|
Home
Health News
International
Women's Health
Men's Health
General Health
Lifestyles
Fast Facts
Editor's Page
Contact Us
Guest Book
Health Links
Black Physicians
Archives
The Fun/Trivia Page
Poison Control
Advertise with Us
(for Allabh Ad Policy, Click here)
Job
Opportunities
Calendar of Events
Newsletter
Sign Up
Clinical Trials
Read what others are saying or asking on the
billboard by clicking here
AOL Black Voices
Medical Disclaimer
(Pursuant to Allabh
policy, we'll always attempt to keep private and protected any personal
info you may provide on this site)
We comply
with the
HONcode
standard for health trust worthy information:
verify here
***************************
|
Executive Board of
ALLABH |
|
Alix Mathieu, MD,
MSc,,, |
|
MBA, MS (Finance), |
|
Co-CEO |
|
Ghislaine
D. Gilbert, |
|
CIO |
|
----------------------------
If you have a web page and can write a classified ad, you stand to
create massive traffic to your own site by joining
Ad Network it's
FREE.
Seasilver, a
liquid dietary supplement that a lot people like and take every day
|
| |
 |
 |
 |
Today, diabetes mellitus is one of the most serious health challenges
facing the United States. The following statistics illustrate the
magnitude of this disease among African Americans.
- In 1998, of 35 million African Americans, about 1.5 million have
been diagnosed with diabetes. This is almost 4 times the number known
to have diabetes in 1968.
- About 730,000 African Americans have diabetes but do not know they
have the disease. Identifying these undiagnosed cases and providing
clinical care for their diabetes is a major challenge for the health
care community.
- For every six white Americans who have diabetes, 10 African
Americans have diabetes.
- Diabetes is particularly common among middle-aged and older adults
and among African American women. Among African Americans age 50 years
or older, 19 percent of men and 28 percent of women have diabetes.
- African Americans with diabetes are more likely to develop diabetes
complications and experience greater disability from the complications
than white Americans with diabetes.
- Death rates for people with diabetes are 27 percent higher for
blacks compared with whites.
|
|
|
Diabetes mellitus is a group of diseases
characterized by high levels of blood glucose. It results from defects in
insulin secretion, insulin action, or both. Diabetes can be associated
with serious complications and premature death, but people with diabetes
can take measures to reduce the likelihood of such occurrences.
Most African Americans (about 90 percent to 95 percent) with diabetes
have type 2 diabetes. This type of diabetes usually develops in adults and
is caused by the body's resistance to the action of insulin and to
impaired insulin secretion. It can be treated with diet, exercise,
diabetes pills, and injected insulin. A small number of African Americans
(about 5 percent to 10 percent) have type 1 diabetes, which usually
develops before age 20 and is always treated with insulin.
Diabetes can be diagnosed by three methods:
- A fasting plasma glucose test and a value of 126
milligrams/deciliter (mg/dL) or greater.
- A nonfasting plasma glucose value of 200 mg/dL or greater in people
with symptoms of diabetes.
- An abnormal oral glucose tolerance test, with a 2-hour glucose value
of 200 mg/dL or greater.
Each test must be confirmed, on another day, by any one of the above
methods. The criteria used to diagnose diabetes were revised in 1997.1
Figure 1. -
Prevalence of diagnosed and undiagnosed diabetes in
African Americans, U.S., 1988-94.
 |
|
| Note:
Diabetes includes both previously diagnosed diabetes and
undiagnosed diabetes (fasting plasma glucose greater than 126 mg/dL). |
|
|
|
Figure 1 shows the prevalence for African
American men and women based on the most recent national study, the NHANES
III survey conducted in 1988-94.2
The proportion of the African American population that has diabetes rises
from less than 1 percent for those aged younger than 20 years to as high
as 32 percent for women age 65-74 years. In every age group, prevalence is
higher for women than men: overall, among those age 20 years or older, the
rate is 11.8 percent for women and 8.5 percent for men.
