Programs for African Americans

About 2 to 5 percent of pregnant women develop mild abnormalities in glucose levels and insulin secretion and are considered to have gestational diabetes. Although these women's glucose and insulin levels often return to normal after pregnancy, as many as 50 percent may develop type 2 diabetes within 20 years of the pregnancy.

Above normal levels of fasting insulin are associated with an increased risk of developing type 2 diabetes—this often predates diabetes by several years. A recent study showed that insulin levels were higher in African Americans than in Caucasians, particularly African American women, indicating their greater predisposition for developing type 2 diabetes. Another study showed a higher rate of above normal levels  in African American adolescents compared with Caucasian adolescents.

Being overweight is a major risk factor for type 2 diabetes. African American adults have substantially higher rates of being overweight than Caucasian Americans. The location of the excess weight is also a risk factor for type 2 diabetes. Excess weight carried above the waist is a stronger risk factor than excess weight carried below the waist. African Americans have a greater tendency to develop upper-body fat, which increases their risk of diabetes. Weight alone accounts for this population's higher prevalence of diabetes. Even when compared with Caucasian Americans with the same levels of obesity, age and socioeconomic status, African Americans still have higher rates of diabetes. Other factors, yet to be understood, appear to be responsible.

Physical Activity

Regular physical activity is a protective factor against type 2 diabetes. Lack of physical activity is a risk factor for developing diabetes. Researchers suspect that a lack of exercise is one factor contributing to the high rates of diabetes in African Americans. In a nationwide survey, 50 percent of African American men and 67 percent of African American women reported that they participated in little or no leisure time physical activity.

Compared with Caucasian Americans, African Americans experience higher rates of diabetes complications such as heart disease, eye disease, kidney failure and amputations. They also experience greater disability from these complications. Some factors that influence the frequency of these complications, such as high blood glucose levels, abnormal cholesterol levels, high blood pressure and cigarette smoking, can be influenced by proper diabetes management. For more details:

Cardiovascular Disease

People with diabetes are more than twice as likely to develop heart disease than people who don't have diabetes. And people with diabetes are five times more likely to have a stroke than those who don't have diabetes. Many people with diabetes have few symptoms of heart disease until the advanced stages. But by managing blood glucose, high blood pressure and cholesterol, African Americans with diabetes can lower their risk.

Eye Disease

Diabetic retinopathy is a deterioration of the blood vessels in the eye caused by high blood glucose. It can lead to impaired   vision  and ultimately to blindness. A nationwide study showed that frequency of diabetic retinopathy is 40 to 50 percent higher in African Americans than Caucasians. Retinopathy may also occur more frequently in African Americans than in Caucasians because of a higher rate of hypertension in African Americans.

Kidney Failure

African Americans with diabetes experience kidney failure, also called end-stage renal disease (ESRD), about four times more often than Caucasians with diabetes. Diabetes is the leading cause of kidney failure and accounted for 43 percent of the new cases of ESRD among African Americans during 1992–1996. Hypertension, the second leading cause of ESRD, accounted for 42 percent of cases. In spite of their high rates of ESRD, African Americans have better survival rates after they develop kidney failure than Caucasians.

Amputations

Based on the U.S. hospital discharge survey, there were about 13,000 amputations among African Americans with diabetes in 1994, which involved 155,000 days in the hospital. African Americans with diabetes are much more likely to undergo a lower-extremity amputation than Caucasian or Hispanic Americans with diabetes. The hospitalization rate of amputations for African Americans was 9.3 per 1,000 patients in 1994, compared with 5.8 per 1,000 Caucasian patients. However, the average length of hospital stay was lower for African Americans (12.1 days) than for Caucasians (16.5 days).

Sexual Dysfunction

Uncontrolled blood glucose levels can cause sexual dysfunction. Check out information on sexual dysfunction and take a sexual dysfunction quiz. 

How Joslin Can Help You:

Major studies show that diet and physical activity can significantly prevent, delay or slow the progression of diabetes complications. Joslin Diabetes Center has more than 100 years of experience in treating diabetes. Our centers have several providers in one location: Endocrinologists are specialists in diabetes care and can work with your primary care physician to manage your diabetes and keep control of your blood glucose. They are there to adjust your treatment plan as needed. Nurses, certified diabetes educators and registered dietitians will help you understand how to manage your diabetes. Call 617-732-2440 for more information or to make an appointment.

For More Information:

• http://win.niddk.nih.gov/sisters/index.htm
• http://diabetes.niddk.nih.gov/dm/pubs/africanamerican/index.htm
• http://www.omhrc.gov/omhrc/