Diabetes and African Americans

African American children seem to have lower rates of type 1 diabetes than white American children. Researchers tend to agree that genetics probably makes type 1 diabetes less common among children with African ancestry compared with children of European ancestry.

Gestational diabetes, in which blood glucose values are elevated above normal during pregnancy, occurs in about two percent to five percent of all pregnant women. Perinatal problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar) are higher in these pregnancies. The women generally return to normal glucose values after childbirth. However, once a woman has had gestational diabetes, she has an increased risk of developing gestational diabetes in future pregnancies. In addition, experts estimate that about half of women with gestational diabetes develop type 2 diabetes within 20 years of the pregnancy.

Several studies have shown that the occurrence of gestational diabetes in African American women may be 50 percent to 80 percent more frequent than in white women.

Compared with white Americans, African Americans experience higher rates of diabetes complications such as 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 blood lipids, high blood pressure, and cigarette smoking, can be influenced by proper diabetes management.

Diabetic retinopathy is a deterioration of the blood vessels in the eye that is caused by high blood glucose. It can lead to impaired vision and, ultimately, to blindness. The frequency of diabetic retinopathy is 40 percent to 50 percent higher in African Americans than in white Americans, according to NHANES III data. Retinopathy may also occur more frequently in black Americans than in whites because of their higher rate of hypertension. Although blindness caused by diabetic retinopathy is believed to be more frequent in blacks than in whites, there are no valid studies that compare rates of blindness between the two groups.

African Americans with diabetes experience kidney failure, also called end-stage renal disease (ESRD), about four times more often than diabetic white Americans. In 1995, there were 27,258 new cases of ESRD attributed to diabetes in black Americans. Diabetes is the leading cause of kidney failure and accounted for 43 percent of the new cases of ESRD among black 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 white Americans.

Based on the U.S. hospital discharge survey, there were about 13,000 amputations among black diabetic individuals 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 white or Hispanic Americans with diabetes. The hospitalization rate of amputations for blacks was 9.3 per 1,000 patients in 1994, compared with 5.8 per 1,000 white diabetic patients. However, the average length of hospital stay was lower for African Americans (12.1 days) than for white Americans (16.5 days).

Diabetes was an uncommon cause of death among African Americans at the turn of the century. By 1994, however, death certificates listed diabetes as the seventh leading cause of death for African Americans. For those age 45 years or older, it was the fifth leading cause of death.

Death rates (mortality) for people with diabetes are higher for blacks than for whites. Figure 3 shows death rates for whites and blacks with diabetes in a national survey of people first studied in 1971-1975 whose mortality was confirmed through 1992-1993. In every age group and for both men and women, death rates for blacks with diabetes were higher than for whites with diabetes. The overall mortality rate was 20 percent higher for black men and 40 percent higher for black women, compared with their white counterparts.

• In 1993, 1.3 million African Americans were known to have diabetes. This is almost three times the number of African Americans who were diagnosed with diabetes in 1963.

• For every white American who gets diabetes, 1.6 African Americans get diabetes.

• The highest incidence of diabetes in blacks occurs between 65 and 74 years of age. Twenty-five percent of these individuals have diabetes.

• Obesity is a major medical risk factor for diabetes in African Americans, especially for women. Some diabetes may be prevented with weight control through healthy eating and regular exercise.

• African Americans have higher incidence of and greater disability from diabetes complications such as kidney failure, visual impairment, and amputations.

• If African Americans can prevent, reverse, or control diabetes, their risk of complications will decrease.

• Healthy lifestyles, such as eating healthy foods and getting regular exercise, are particularly important for people who are at increased risk of diabetes.

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Reprinted with permission from the National Diabetes Institute Clearinghouse

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