About one-third of total diabetes cases are undiagnosed among African
Americans. This is similar to the proportion for other racial/ethnic
groups in the United States.2
National health surveys during the past 35 years show that the
percentage of the African American population that has been diagnosed with
diabetes is increasing dramatically.3
The surveys in 1976-80 and in 1988-94 measured fasting plasma glucose and
thus allowed an assessment of the prevalence of undiagnosed diabetes as
well as of previously diagnosed diabetes. In 1976-80, total diabetes
prevalence in African Americans age 40-74 years was 8.9 percent; in
1988-94, total prevalence had increased to 18.2 percent--a doubling of the
rate in just 12 years.2
Prevalence in African Americans is much higher than in white Americans.
Among those age 40-74 years in the 1988-94 survey, the rate was 11.2
percent for whites, but was 18.2 percent for blacks--diabetes prevalence
in blacks is 1.6 times the prevalence in whites.2
|
|
|
The frequency of diabetes in African American
adults is influenced by the same risk factors that are associated with
type 2 diabetes in other populations. Two categories of risk factors
increase the chance of developing type 2 diabetes. The first is genetics.
The second is medical and lifestyle risk factors, including impaired
glucose tolerance, gestational diabetes, hyperinsulinemia and insulin
resistance, obesity, and physical inactivity.
Genetic Risk Factors
The common finding that "diabetes runs in families" indicates
that there is a strong genetic component to type 1 and type 2 diabetes.
Many scientists are now conducting research to determine the genes that
cause diabetes. For type 1 diabetes, certain genes related to immunology
have been implicated. For type 2 diabetes, there seem to be diabetes genes
that determine insulin secretion and insulin resistance. Some researchers
believe that African Americans inherited a "thrifty gene" from
their African ancestors. Years ago, this gene enabled Africans, during
"feast and famine" cycles, to use food energy more efficiently
when food was scarce. Today, with fewer such cycles, the thrifty gene that
developed for survival may instead make the person more susceptible to
developing type 2 diabetes.
Figure 2. -
Time trends in the percentage of adolescents and adults in
the U.S. who are overweight, U.S., 1988-94.
 |
|
Medical Risk Factors
Impaired Glucose Tolerance (IGT)
In some people, their blood glucose level after a meal or after an oral
glucose test rises higher than is considered normal but not high enough
for them to be diagnosed with diabetes. These individuals are described as
having impaired glucose tolerance (IGT). IGT may be an early stage of
diabetes, and people with IGT are at higher risk of developing type 2
diabetes than people with normal glucose tolerance. Rates of IGT among
adults age 40-74 years in the NHANES III survey were similar for black (13
percent) and white (15 percent) Americans.2
Gestational Diabetes (GDM)
About 2 to 5 percent of pregnant women develop mild abnormalities in
glucose levels and insulin secretion and are considered to have
gestational diabetes. Although these women's glucose and insulin levels
often return to normal after pregnancy, as many as 50 percent may develop
type 2 diabetes within 20 years of the pregnancy.
Hyperinsulinemia and Insulin Resistance
Higher-than-normal levels of fasting insulin, called hyperinsulinemia, are
associated with an increased risk of developing type 2 diabetes.
Hyperinsulinemia often predates diabetes by several years. Among people
who did not have diabetes in the NHANES III survey, insulin levels were
higher in African Americans than in whites, particularly African American
women, indicating their greater predisposition for developing type 2
diabetes.4 Another
study showed a higher rate of hyperinsulinemia in African American
adolescents compared with white American adolescents.5
Obesity
Overweight is a major risk factor for type 2 diabetes. The NHANES surveys
found that overweight is increasing in the United States, both in
adolescents and in adults. Figure 2 illustrates these data and also shows
that African American adults have substantially higher rates of obesity
than white Americans.6,7
In addition to the overall level of obesity, the location of the excess
weight is also a risk factor for type 2 diabetes. Excess weight carried
above the waist is a stronger risk factor than excess weight carried below
the waist. African Americans have a greater tendency to develop upper-body
obesity, which increases their risk of diabetes.
