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Among African-Americans diabetes, a disease associated with being overweight or obese, is twice as likely to be diagnosed compared to the general population. African-Americans also suffer more from comorbidities of diabetes, such as high blood pressure (hypertension) and high cholesterol (hyperlipidemia). It has been suggested that the higher rate of diabetes in the community is due to the fact that most African-Americans see diabetes as a genetic disorder over which they have no control and remain noncompliant in their own treatment. Economic disadvantage, lack of access to medical care and cultural behavior are some factors that contribute to the higher rate of diabetes in this community. However, it is not clear whether these factors are responsible or explain all of the differences between African-Americans and others in the US population. Moreover, we can conclude that there are genetic factors at play.

The medical conditions most commonly associated with diabetes are high blood pressure and high cholesterol. African-Americans have a higher risk to these ailments because of the high rate of obesity.5 Metabolic Syndrome is also a component to all of these health issues. The syndrome is described as a group of factors that occur together, which can contribute to a higher chance of heart disease, stroke and Type 2 diabetes. Several factors, environment, diet, availability of quality health care, as well as genetics, contribute to the higher rate of diabetes in the community. In the following sections we examine risk factors for diabetes as well as comorbidities that are predominant among African-Americans.

Risk Factors for Diabetes

African-Americans tend to blame genetics and family history to the nature of diabetes in the community. Family history can be described as sharing “genes, behaviors, lifestyles and environments that may increase may influence their health and their risk of chronic disease” (CDC.) Along with genetics, obesity is the major risk factors for diabetes as it affects the African-American community. Table 1 below shows the major and secondary risk factors associated with diabetes in the general American population.

Complications of untreated and treated diabetes in the African-American community

Several studies found that African-Americans are 1.4 to 2.2 times more likely to have diabetes than white persons. The rates of disease complications caused by diabetes vary by disease and minority group.1,8 Kidney, eye, and cardiovascular diseases are the most common comorbidities of diabetes in African-Americans. Native Americans are prone to these same illnesses due to the prevalence of smoking in their community, while obesity also plays a role. Moreover, statistics show the rate of disease amongst African-Americans is higher than any other race.

Kidney Disease

End stage renal disease (ESRD) is a complication of diabetes that affects 34% of patients with the disease. A recent study at Wake Forest University demonstrates that “African-Americans have higher overall incidence rates of end-stage renal disease (ESRD) compared with American whites” and “... diabetes mellitus types I and II, and chronic glomerulonephritis (CGN) all occur more frequently in African-Americans. To explore the possibility that hereditary factors may play a role in the increased risk of ESRD in African-Americans...” 9 Among African-Americans, ESRD is higher than those of the white population at the rate of 2.6 times.9 There were 137 new cases of diabetes-related ESRD per million among African-Americans and 38 cases per million among whites from 1988 to 1990.8 ESRD among African-Americans is more likely related to diabetes that in other races and Hispanic Americans, African-Americans, and American Indians also have higher rates of early stage kidney disease (proteinuria).8 It is unclear why African-Americans have more diabetes-related ESRD and higher rates of hypertension than whites. It has been suggested that the co-occurrence of both hypertension and Type 2 diabetes may account for the higher rate of ESRD in the African-American community.

Eye Disease

Retinopathy is another comorbidity of obesity that disproportionately affects non-whites. Untreated retinopathy can cause blindness, and diabetic retinopathy is the major cause of blindness among adults ages 20 to 74 in the US. Risk factors for diabetic retinopathy include Type 1 or Type 2 diabetes. A study done by the American Medical Association found “Among patients with diabetes, African-Americans have higher prevalence rates of high blood pressure and are 2.6 to 5.6 times more likely to have diabetic nephropathy, including diabetic end-stage renal disease, than white patients.”10 African-Americans are at a greater risk for retinopathy because of the high incidence of diabetics in the population. A survey done on the city of Boston found “causes of blindness and visual impairment in persons 40 years or older, there was a greater proportion of African-Americans than of whites who were visually impaired from diabetic retinopathy.” 10

Coronary Artery Disease

Diabetes predisposes those people with it to have heart disease more compared to the general population. Minorities and white persons do not exhibit consistent disparities in coronary artery disease due to diabetes. A study funded by AHRQ found that African-American diabetic patients exhibit a particular lipid profile that is different from the rest of the population: low HDLs (high-density lipoproteins), high LDLs (low-density lipoproteins), and lower triglycerides. The lipid profile is important “… because having too few HDLs, too many LDLs, or too many triglycerides are all risk factors for heart disease.”11 For this reason, it has been recommended that in treating dyslipidemia (an abnormal amount of lipids) in the blood) among African-Americans, clinicians’ should focus largely on improving LDLs and HDLs.11