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(The Dallas Examiner) – African Americans adults were 60% more likely than non-Hispanic White adults to be diagnosed with diabetes, according to the U.S. Department of Health and Human Services Minority Department’s most recent report.
To help close the gap and provide guidance on obtaining better treatment options for minority communities, especially the Black community, the National Institute of Minority Health and Health Disparities hosted a webinar with Dr. O. Kenrik Duru, professor of Medicine at the David Geffen School of Medicine at UCLA to close out Black History Month on Feb. 29.
The objective of the presentation was to give guidelines and recommendations for diabetes screening as well as promote and emphasize secondary screening for diabetes-related complications.
In Duru’s report, there were cases for and against raced-based primary diabetes screening.
Duru summarized that Black and African American, Latino and Hispanic, and Native American and Alaska Native patients are less likely than White patients to successfully achieve primary and secondary diabetes prevention, due to social and environmental pressures.
To combat these issues and address these concerns, Duru’s research focused on enhancing physical activity among older adults from racial and ethnic minority groups and designing interventions to reduce disparities in medication adherence and clinical outcomes for patients with diabetes.
Eliseo Stable-Perez, director of the NIMHD, thanked the participants for joining in on the seminar.
“I want to thank you for joining us for our first NIMHD Director’s Seminar Series for 2024 and happy Leap Day as well,” Stable-Perez said. “As Black History Month draws to a close this leap year, I want us to take a moment to recognize scientific public health leaders from the Black and African American community in our country’s history, from our past, our present and hopefully our future who made an impact on our nation and indeed around the world. We pay tribute to the Black and African American trailblazers in clinical and health services research who are committed to shaping a better and more equitable future for underserved and underrepresented communities.”
Duru was then introduced as the guest lecturer in honor of Black History Month.
“We probably all know diabetes prevalence is high and increasing and a CDC statistic from a couple years ago shows that we believe 38 million Americans have diabetes, and 1 in 5 don’t know this,” Duru said. “In 2000, it was estimated there were 150 million people on earth with diabetes. That number doubled around 2010 to 300 and is going to double again to 600 million sometime after 2030. We’ve been very unsuccessful in bending the curve which continues to go upward every year, and this is a problem because of the numerous known complications of diabetes that we see.”
Today, Duru said he sees patients much more and sees more complications from his patients having diabetes such as microvascular complications, changes in small vessel capillaries which include chronic kidney disease. This can cause dialysis, foot problems such as ulcers and neuropathy that can lead to amputations, and eye damage that can lead to blindness.
Macrovascular complications from diabetes through large vessels including arteries can lead to heart attacks, myocardial infarction, chest pain, coronary heart disease, congestive heart failure and stroke.
Duru also said that there are quite a few cancers linked to diabetes.
“We believe diabetes actually leads to increased rates of pancreatic cancer, as well as hepatocellular cancer,” he stated. “We learned quickly in 2020 diabetes is a risk factor for severe COVID-19 infection, the kind that puts you in the hospital or the ICU or leads to mortality. We also know diabetes is a predictor of major depression, not surprising. Diabetes is an independent risk factor for dementia, particularly vascular dementia, and diabetes in and of itself causes skeletal muscle atrophy and you’ll hear about the merits of prevention. Where people say if the person is 70 or 75, they won’t live long enough to have those complications – dialysis and retinopathy – but will develop muscle atrophy, you are not able to lift things, pull things, do the things you need to do. This is one contributor to loss of independence, so I’m a big believer in trying to prevent diabetes the best we can from childhood through older adulthood.”
In one study from 2019, each non-White group had a higher prevalence of diagnosed and undiagnosed diabetes in the U.S. These groups include Blacks, Mexican Americans, Puerto Ricans, Cubans, Dominicans, Central and South Americans, and East, South and Southeast Asians.
Duru then compared diabetes through a historical context dating back 130 years ago to 1898.
