Over one in 10 adults in America have been diagnosed with diabetes. Of the 34 million American adults that are affected, more than half belong to racial and ethnic minority groups, with some subgroups being more susceptible to the disease than others. A study on the racial and ethnic disparities in prevalence and care of patients with Type 2 diabetes found that 9% of Asian Americans, 13.2% of African Americans, and 13.9% of Mexican Americans have been diagnosed with diabetes, while only 7.6% of White Americans have been diagnosed.
Diabetes occurs as a result of the body’s inability to produce or make use of insulin, a hormone produced by the pancreas. There are two types of diabetes, Type 1 and Type 2, and each affects individuals differently. People suffering from Type 1 diabetes do not produce insulin, while those with Type 2 diabetes do not react appropriately to insulin production.
The disproportionate prevalence — particularly of Type 2 diabetes — in minority groups can largely be attributed to a number of social factors, such as a lack of access to education about diabetes prevention and treatment. Educated individuals are generally more aware of diabetes risk factors — like physical inactivity and poor diet — and more likely to reduce harmful behaviors. In comparison to White Americans, members of minority groups have more limited access to quality education, resulting in a sizable education gap between White Americans and minority Americans. This gap can ultimately be attributed to the fewer resources available at schools attended largely by students of color, including disparate access to college-preparatory or college-level courses and less qualified educators.
The lack of access to higher quality education plays a role in the unequal predominance of disease in minority Americans, as they may be unaware of the preventative actions that they can take to stave off the onset of Type 2 diabetes, such as exercising and eating healthy. However, additional external factors can make it more difficult for minority individuals to implement these measures.
Minority groups, including African Americans and Mexican Americans, are more likely to live in poorer, more malnourished neighborhoods referred to as “food deserts.” In such areas, inhabitants experience difficulty accessing affordable, healthy foods and, as a result, are more inclined to consume more readily available low-nutrition options. Additionally, the deficiency in economic and social resources in impoverished neighborhoods contributes to the lack of adequate exercise spaces for minority individuals. As a result, minority Americans’ are less likely and less able to incorporate routine exercise and healthy eating into their lifestyles. This often results in insulin resistance and hypertension, both of which are characteristic of Type 2 diabetes.
Elias Spanakis and Sherita Golden, researchers at the Johns Hopkins University School of Medicine, looked at several studies regarding the effects of glucose metabolism and insulin resistance on the onset of diabetes in minority groups. In comparison to White Americans, African Americans, Mexican Americans and Asian Americans are more likely to experience significant levels of insulin resistance and hyperinsulinemia, a condition in which higher-than-normal levels of insulin accumulate in the body; however, despite displaying a higher degree of insulin resistance, Asian Americans also experienced lower levels of insulin secretion in comparison to White Americans.
Insulin resistance, paired with glucose intolerance, directly correlates with higher body mass index (BMI). As BMI increases in response to stronger and more frequent heart contractions, cardiac output and blood pressure increase as well. Exercise can combat high blood pressure levels by reducing the amount of effort the heart requires to pump blood to the body and, in turn, aid the insulin resistance characteristic of Type 2 diabetes by increasing the expression of insulin receptor genes in the body.
Elevated BMI levels often serve as a good indicator of obesity, and a relationship certainly exists between obesity and the development of Type 2 diabetes in minority groups. African Americans endure the highest obesity rate, while Asian Americans experience, overall, a much lower rate. However, considerable variation does exist among Asian American subgroups; Korean Americans and Chinese Americans experience lower obesity prevalence rates than that of their Viatnemase and Japanese counterparts. In addition, Asian Indians endure an inexplicably high Type 2 diabetes prevalence rate, despite having one of the lowest obesity prevalence rates of the minority groups. Asian Indians’ larger waist circumstance – in comparison to that of White Americans – can account for this difference.
Minority groups often experience higher rates of obesity due to the prevalence of particular societal factors, including increased levels of psychological stressors, higher unemployment rates, fewer places to purchase and consume healthy foods and fewer places to exercise. High stress levels, poor dietary habits, and a lack of exercise lead to the accumulation of fat tissue, increased BMI, and a greater chance of becoming obese, all of which correlate with the advancement of Type 2 diabetes. Thus, losing and keeping off weight, engaging in consistent physical activity, and having a clean diet are key to preventing Type 2 diabetes, and the concern remains that minority groups may be unable to maintain these crucial habits due to socioeconomic factors.
In an effort to minimize the health disparities between and among racial and ethnic groups, multiple systems have been put into place to educate particular subpopulations. For example, the American Diabetes Association’s (ADA) support for the Eliminating Disparities in the Diabetes Prevention, Access, and Care Act (EDDPAC) helps to ensure that the Centers for Disease Control and Prevention (CDC) hosts public educational programs regarding “the effects of diabetes in minority populations… [providing] better diabetes care to minority populations, and [carrying] out culturally appropriate community-based interventions.”
While efforts are currently underway to educate minority populations on various social risk factors, holistic changes are needed to make significant improvements to the lifestyle factors that affect minority communities.