Your Health Matters: Type 2 diabetes targets an uneven playing field

WORTHINGTON — Type 2 diabetes does not seem to treat all ethnicities of people with the same level of fairness.

The numbers do not lie. A 2020 report by the CDC shows estimates of both diagnosed and undiagnosed cases of diabetes by ethnic groups in the U.S. This includes 16.4% of African Americans, 14.9% of Asian Americans, 14.7% of Hispanic people and 11.9% of white people.

American Indians and Alaskan natives likely have the overall highest rates, but it is noted that large-scale data collection efforts have very much understudied these groups when it comes to undiagnosed cases of diabetes. We do know that 14.7% of this group has a clinical diagnosis of diabetes.

Prediabetes prevalence, which means not yet meeting the threshold for a diabetes diagnosis — an A1C of 6.5% or greater — shows differences also. These numbers reflect that 45.7% of black adults, 41.6% of Hispanic adults, 40.8% of white adults, and 39.4% of Asian adults are trending toward a diagnosis of diabetes.

So the billion-dollar question is, what causes these differences? As an aside, a million dollars used to be a huge sum of money, but doesn’t put diabetes costs in the right perspective today.

Is there a genetic component that makes some ethnicities more susceptible than others?

According to the World Health Organization, those of Asian descent have slightly more body fat than whites of the same height and weight, and that fat may be distributed more in the belly area. This may make the insulin produced less effective at lowering blood sugar, termed insulin resistance, making a type 2 diabetes diagnosis more likely.

There is also some research showing that African-Americans may have lower levels of potassium in their bodies than whites. A potassium deficiency may increase your risk of developing type 2 diabetes. But this is likely offset by the fact that African-Americans seem to be better at producing insulin than white people.

Research that seems to be more telling shows there are higher rates of diabetes among Chinese-Americans, Japanese-Americans and Mexican-Americans than those living in their native countries respectively.

Although not definitive, this information seems to point at least in part to our diets in America that tend to be higher carbohydrate (sugar) and higher fat. Another component that can’t be denied is that the prevailing culture in the U.S. tends to be less active.

As we have discussed in past articles on this topic, the makeup of the food we put on our plates, combined with inadequate exercise, puts many of us at risk regardless of our countries of origin.

These lifestyle areas can help to explain the occurrence of type 2 diabetes for our population as a whole, but don’t really explain the differences among ethnicities; nor has there ever been a firmly established genetic variability among different ethnicities.

So what else could it be?

I believe a factor that plays a big role is awareness. This includes education on a medical condition, the risks, the causes, preventative steps to take, and very importantly understanding how to navigate the American healthcare system for many first-generation families in the U.S.

Modern terms such as health literacy, social determinants of health, and even systemic racism are often used to help explain this uneven playing field we are trying to solve.

I choose to call this awareness and maybe even better multidirectional awareness, to include players such as the patient and families, the healthcare professional, policymakers, and the community at large that need to participate to close this gap.

Addressing awareness is a process that takes time — time to create relationships, educate, build trust, and change the patterns we can all fall victim to. I feel like the real difference is made locally with feet on the ground and many players engaged.

I am helping with a grant project designed to address this topic in the Karen community in the Worthington area, which is one of the ethnic groups with greater risk of developing type 2 diabetes. The Karen people are refugees from Burma in Southeast Asia, who fled due to civil war within their former country. We are working to educate people on the risks, screen them for type 2 diabetes, and then help them to work through the local healthcare system with the goal being to live healthier lives.

Worthington is a wonderful microcosm of the world with multiple ethnicities present, and many of these people experience type 2 diabetes at a higher rate. There is still much more work to be done, but it doesn’t happen without action. My worldview is the situations we face do not happen by chance, but that we are where we are for a specific reason and we are called to act and impact where we are at in a given time.

If you ask me, one of the few positives that came out of the pandemic was a much better understanding of how our community and world fit together to really make things function. When certain areas are taken away we can see how we are interdependent on one another. From the grocery stores to the healthcare workers, teachers and paras, law enforcement, production workers, and farmers. We all have a role to play or a job to do that is very much depended upon by many other sectors of our community and if you take out one sector, there is a major ripple effect in others.

Let’s rise to the challenge to level the playing field in our communities.