T2D Prevention In People Of Color

Diabetes is a problem worldwide, but especially in the United States. Sugar-sweetened beverages and ultra-processed meats, combined with limited physical activity and the obesity epidemic, are putting more people at risk of developing diabetes. Racial minority groups experience disproportionate rates of diabetes and worse health outcomes.

Type 2 diabetes intro

Type 2 diabetes is a disease that leads to variable degrees of insulin resistance and impaired secretion, possibly leading to high blood sugar levels. Normally, a hormone called insulin keeps levels under control by helping move glucose from the bloodstream into cells. In diabetes, there are problems with how insulin is produced or used.¹ 

Type 1 diabetes occurs when insulin isn’t produced sufficiently due to autoimmune destruction of the insulin-producing cells of the pancreas, and type 2 diabetes occurs when cells don’t respond to insulin properly or there is relative insulin deficiency. Only type 2 diabetes can be prevented to an extent.  

In the United States, more than 37 million people (1 in 10) have diabetes, 90–95% of whom have type 2. It’s estimated that by 2060, the number of adults diagnosed with diabetes will almost triple, and 1 in 6 people will have the disease.² ³

The risk of diabetes isn't equal for all though, with non-white populations experiencing disproportionate rates of type 2 diabetes (T2D) and consistently lower health outcomes compared to their Caucasian counterparts. 

Socioeconomic factors often contribute to the development of diabetes, such as occupation, education, income, and lack of access to healthcare and suitable health-related education. Addressing these inequalities of health outcomes for White and non-White populations begins with understanding how it has arisen.

Type 2 diabetes and racial disparity: uncovering the facts

Diabetes follows the pattern of disproportionate rates and health outcomes in minority races. According to a recent report, the prevalence of diabetes in the general population sits as high as 13%, but this value changes based on race/ethnicity.⁴ ⁵ 

Disproportionately high rates of diabetes can be observed in BIPOC populations as below:⁶

• American Indians/Alaska Natives (14.7%)

• Hispanics (12.5%)

• Non-Hispanic Blacks (11.7%) 

• Non-Hispanic Asians (9.2%)

• Non-Hispanic Whites (7.5%)

Type 2 diabetes is also rising significantly for youth under 20 years of age, with predictions expecting the rate to increase by about six times. In addition, racial and ethnic disparities are likely to widen, with the highest prevalence among non-Hispanic Black youth.⁷ ⁸ 

Research suggests that some racial disparities in type 2 diabetes may be due to inherent genetic risk factors. For example, African ancestry has been associated with a 33% increased risk of type 2 diabetes, between those with the highest and lowest categories of African ancestry. One study found that Latino populations are more likely to have a genetic variant that increases the risk of type 2 diabetes by four times.⁹ ¹⁰

Black, Indigenous, and other people of color (BIPOC) patients experience consistently worse health outcomes in diabetes. This discrepancy can partly be explained by several factors, such as systemic racism and the quality of medical care received. Systemic racism can affect self-care behaviors and the quality of care provided to an individual with diabetes, negatively impacting their health outcomes and mortality.¹¹

Research shows that minority populations are less likely to receive recommended preventative care for type 2 diabetes, such as HbA1c testing, possibly preventing them from being identified as high-risk.¹² 

The Social Determinants of Health (SDOH) are a range of socially determined factors that can impact the health outcomes of an individual or group, either positively or negatively. Therefore, the social determinants of health are responsible for creating some of the racial disparities in diseases such as diabetes. 

The US Department of Health and Human Services has grouped these determinants into five categories.¹³

• Economic Stability, such as the ability to purchase nutritious food

• Education Access and Quality, associated with future employment opportunities and education on healthy lifestyle behaviors¹⁴

• Access to quality healthcare, including insurance access, availability of healthcare professionals, and length of wait times. Research shows that insurance status is the strongest predictor of whether people with diabetes have access to screening and healthcare. Personal beliefs and structural barriers to care  likely mediate the association between low socioeconomic status and chronic kidney disease.¹⁵ ¹⁶ ¹⁷

• Neighborhood and built environment, including the access, availability, affordability, and quality of healthy and affordable food options, and availability of safe outdoor areas for physical activity. Research shows that availability of fast-food outlets and convenience stores is associated with a higher risk of diabetes, while a healthier food environment is associated with a lower risk.¹⁸ ¹⁹

• Social community, including social support and systemic discrimination. Some research suggests that social support is associated with better glycemic control and quality of life, whilst lack of social support increases diabetes mortality and complications.²⁰ ²¹ 

If you’d like to learn more about Social Determinants of Health, you can read our blog on it here.²²

Why prevention of type 2 diabetes in BIPOC communities is so vital

96 million adults (38% of the adult population) in the United States have prediabetes. Actions can be taken to prevent prediabetes from becoming type 2 diabetes, particularly as the lifetime risk of T2DM for Hispanic females in the US is over 50%.²³ ²⁴

Diabetes complications in BIPOC communities 

While it’s established that BIPOC communities experience higher rates of diabetes, it has also been found that these populations experience worse glycemic control and complications of type 2 diabetes. Unmanaged diabetes comes with many complications, such as heart disease, neuropathy, retinopathy, and kidney disease. For example, those with type 2 diabetes are between two and four times more likely to develop cardiovascular disease.²⁵ ²⁶ 