Although African Americans have higher rates of obesity, researchers do
not believe that obesity alone accounts for their higher prevalence of
diabetes. Even when compared with white Americans with the same levels of
obesity, age, and socioeconomic status, African Americans still have
higher rates of diabetes. Other factors, yet to be understood, appear to
be responsible.
Physical Activity
Regular physical activity is a protective factor against type 2 diabetes
and, conversely, lack of physical activity is a risk factor for developing
diabetes. Researchers suspect that a lack of exercise is one factor
contributing to the high rates of diabetes in African Americans. In the
NHANES III survey, 50 percent of black men and 67 percent of black women
reported that they participated in little or no leisure time physical
activity.8
|
|
|
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 2
percent to 5 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.
Eye Disease
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.9
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.
Kidney Failure
African Americans with diabetes experience kidney failure, also called
end-stage renal disease (ESRD), about four times more often than diabetic
white Americans.10 In
1995, there were 27,258 new cases of ESRD attributed to diabetes in black
Americans.11 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.10
Amputations
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.12
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).
Figure 3. -
Mortality rates in black and white diabetic men and women
in a sample of the U.S. population, 1971-1993.
Age in 1971-75 |
|
|
|
|
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.12
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 1992-1993.13
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.
Points To Remember
- 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.
|
|
|
|
Within many African American communities
around the country, NIDDK supports centers that provide nutrition
counseling, exercise, and screening for diabetes complications. These
centers are called Diabetes Research and Training Centers.
Prevention
In 1996, NIDDK launched its Diabetes Prevention Program (DPP). The goal of
this research effort is to learn how to prevent or delay type 2 diabetes
in people with impaired glucose tolerance (IGT) and in women with IGT who
have a history of gestational diabetes. Both conditions are strong risk
factors for type 2 diabetes.
About 4,000 volunteers are needed to participate in DPP. The study is
being conducted at 25 centers throughout the United States and is
enrolling volunteers from groups at high risk for developing type 2
diabetes. Because of the high risk of developing type 2 diabetes among
some ethnic groups, about half of the DPP participants will be African
American, Hispanic American, Native American, and Asian/Pacific Islanders.
Other high-risk participants will include elderly, overweight people and
women with a previous history of gestational diabetes.
DPP will evaluate several interventions to prevent type 2 diabetes,
including an intensive healthy eating and exercise program and the use of
diabetes medication. Researchers are tailoring interventions to the
cultural needs of individuals in the program. Recruitment into the study
began in the summer of 1996, and participants will be followed for an
average of 4.5 years, with findings to be released in 2002.
Education and Awareness Activities
Recently, NIDDK joined the Centers for Disease Control and Prevention to
sponsor the National Diabetes Education Program (NDEP). The goal of this
program is to reduce the death and disability associated with diabetes and
its complications. The NDEP will conduct ongoing diabetes awareness and
education activities for people with diabetes and their families. Special
efforts will be made to address the needs of certain ethnic groups that
are hardest hit by diabetes, including African Americans, Hispanic
Americans, Asian Americans, Pacific Islanders, and Native Americans.
Through these efforts, the NDEP hopes to improve the treatment and
outcomes for people with diabetes, promote early diagnosis, and,
ultimately, prevent the onset of diabetes.
|
|
|
1. American Diabetes
Association. Report of the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus. Diabetes Care, Vol. 20, p. 1183-1197,
1997.
2. Harris MI, Flegal KM, Cowie CC, et al. Prevalence
of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in
U.S. Adults: The Third National Health and Nutrition Examination Survey,
1988-94. Diabetes Care Vol. 21, p. 518-524, 1998.