“So in 1898, it was noted that diabetes is rare in the colored race, those are people that now we would refer to as Black,” Duru acknowledged. “In 1913, it was noted diabetes was 2 1/2 times as common among Jews than non-Jews and things were changing in this country. By the 1950s discovery was made that Pima Indians have the highest diabetes rate in the world. In the 1980s, Mexican Americans were a diabetic race, and you can see a lot of changes here from the beginning, the end rather, 19th century through the end of 20th century. And just a note while we’re talking about this, disparities are not pre-ordained. So, these are some more quotes regarding Black people and diabetes. Apparently, someone took minutes from the 1904 American Medical Association convention, and someone said, ‘I have never seen a case of diabetes in a colored patient, and I do not know of another practitioner who has.’”
Duru said Charles Burnie was the first licensed Black physician in South Carolina and was quoted in 1910 as saying that it was rare for Black people to have diabetes.
“He has noted in the Negro race, I think we can assume given again the segregation of the day, that all of his patients, almost all of his patients were Black, and he saw very few cases of diabetes,” Duru stated. “This is not surprising. Unfortunately in those days, I think Black people took jobs that no one else would, and there was a lot of aggressive physical labor for both men and for women. We saw very few Black people working desk jobs. Also, I think food wasn’t in abundance, you couldn’t eat to excess across the population so not surprising we saw lower rates among Black individuals 130 years ago of diabetes.”
Duru said the main cause today of diabetes is obesity.
“Obesity directly affects all of these organs, and that is what has changed in our society. That’s what is driving these multiple different phenotypes of diabetes in the patients that we see,” Duru concluded. “In my belief, genetics is not a major driver of diabetes disparities. I think there’s a recent ‘nature’ study from last month that looked at the Type 2 diabetes global genomics initiative that had more than 2.5 million patients, diverse people around the world, 40% non-White participants. The authors conducted a GWAS analysis, that’s a genome wide association study and they found 127 single nucleotide polymorphisms, genetic differences in a population that in this case predict diabetes and 127 contents of origin. This was only 10% of the total number of SNPs, however when you adjust for BMI, 103 were no longer significant. Eighty one percent, we’re talking about 20% of 10% number tied to race/ethnicity which is 2.5%. I don’t think we’re going to find much if we’re trying to solve this problem with genetics. It may not be the road to go for diabetes disparities. But that road goes right down the lanes of obesity and social determinants of health.”
Duru then spoke about the studies and research done by Felicia Hill Briggs, a motivational speaker and expert on social determinants in diabetes, who died last year.
“To my knowledge, this diabetes care paper she wrote in 2020 is still the gold standard for looking at all these studies,” Duru said. “All of these things have been shown to link to higher rates of diabetes and/or complications. We see this at the individual level, lower income, lower
levels of education, lower occupational grade. At the geographic level, people who live in census tracts have lower high school graduation rates, more single parent households. We see this with the built environment, if there’s a higher local density of fast-food restaurants, local rates of diabetes are higher. We see this with social context if there’s lower neighborhood social cohesion. There’s a study in the meet and greet we talked about that showed this. When you have lower cohesion, you have greater rates of diabetes.”
Duru spent the last part of the lecture focused on diabetes prevention.
“Prior to 1997, we really didn’t have great data showing you could prevent diabetes. There were some people who thought if you gained weight and became obese, it was going to be
inevitable, and we couldn’t do much at that point,” Duru explained. “But there was first a study in China that showed if you instituted lifestyle change with diet and exercise, you could lose weight and therefore prevent diabetes. Which, again, was terrific to see that in a study. The National Institute of Health jumped on this which is great and launched a trial called the diabetes prevention program.”
The study showed that lifestyle change along with a healthy diet and behavior modification led to a great reduction of diabetes and its complications for people of all backgrounds, especially of people of color with over 50% to 60% of reduction. In fact, the study showed that diet and lifestyle change had a greater impact than those just taking medications alone.
To be proactive about overcoming and preventing diabetes, an individual should get yearly screenings if they screen positive, according to Duru.
“As of today, there are guidelines that anyone who is asymptomatic, age 35 to 70, overweight or obese should be screened for prediabetes/Type 2 diabetes and overweight should be defined as BMI greater or equal to 25,” he said.
Duru concluded that the best way for minority groups to prevent diabetes, reverse diabetes and its damages is to exercise, get moving, make lifestyle changes such as losing weight, eating healthier and stress reduction such as getting good sleep.
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