Episode 106: Understanding Your Diabetes Medication

Your Diabetes Medication

Diabetes in Black Americans: How to Lower Your Risk

Black Americans are disproportionately affected by diabetes, but education and lifestyle changes can reduce the risk.

Tracy E. Hopkins

By Tracy E. HopkinsMedically Reviewed by Kacy Church, MD

Reviewed: May 16, 2023FacebookTwitterPinterestCopy Link

Medically Reviewed

diabetes-in-african-americans-how-to-lower-your-risk Controlling Blood Sugar
Type 2 diabetes is characterized by high blood sugar.iStock

More than 100 million American adults live with diabetes or prediabetes. But despite the prevalence of these conditions among different racial and ethnic groups, the Black American community is disproportionately affected, according to the Centers for Disease Control and Prevention (CDC).

In the United States, African American adults were 60 percent more likely than non-Hispanic white adults to be diagnosed with diabetes in 2018, and non-Hispanic Black Americans were twice as likely as non-Hispanic white Americans to die of diabetes in 2019, according to statistics from the U.S. Department of Health and Human Services Office of Minority Health.

About 4.9 million African Americans aged 20 years or older have been diagnosed with diabetes, according to the American Diabetes Association. African American women who develop gestational diabetes during pregnancy face a 52 percent increased risk of type 2 diabetes in the future than Caucasian women diagnosed with gestational diabetes.

Other research shows that Black people tend to experience more diabetes-related complications, like diabetic retinopathy and neuropathy, than non-Hispanic white Americans.

RELATED: How to Help Prevent Kidney Disease When You Have Diabetes

Researchers believe that genetic, environmental, socioeconomic, physiological, and behavioral factors are all contributors to this health disparity, notes the National Institutes of Health (NIH).

Boxed In: What COVID-19 Has Taught Us About Racism As a Public Health Crisis

Recorded 11/09/20. In this episode of Boxed In, psychiatrist and Everyday Health Medical Editor in Chief Patrice Harris, MD, discusses how disparities within the healthcare system lead to vastly different health outcomes for Black Americans.

That means that while some of the risk factors for type 2 diabetes in Black people can be beyond an individual’s control, it’s important to know about the things you can remedy if necessary.

For example, knowing your family history of diabetes and related health conditions can help you adjust your behavior, says Marjorie A. Pennant, MD, an endocrinologist at the University of Maryland Center for Diabetes and Endocrinology in Baltimore and an assistant professor of medicine at the university’s school of medicine, who specializes in treating patients with diabetes and other endocrine disorders, along with helping patients with weight management.

“Knowing your family medical history is key,” she says. “If you have a first-degree relative with diabetes, you have a two- or threefold risk of developing diabetes. It’s even higher if you have both parents with a history of diabetes.”

An article published in Diabetes Care confirmed that genetics play a role in a person’s chances of getting type 2 diabetes. The article notes that the risk of developing type 2 diabetes is 40 percent when one parent has the disease, and 70 percent when both parents have diabetes. But genetics aren’t the only thing that can affect diabetes risk.

RELATED: How Diabetes Risk Changes When You Have a Parent With the Disease

Why Dietary Choices Matter When It Comes to Preventing Type 2 Diabetes

Regardless of race, ethnicity, or sex, achieving and maintaining a healthy body weight matters when it comes to preventing diabetes. According to the American Heart Association (AHA), 55 percent of Black women and 38 percent of Black men are overweight or have obesity.

Your weight, body mass index (BMI), and waist circumference are key indicators of your physical health and, in turn, your risk of diabetes, Pennant says. Obesity or excess weight can make your body resistant to insulin, the hormone that regulates blood sugar. When obesity causes insulin resistance, your blood sugar levels rise, dramatically increasing the risk of diabetes, according to Johns Hopkins Medicine.

“If you’re overweight, losing 5 to 15 percent of your body weight will help in preventing diabetes,” Dr. Pennant says.

Insulin resistance can exist alone, but type 2 diabetes is considered the “predominate consequence” of this condition, according to an article in StatPearls updated in September 2022.