3. Tull ES, Roseman JM. Diabetes in African Americans.
Chapter 31 in Diabetes in America. 2nd Edition (NIH Publication No.
95-1468, pp. 613-630). Bethesda, MD: National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, 1995 (http://diabetes-in-america.s-3.com).
4. Harris MI. Unpublished data from the Third National
Health and Nutrition Examination Survey, 1988-94.
5. Jiang X, Srinivasan SR, Radhakrishnamurthy B,
Dalferes ER, Berenson GS: Racial (black-white) differences in insulin
secretion and clearance in adolescents: the Bogalusa heart study.
Pediatrics 97:357-360, 1996.
6. Kuzmarski RJ, Flegal KM, Campbell SM, Johnson CL:
Increasing prevalence of overweight among US adults. The National Health
and Nutrition Examination Surveys, 1960 to 1991. JAMA 272:205-211, 1994.
7. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM,
Johnson CL: Overweight prevalence and trends for children and adolescents.
Arch Pediatr Adolesc Med 149:1085-1091, 1995.
8. Crespo CJ, Keteyian SJ, Heath GW, Sempos CT:
Leisure-time physical activity among US adults. Arch Intern Med 156:93-98,
1996.
9. Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt
DD: Is the risk of diabetic retinopathy greater in non-Hispanic blacks and
Mexican Americans than in non-Hispanic whites with type 2 diabetes: a US
population study. Diabetes Care, vol. 21, in press.
10. Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP,
Hawthorne VM: Disparities in incidence of diabetic end-stage renal disease
by race and type of diabetes. New Engl J Med 321:1074-1079, 1989.
11. U.S. Renal Data System. USRDS 1997 Annual Data
Report. Bethesda, MD: National Institute of Diabetes and Digestive and
Kidney Disease, National Institutes of Health, 1997.
12. Geiss, LS (editor). Diabetes Surveillance, 1997.
Centers for Disease Control and Prevention, Atlanta, Georgia, 1997.
13. Gu K, Cowie CC, Harris MI: Mortality in adults
with and without diabetes in a national cohort of the US population,
1971-93. Diabetes Care, vol. 21, July 1998, in press.
|
|
|
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Tel: (301) 654-3327
Fax: (301) 907-8906
E-mail: National
Diabetes Information Clearinghouse
The National Diabetes Information Clearinghouse (NDIC) offers
additional information about diabetes including the following:
- The Diabetes Dictionary (booklet available in English and
Spanish)
- Do Your Level Best: Start Controlling Your Blood Sugar Today
(booklet, limited literacy).
Single copies are free. Bulk orders are available for health care
professionals. For more information about diabetes and African
Americans and to order publications, contact NDIC.
Weight-control Information Network
1 Win Way
Bethesda, MD 20892-3665
Tel: (301) 951-1120 or (800) WIN-8098
Fax: (301) 951-1107
E-mail: win@info.niddk.nih.gov
American Diabetes Association National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Tel: (800) 232-3472
Fax: (703) 549-6995
Home page: http://www.diabetes.org
|
|
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
E-mail: National
Diabetes Information Clearinghouse
The National Diabetes Information Clearinghouse (NDIC) is a service of
the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The NIDDK is part of the National Institutes of Health under the U.S.
Department of Health and Human Services. Established in 1978, the
clearinghouse provides information about diabetes to people with diabetes
and their families, health care professionals, and the public. NDIC
answers inquiries; develops, reviews, and distributes publications; and
works closely with professional and patient organizations and Government
agencies to coordinate resources about diabetes.
Publications produced by the clearinghouse are reviewed carefully for
scientific accuracy, content, and readability.
This e-text is not copyrighted. The clearinghouse encourages users of
this e-pub to duplicate and distribute as many copies as desired.
|
HOME
|
NIH Publication No. 98-3266
August 1998
e-text updated: 20 September 1998
|
|
