In the U.S just over 29 million people, 9.3% of the population, has diabetes. Of that number, nearly 28% are undiagnosed. That means a staggering eight million people are walking around with a potentially deadly disease and no treatment.
Since early intervention and a comprehensive treatment plan are key to managing diabetes, those with undiagnosed diabetes are essentially ticking time bombs. What makes this situation even worse is that certain populations in the U.S are not only less likely to be diagnosed but are also more likely to receive poor or inadequate care for the diabetes. Here are five of the most underserved diabetes populations in the U.S.
1. America Indian/Alaska Natives
According to the U.S. Department of Health and Human Services’ Indian Health Service, American Indians or Alaska Natives are over twice as likely to have diabetes as non-Hispanic whites. While this is a disturbing statistic, what is even more disturbing is that 95% of the cases of diabetes among this population is Type 2 diabetes, a condition that may be prevented with early intervention and education.
From 1994 to 2004, the incidence of diabetes in American Indian and Alaska Natives increased by 68%. Thirty percent of those without diabetes are pre-diabetic, which means that without intervention, diabetes is looming on the horizon.
Rates of both Type 1 and Type 2 diabetes in Hispanics are nearly double those of non-Hispanic whites in the U.S., especially as the population increases with age. Latino women also have a higher chance of developing gestational diabetes, a condition that increases their chances for developing Type 2 diabetes later in life.
Rates of diabetes can vary widely among subpopulations, from a rate of nearly 14% for Puerto Ricans to just under 8% for Cubans and Central or South Americans.
3. African Americans
Nearly five million African American adults in the U.S. have diagnosed or undiagnosed diabetes. This is almost one in five adults over the age of 20. As the obesity epidemic continues to affect this particular population disproportionately, the number of Type 2 diabetes is expected to rise.
African Americans are also 2.3 times more likely to die from diabetes than non-Hispanic whites and are also more likely to develop serious complications (e.g., diabetic retinopathy and lower limb amputation) than non-Hispanic whites.
4. Low-income people of any race
Data gathered over ten years from over 10,000 participants found that those in the lowest socioeconomic brackets were twice as likely to develop Type 2 diabetes as those in the highest income brackets. Although lifestyle factors such as obesity, smoking, and activity level contributed to higher rates, the constant among all participants was income level.
Lead author Silvia Stringhini of the University Hospital of Lausanne in Switzerland believes that half of the problem is inflammation, and inflammation is tied to income in surprising ways:
“The stress related to financial adversity — that of living in poor, unsafe and polluted neighborhoods, experiencing more stressful life events, or experiencing abuse and violence — [may contribute to] an exacerbated inflammatory responses in adult life.”
5. Women of any race
Women with Type 1 diabetes have a 40% higher chance of dying from any cause than men with the same illness, according to a meta-analysis of data from studies involving over 20,000 participants. They are twice as likely to die from cardiovascular issues as men. Study authors speculate that insulin control in women is the culprit, but there is no consensus on what factors influence this control. There is a growing awareness that medical care discriminates against women in general, even more so for minority and low-income women. This inequality could be a major factor in poor diabetes outcomes for women.
With the growing awareness of these underserved populations and a new understanding of the high cost of diabetes care, there are some positive changes occurring in diagnosis and treatment for diabetes.
Culturally-sensitive patient education makes a difference
A study of culturally-sensitive diabetes education programs delivered to high-risk Latino populations found that for both patients and healthcare providers, the cultural sensitivity made a big difference in clinical outcomes. Not only were patients better informed, but healthcare providers adhered more closely to standards of care than they did previously for similar populations. This resulted in a decreased incidence of complications due to diabetes and better outcomes in general.
Medicaid expansion under the Affordable Care Act increases access
Under the Affordable Care Act, states had the option to expand Medicaid coverage for the lowest income citizens. Initially, 26 states chose to expand coverage, and 24 chose not to. A new study found that states that expanded Medicaid coverage had a 23% increase in diabetes diagnoses, while states that chose not to expand had a less than 1% increase.
Does this mean that states that expanded Medicaid simply have more diabetes cases? Likely not, says Vivian Fonseca, MD, professor of medicine and pharmacology, Tullis Tulane alumni chair in diabetes chief, section of endocrinology at the Tulane University Health Sciences Center, Tulane University School of Medicine:
“The division of states created an opportunity to examine the impact of Medicaid expansion on specific health metrics, such as detection of disease. Clearly, expanding Medicaid has allowed those 26 states that did so to identify a large number of people who previously did not know they were living with diabetes. Early identification can be potentially life-saving for people with diabetes.”
Diabetes in general and the spread of Type 2 diabetes across the world is an alarming health problem that is reaching epidemic proportions. There is some evidence that outreach programs, including getting hospitals involved in mobile healthcare and implementing nutrition education programs for low-income and minority populations, can make a difference in outcomes.
How can you help in your community? Do you feel like you’re not getting the help you need?