Which Populations are Most Affected by Diabetes?

Disparities in Diabetes

Summary

Globally, 1 in every 10 people are living with diabetes. In the United States specifically, diabetes was the 7th leading cause of death in 2019 and accounts for a significant portion of the country’s health expenditures. As a whole, diabetes is a significant public health concern that warrants both biomedical and social interventions that ensure those most impacted are able to manage their condition and maintain a high quality of life.

Although people from any race or ethnicity are susceptible, racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic. These populations are more likely to have diabetes, be affected by its resulting complications, have higher mortality rates, and have lower diabetes control.

It’s incredibly important that the root causes of the condition for these high-risk groups are well understood and that culturally sensitive and appropriate interventions are implemented to prevent new cases and manage existing ones.

The Global Impact of Diabetes

According to the IDF Diabetes Atlas, there are 537 million adults between the ages of 20 and 79 years living with diabetes [1]. This means 1 in every 10 people around the world are currently living with the condition. The prevalence of diabetes has been rising rapidly and it is estimated that a total of 643 million people will have diabetes by 2030. Even more alarming is the fact that 3 out of every 4 people living with diabetes resides in a low- and middle-income country [1].

In the United States alone, 37.3 million Americans, or 11.3% of the population, has diabetes (as of 2019) [2]. This number is likely much higher today, as roughly 1.4 million Americans are newly diagnosed every year. Additionally, the Center for Disease Control (CDC) estimates that about 1 in 5 people with diabetes do not know that they have it [3].

With the number of individuals with pre-diabetes and diabetes growing each year, there has been increased focus on how it impacts certain populations who disproportionately carry the burden of the epidemic.

Race and Ethnic Groups Most Affected

Although diabetes can affect any race, ethnicity, age, gender, and social class, the condition is more common among certain racial and ethnic minority groups, as well as those with lower socioeconomic status [4]. People in these groups have higher rates of prolonged illness and are significantly more likely to die as a result of complications.

According to the American Diabetes Association, the rates of diagnosed diabetes in adults by race/ethnic background are [2]:

14.5% of American Indians/Alaskan Natives
12.1% of non-Hispanic blacks
11.8% of Hispanics
9.5% of Asian Americans
7.4% of non-Hispanic whites

As shown above, American Indian and Alaska Native people are more likely to have Type 2 diabetes than any other racial or ethnic group in the United States, and are twice as likely as non-Hispanic whites [5].

Additionally, a large portion of Appalachia (a region in the Eastern United States that stretches from the Southern Tier of New York State to northern Alabama and Georgia) is considered to be the “diabetes belt” because of the high rates of diagnosed diabetes in the area [6].

Diabetes Complications in Highly Affected Populations

In addition to the increased requirements for disease management and control among these populations, there are significant risks of diabetes-related complications and adverse health outcomes. For example, kidney failure from diabetes has historically been the highest among Native American populations, however the gap has decreased significantly in the last decade [5].

Additionally, Hispanic and non-Hispanic Black populations with diabetes have worse glycemic control and higher rates of retinopathy when compared to other racial groups [7].

Despite the knowledge now available about diabetes and its risk factors, as well as the overall decline in diabetes-related complications, the gap in rates between racial and ethnic minorities and white people in the United States has not substantially decreased [6].

A major contributing factor is that while these groups carry the majority of the burden of the disease, they typically have less access to healthcare services. This means they are more likely to develop diabetes, are unable to manage complications, and are more likely to die prematurely.

As we try to understand why these health disparities exist so that we can address them, it’s important that we look at social determinants of health. We’ll talk more about these in another article, however right now, it’s important to know that social determinants of health are “conditions in the places where people live, work, and play that affect their health risks and outcomes” [6]. These conditions, when identified, can serve as important intervention areas for improved health equity [8].

Addressing Health Disparities & What We Can Do

Improving the health of those most impacted by diabetes requires collaboration from clinicians, health systems, and affected communities themselves. There are many types of interventions that target social determinants of health, improve health outcomes, and reduce disparities among high-risk populations. These include:

Leveraging population health approaches, such as engaging community members in prevention efforts and connecting people to local resources (high-quality and healthy food, housing, transportation, mental health care, etc.) [5]
Initiating team-based patient care that goes beyond biomedical health and includes access to educators, advocates, nutritionists, and other community-based healthcare providers.
Utilizing technology that empowers individuals to take control over their health, as well as allows them to get access to insights and recommendations about their condition in between routine clinical visits.
Implementing programs (such as the CDC’s Division of Diabetes Translation Project) that recognize and reflect specific cultural practices of high-risk groups, and ensure that interventions are aligned with the community’s perspectives and beliefs [9].