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Minority Americans suffer most from diabetes

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November is American Diabetes Month. A little vague on what diabetes is, eh? Has something to do with blood. . . but what? Are people born with it or do they catch it? Isn’t that amputee down the street a diabetic? You can learn about diabetes, and the more than 16 million Americans who are known to have it, by visiting the site of the American Diabetes Association. You will also find information about diabetes at weblogs this months. I’ve joined many other bloggers in Blogging for a Cure.

Though diabetes is a medical condition that impacts the entire American population to a nearly epidemic extent, some groups suffer from the disease more than others. African Americans and Native Americans are particularly susceptible. Asian Americans are becoming more susceptible and Asians will be half of diabetics worldwide by 2025.

Today, diabetes mellitus is one of the most serious health challenges facing the United States. The following statistics illustrate the magnitude of this disease among African Americans.

  • 2.3 million African Americans have diabetes.

  • For every six white Americans who have diabetes, 10 African Americans have diabetes.

  • Approximately 10.8 percent of all African Americans have diabetes.

  • African Americans with diabetes are more likely to develop diabetes complications and experience greater disability from the complications than white Americans with diabetes.

  • Death rates for people with diabetes are 27 percent higher for African Americans compared with whites.

  • Most persons of West African descent have Type II diabetes, which is caused by depressed insulin secretion and the body resisting usage of whatever insulin is available. There are two theories about what causes the high rate of diabetes among Americans of color. Some researchers believe there is a genetic basis. Others assert environmental and lifestyle differences, such as being overweight and lack of physical activity, are at fault. Both are more common among African Americans than among white Americans.

    Native Americans have diabetes at an even greater rate than African Americans. In addition, Indian children are more likely to be diagnosed as diabetics.

    About 15 percent of American Indians and Alaska Natives who receive care from the Indian Health Service have been diagnosed with diabetes, a total of 105,000 people. On average, American Indians and Alaska Natives are 2.6 times as likely to have diagnosed diabetes as non-Hispanic whites of a similar age. The available data probably underestimate the true prevalence of diabetes in this population. For example, 40 to 70 percent of American Indian adults age 45 to 74 were found to have diabetes in a recent screening study in three geographic areas. Data from the Navajo Health and Nutrition Survey, published in 1997, showed that 22.9 percent of Navajo adults age 20 and older had diabetes. Fourteen percent had a history of diabetes, but another 7 percent were found to have undiagnosed diabetes during the survey.

    Type 2 diabetes is becoming increasingly common in youth. Researchers studying 5,274 Pima Indian children from 1967 to 1996 found that the prevalence of type 2 diabetes in girls ages 10 to 14 increased from 0.72 percent in the period 1967 to 1976 to 2.88 percent in the period 1987 to 1996. Reports include an increasing incidence in First Nation populations in Canada.

    Studies of the Pimas suggest a genetic link to insulin production and resistance.

    Although the specific genes responsible for the inheritance of type 2 diabetes have not been located, NIDDK scientists studying the Pima Indians have identified a gene called FABP2 that may play a role in insulin resistance. More recent studies have shown that a variant in the PPPIR3 gene that is more common in Pimas than Caucasians is associated with type 2 diabetes and insulin resistance.

    However, again, envirommental and lifestyle differences are likely to largely explain the high rate of the disease among a minority group. African-Americans and Indians are the poorest of Americans and most likely to be in bad health. Among the impacts of their poverty is lack of access to medical care that might prevent development of diabetes or other diseases.

    The connection of diabetes to non-whites does not stop with people of West African and Indian descent. Asians, including Asian Americans, have the fastest growing rate of the disease in the world.

    The incidence of diabetes in Asians and Pacific Islanders is growing at an alarming rate with 90-95% being type 2 diabetes. The World Health Organization (WHO) estimated that the number of individuals affected by diabetes mellitus in 1995 had increased to 135 million from the 1985 estimate of 30 million, and it is projected that 300 million people will be affected by 2025. Approximately half of this population will be Asians and Pacific Islanders. China is predicted to have the highest rise in prevalence rate (68%) followed closely by India (59%) and other Asian countries and Pacific Islands (41%).

    . . .The high prevalence of diabetes in Asian immigrants may be a result of westernization and urbanization with an increase in consumption of animal fat and sedentary lifestyle, superimposed upon a predisposed genetic background. Diabetic risk was reported to be associated with obesity – defined as an increase in body mass index (weight in kg divided by the square of height in m) and, in particular, with increased central adiposity (fat belly).

    What can be done about a disease that is crippling and hastening the deaths of millions of Americans, a disproportion of whom are people of color?

  • Research. Preliminary research, as stated above, has identified two genes that may play a role in the development of Type II diabetes. Additional funding could greatly accelerate the investigation of that and other possible genetic contributors to the illness. In addition to lobbying the government, consider making your workplace United Way contribution to the ADA.

  • Preventive care. Health departments need to identify families at a risk for developing diabetes before the disease manifests itself. In a time of cuts in Medicaid and state health care funding, that is occurring less often. Lean on your state government, particularly, in regard to childrens’ healthcare.

  • Lifestyle changes. Like charity, healthcare begins at home. All Americans, including minorities, can greatly reduce their and their childrens’ risk of developing diabetes by exercising, eating a balanced diet and being tested for early signs of the disease.

  • Note: This entry also appeared at Silver Rights.

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