Understanding what makes for a diabetes-friendly diet — and which traditions don’t fall under that umbrella — may help you achieve a healthy weight, as well as prevent or delay diabetes from progressing. Whatever eating way you follow, a great start is to limit your intake of sugar-sweetened drinks, processed packaged food, and red meat, and focus on including whole grains, healthy fats, and plant-based protein, according to Pennant.

RELATED: 7 Healthy Meal Tips for Type 2 Diabetes

How Access, Discrimination, and Stress Play a Role

Past research has suggested that Black and Hispanic adults with diabetes in the United States have worse glycemic and blood pressure control than other groups of Americans, and that there is growing reason to believe that race and ethnicity may influence individuals’ diabetes care, even for those people who are fully insured.

The study found that poor (or no) physician support, as well as a perception that the condition isn’t serious, and a lack of knowledge of how to treat diabetes all contributed to higher rates of poor disease management.

In addition to a lack of education, the elevated risk of diabetes for Black Americans may be influenced by a lack of neighborhood resources that support exercise and proper nutrition, suggested a study published in the American Journal of Public Health.

“A lot of the answers point to social determinants of health as contributors to the disease,” says Tiffany Gary-Webb, PhD, a professor of epidemiology and the associate director of the center for health equity at the University of Pittsburgh (who was not involved in the American Journal of Public Health study).

“For example, aspects of residential environment, particularly in neighborhoods with more poverty, contribute to these disparities through lack of access to healthy food. [These] ‘food deserts’ and ‘food swamps’ are places saturated with fast food, convenience stores, and unhealthy foods,” she says, adding that poor access to exercise facilities or safe outdoor areas to exercise may also be contributing factors.

In the same vein, stress and emotional distress play a role in diabetes risk and management. In fact, past research suggests that stress can contribute to both the onset and progression of diabetes.

“African Americans experience increased stress due to discrimination, institutional racism, and many other factors,” Dr. Gary-Webb explains. “Researchers are studying what this increased stress does to the body — for example, whether it leads to higher levels of the stress hormone cortisol or accelerated cellular aging.”

RELATED: Can Stress Trigger Type 2 Diabetes?

6 Ways to Prevent or Improve Your Management of Diabetes

While factors such as racism and discrimination, as well as access to healthy food, education, and exercise are broader societal issues beyond most individuals’ direct control, many factors — even genetics — are not.

“Even with genetics and a family history of diabetes, you still have control through lifestyle intervention,” Pennant says.

Here are six ways to reduce your risk of diabetes.

1. Get Screened

During your annual doctor’s visit, ask to be screened for prediabetes and diabetes. Simple blood test options include A1C and fasting and glucose tolerance, notes the Mayo Clinic. “Typically, if you have a parent or a sibling with diabetes, you are at risk,” says Omar El Kawkgi, MBBCh, an endocrinologist at Mayo Clinic Health System in Eau Claire, Wisconsin. He advises those in this group who are older than 35 to get screened.

Also, keep in mind that the standard A1C test may not be enough to receive a diagnosis in Black Americans. According to a review published in PLoS One in September 2017, about 11 percent of Black Americans have a gene variant that may make the A1C test ineffective. If all signs point to diabetes, ask your doctor for another test, such as a fasting or glucose tolerance test, to check for diabetes.

The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 35 or older, and in groups such as people younger than 35 who are overweight or obese, women who have had gestational diabetes, and people who have been diagnosed with prediabetes.

RELATED: A1C Test May Miss Diabetes in Some Black Americans, Study Finds

2. Practice Heart-Healthy Habits, Too

In adults with diabetes, the most common causes of death are heart disease and stroke, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Consider heart-healthier cooking methods, like baking, broiling, and grilling instead of frying foods, Dr. El Kawgi says. Opt for fish, lean meats, and legumes like beans and lentils over processed meats, red meat, and fatty cuts of meat, according to the AHA. Consider using olive oil and avocado oil instead of butter, margarine, and mayonnaise too, also per AHA. And cut back on salt.

Following these types of heart-healthy diet guidelines can reduce your total and bad cholesterol, lower your blood sugar, and decrease your blood pressure, the Cleveland Clinic says.

