Minorities in U.S. bear the brunt of growing diabetes epidemic

Obesity and sedentary lifestyle trigger disease among high-risk groups

Health care professionals are challenged on a daily basis to find new ways to treat, educate, and motivate their patients in the face of what is rapidly becoming a health care emergency: uncontrolled diabetes.

Although physicians may be alarmed by how common diabetes is becoming in their practices today, patients often don’t seem to share their concern. A trend, especially prominent in our minority populations, points to a problem existing beyond a particular race. A lifestyle of overeating and remaining inactive allows this potentially deadly disease to strike its victims at a younger age, causing more disability and ultimately taking more lives.

Minorities bear a disproportionate share of the disease in American society. Health care professionals know the epidemic is treatable and manageable, but they have yet to find a way to get more people at the highest risk to comply with a more health-conscious lifestyle.

The data support what some might otherwise take as hyperbole. According to the Centers for Disease Control and Prevention in Atlanta and the American Diabetes Association in Alexandria, VA, the current situation is as follows:

o All minorities in the United States suffer diabetes at a far higher rate than whites.

o Nearly 6% of the general population has diabetes, diagnosed and undiagnosed, with nearly 800,000 new cases diagnosed each year. Of those, approximately 90% have Type II diabetes, and 80% of Type II diabetics are obese.

o Diabetes causes an enormous drain on the health care system, costing in excess of $92 billion per year in direct medical costs. For minority groups, the numbers are even more significant:

— Native Americans: 12.2 % of the population over the age of 19 is diagnosed as diabetic. The undiagnosed rate is estimated to be almost equal to the number of those diagnosed. On the average, Native Americans are 2.8 times as likely to have diagnosed diabetes as whites of a similar age.

The Pima Indian tribe in southern Arizona has the highest rate of diabetes in the world. Half of the tribe’s adult members have diagnosed diabetes, and the tribe suffers an alarming rate of complications with a rate of diabetic end-stage renal disease six times higher than the white rate.

— African Americans: 10.8% have been diagnosed as diabetics. They are 1.7 times more likely to have diabetes than whites of a similar age. Of African Americans between the ages of 65 and 74, 25% have diabetes.

One in four black women over the age of 55 has diabetes. African Americans are 40% more likely to experience severe visual impairment than whites, and black women are three times more likely to go blind than white women. In addition, blacks are 72% more likely to have diabetes-related lower extremity amputations and 117% as likely to have amputations than Hispanic-Americans.

— Mexican-Americans: 10.6% of the population is diagnosed, with 1.9 times greater likelihood of having diabetes than whites of a similar age.

Other Hispanics have correspondingly high rates of diabetes: 24% of Mexican Americans and 26% of Puerto Ricans between the ages of 45 and 74 have diabetes. Nearly 16% of Cuban Americans between the ages of 45 and 74 have diabetes.

— Other groups: While Asian Americans and Pacific Islanders are also at great risk for diabetes, insufficient numbers of definitive studies have been done to determine prevalence rates or incidence of complications.

Anecdotally, researchers say when Asians adopt a western diet high in fat, whether in their home countries or as a result of migration, their experience of diabetes increases dramatically.

Why are certain groups more at risk?

The general population is becoming fatter and more sedentary, but the reasons for the extremely high risk of diabetes among minorities are still baffling.

One concept that receives a great deal of credence in some circles is the "thrifty gene" theory supported by nearly 20 years of research. Thrifty genes harken back to prehistoric times when those most likely to survive were those who could store enough fat needed to live through long periods of starvation. Since the fittest survived, at least long enough to reproduce, they carried that gene forward to a society where the storage of fat is not only unnecessary, it can be a fatal flaw. (For more information on incidence of the disease by race, see chart, p. 14.)

Whites may have these thrifty genes, too, since until fairly recently, people were all hunter-gatherers. It’s possible, however, that due to differences in socioeconomics, more minorities go on to express these genes and suffer their consequences. Their greater risk of developing the disease, compounded by the realities of poverty, probably contribute much to producing these sobering statistics.

This issue of Diabetes Management and future issues will examine the impact of diabetes on minorities from a variety of perspectives, as well as present different methods of raising patient awareness and helping more patients control the disease.