolism in 2012, which points to an interplay of clinical and biological factors, health behaviors, and environmental influences.

The paper is a self-titled “Endocrine Society Scientific Affirmation,” led by Sherita Hill Golden from the Department of Medicine at Johns Hopkins University School of Medicine in Baltimore, MD.

In it, the authors identify many “themes” that may make clear the racial disparities in diabetes and other endocrine disorders. Firstly, they remember that obesity - more prevalent among Dark Americans - and overweight - which is more frequent among American Indians - is usually partly responsible for the higher rates of the problem in these groups.

In addition they mention that exercise levels are lower among non-Hispanic Black adults and Native Americans, while smoking is more frequent.

However, the authors also emphasize the value of environmental influences and early life events for triggering obesity and type 2 diabetes.

“[E]arly life conditions, such as for example prenatal undernutrition and stress, maternal stress, or maternal obesity during pregnancy, may change the developmental biology in offspring, leading to a future increased risk of growing obesity and type 2 diabetes,” write Golden and team.

Mothers with overweight and obesity will give birth to diabetes-predisposed children - this fact, mention the authors, may describe higher rates of the problem found in Native Americans, for example.

On the other hand, specialists also associate lower birth weight with a higher risk of type 2 diabetes, particularly among Black mothers.