3. Watch Your Sugar Intake

“A key message I tell patients is to watch their sugar intake, because it’s one of the biggest drivers of heart disease, diabetes, and weight gain,” Pennant says.

According to a June 2020 report out of the Rudd Center for Food Policy & Obesity at the University of Connecticutcalled Sugary Drinks Facts 2020, beverage companies continue to disproportionately target advertising for these beverages to Black and Hispanic youth, which likely contributes to the higher rates of obesity, type 2 diabetes, and heart disease in these groups.

Metabolically, sugary drinks are insidious. As a past article noted, sugary beverages are high in added sugar and don’t offer nutrition, leading to weight gain and increasing cravings for more sugary products. Independently, the high refined carbohydrate content increases the risk of insulin resistance, inflammation, and impaired B cell function, which is a combination of factors that sets the stage for type 2 diabetes.

Pennant recommends adding half a plate of veggies to each meal and eating more whole fruits instead of juice to reduce sugar intake. For example, she suggests eating an orange instead of drinking orange juice. The reason? Whole fruits contain more fiber than juice, which means the whole fruit provides more satiating nutrition.

Most Americans do not get enough fiber (between 21 and 38 grams is recommended, depending on sex, per the Mayo Clinic). This nutrient may be protective against metabolic disease including diabetes, according to a meta-analysis published in the December 2017 Nutrients.

4. Get Moving

According to the Diabetes Prevention Program, you can prevent or delay the onset of type 2 diabetes by losing 5 to 7 percent of your body weight. You can also increase your chances of weight loss by following a low-fat diet and exercising for 150 minutes a week, the program found.

Exercise is particularly beneficial for people at risk for type 2 diabetes because it helps increase insulin sensitivity, thereby helping the body use glucose more efficiently, noted an article published in March 2017 in BMJ Open Sport — Exercise Medicine. In fact, a review published in the World Journal of Diabetes cited prior research that suggested walking for 30 minutes each day could reduce type 2 diabetes risk by 50 percent.

If you’re new to exercise, Pennant recommends taking baby steps. You don’t have to go to the gym to get a lot of movement; simple lifestyle changes like a 30-minute brisk walk daily or taking the stairs instead of the elevator can make a big difference in increasing your physical activity, Pennant says.

5. Don’t Smoke, or Quit if You Do

According to the CDC, smokers are 30 to 40 percent more likely to develop type 2 diabetes than those who don’t have this habit. Smoking increases inflammation and disrupts the way your cells function, potentially interfering with how your body uses insulin, notes the U.S. Food and Drug Administration (FDA).

If you do develop type 2 diabetes, continuing to smoke can further elevate your risk for diabetes complications such as stroke and heart disease, per the CDC and FDA.

6. Seek Preventive Care

Although access to quality medical care and finding a positive doctor-patient relationship is challenging for many Black Americans, Pennant says that, if possible, regular checkups with your primary care physician, eye doctor, dentist, and foot doctor can help you spot warning signs sooner, reduce your risk of diabetes, or increase your chances of getting the right treatment if you end up receiving a diagnosis.

Ask your doctor for a referral to a specialist, particularly if you’re having a hard time losing weight, Pennant says.

Pay attention to potential symptoms, too. Pennant says these may be increased thirst, frequent urination, increased hunger, fatigue, blurred vision, and areas of darkened skin, usually in the armpits and neck.

“These may be signs that your body is making a lot of insulin just to keep your blood sugar normal,” Pennant says. They could be signs of diabetes, prediabetes, or the need for continued monitoring.

RELATED: 10 People Who Can Help You Manage Type 2 Diabetes

The Takeaway on Lowering Your Risk of Diabetes

Although diabetes is a real threat among Black Americans, you can take steps to stay healthy and avoid the onset of this disease. Work with your healthcare provider to reduce your risk factors. A healthy diet, staying physically active, losing weight, and giving up bad habits like smoking can help keep your blood sugar within a healthy range and keep diabetes at bay.

Additional reporting by Valencia Higuera and Carmen Chai.

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