Minority populations with diabetes also have higher rates of lower limb amputations, end-stage kidney disease, heart attacks, and stroke than White people. While some research has found that retinopathy is more prevalent in non-White populations, further research suggests that factors other than race are likely contributing.²⁷ ²⁸ ²⁹

Given these racial disparities, efforts should be made to bring things to a more even playing field, helping BIPOC communities avoid diabetes at a comparable rate to Caucasians through preventative measures. Preventative measures are actions taken ahead of time, before an individual has diabetes or during the pre-diabetic phase. These may include: 

• Education on the risk factors of diabetes. It’s important to recognize that socioeconomic status is linked to educational attainment. Therefore, people of color with low socioeconomic status will need support to access this education.³⁰ ³¹

• Scheduled screening appointments, especially for high-risk people³²

• Regular health checkups³³

Modifiable risk factors for type 2 diabetes

Some lifestyle-related risk factors for type 2 diabetes can be modified. These include:

• Weight: People who are overweight or have obesity are more likely to develop diabetes.³⁴

• Diet: Having a poor diet with excessive amounts of refined grains, red and processed meat, sugar-sweetened beverages, and ultra-processed foods high in sugar and salt increases the diabetes risk.³⁵ ³⁶

• Physical inactivity: People with a sedentary lifestyle are more likely to develop type 2 diabetes.³⁷

• Smoking cigarettes: People who smoke are 30–40% more likely to develop type 2 diabetes.³⁸

Uncontrollable and genetic risk factors for type 2 diabetes

While diet and physical exercise can be modified, some risk factors that contribute to individual developing diabetes cannot be controlled. These include:

• Age: The risk of diabetes increases with age. People aged 45–64 are at the highest risk of type 2 diabetes.³⁹

• Family history: People who have a parent or sibling with type 2 diabetes are more likely to develop the disease.⁴⁰

• Genetic susceptibilities: Certain genetic variants increase the risk of type 2 diabetes, likely by interacting with environmental factors.⁴¹ 

• Having had gestational diabetes: Women who have had gestational diabetes during pregnancy are more likely to develop type 2 diabetes later in life as well as in their offspring.⁴² ⁴³

What can you do to prevent type 2 diabetes right now?

There are many different lifestyle changes you can make to help avoid getting type 2 diabetes. Some ideas include:⁴² ⁴³

• Let your doctor know if you have any risk factors, such as family history or gestational diabetes.

• Physical activity: The American Heart Association (AHA) recommends getting at least 150 minutes of moderate-intensity physical activity (such as brisk walking, dancing, gardening, or biking) or 75 minutes of vigorous physical activity (such as running, swimming, heavy yard work, and jumping rope) each week. However, even light-intensity physical activity has health benefits.⁴⁴

• Dietary changes: Choosing smaller portion sizes, limiting sugar-sweetened beverages, and increasing wholegrain intake can help reduce the risk of type 2 diabetes. Some research suggests that an increased dairy intake protects against diabetes in young Black people with obesity. Furthermore, you may decide to increase nut and peanut butter consumption, as well as coffee consumption, although the exact causation hasn’t yet been established.⁴⁵ ⁴⁶ ⁴⁷ ⁴⁸ ⁴⁹

• Develop a quit-smoking plan: Stopping smoking can make it easier to manage blood sugar levels in diabetes and reduce the risk of experiencing serious complications such as heart and kidney disease, retinopathy, neuropathy, and limb amputations.⁵⁰

• Undertake screening: It’s recommended to screen routinely for blood sugar levels and other early signs of type 2 diabetes. Research indicates a strong connection between certain genes and type 2 diabetes in Black people, supporting the need for screening high-risk populations. Screening can be costly, but understanding your risk could motivate you to make important lifestyle changes and discuss future monitoring with your doctor. A medical social worker could help find available options that are most affordable. A simple and free way to assess your risk of diabetes is by taking a short test on the Centers for Disease Control and Prevention (CDC) webpage.⁵¹ ⁵² ⁵³

The lowdown

Diabetes can affect anyone, but racial minority groups are at an especially high risk of developing it and suffering worse health outcomes as a result. Many barriers make diabetes more worrisome for people of color, but changes can be made to reduce the disparities.

Supporting ethnic communities through the use of public health education, access to high-quality food, and promotion of racial and ethnic representation in healthcare may help to reduce new cases of diseases like diabetes in the younger generation. Preventative measures now can help safeguard future populations.

Frequently asked questions

Is it possible to cure type 2 diabetes?

There’s no cure for type 2 diabetes. However, you may be able to reverse the condition so that you don't need any medications to manage it. It’s a good idea to see your doctor to discuss a treatment plan best suited to your needs.

How can I control type 2 diabetes without insulin?

Type 2 diabetes is characterized by insulin resistance, so insulin injections are usually not required until the later stages of the disease. Taking steps like losing weight, engaging in regular physical activity, and quitting smoking can help manage the symptoms of type 2 diabetes and prevent adverse complications.

What foods help prevent type 2 diabetes?

Type 2 diabetes risk can be reduced by following a healthy diet. Some changes you could make include increasing your intake of non-starchy vegetables (like peppers, broccoli, and asparagus), lean protein, fruit, and whole grains.⁵⁴