Diabetes’ impact on diverse populations

By Kellie Schmitt

The statistics on diabetes are staggering. The disease already affects 8.3 percent of Americans, and that number could climb to one in three by 2050, according to experts on a Health Journalism 2012 panel.

Those figures aren’t distributed evenly. Diabetes disproportionately impacts older adults and diverse populations. That’s troublesome, says Rita Louard, M.D., not only because of the differential rate, but also because those populations are expected to climb. 

“The rates are going to be exploding,” said Louard, director of the Clinical Diabetes Program – Moses Campus, Montefiore Medical Center. “The implications in terms of health care consequences down the line can be considerable.”

Along with the health burdens – which include amputations, blindness and increased risk of death – the cost of treating diabetes is also tremendous, Louard said.

Louard works in the Bronx, which has the highest rate of diabetes among New York City boroughs, she said. Along with large numbers of minorities, the area also has high rates of poverty and uninsured populations. 

But statistics aren’t what motivated Louard to speak about diabetes: “What I came to talk about: We have the opportunity to make things better.”

For patients with diabetes, tight glycemic control early on can significantly delay complications.

Conveying that message to diverse populations isn’t a one-size-fits-all approach, though. Instead, culturally and linguistically sensitive interventions are essential to any educational outreach, she said.

Louard pointed to public health outreach that has had community success such as green carts, farmers’ markets, and hosting local recreational activities. Increased access to health care is also critical.

“If we can have improvement in barriers to care, insurance is important,” she said. “Stressors in the system will make hard for economic disadvantaged patients to get care.”

While type 1 and 2 diabetes are commonly mentioned, gestational diabetes is the most common complication of pregnancy, said Connie Crawley, a nutrition and health specialist at The University of Georgia Cooperative Extension.

Along with pregnancy complications, gestational diabetes serves as an early warning to women that they’re at risk of developing the disease themselves and an opportunity to adjust behaviors early on.

Gestational diabetes occurs in about 7 percent of pregnancies, though there are likely many more cases that are not well documented, Crawley said.

 “This is a big public health problem that we’re not addressing very well right now,” she said. “It really is something we need to think more about.”

Women are more likely to develop diabetes when pregnant because changing hormones levels make their bodies less sensitive to insulin. Risk factors include age, ethnicity, excess weight, having a previous baby over 9 pounds, family history, polycystic ovarian disease, and a history of glucose tolerance.

Crawley agrees that all pregnant women should be screened from their first pre-natal visit. Screening is done by consuming a sugar drink and evaluating blood sugar levels.

 “What’s good about pregnancy is they’re often motivated to do whatever they need to do to take care of themselves,” she said.

But, once the baby is delivered, the mother can’t be forgotten, Crawley said.

Another aspect of diabetes addressed during the panel was diabetes-related kidney failure. Often symptoms aren’t detected until the disease is very advanced.

“The critical message: these patients need to be identified much earlier so they can benefit from treatment we have,” said Janice Lea, M.D., a professor in the Department of Medicine, Division of Renal Medicine at Emory University School of Medicine.

Lea also discussed diet, and how lifestyle modifications such as exercise and weight loss can reduce blood pressure.  Education, early detection and more clinical research in African Americans are all essential.  

The panelists stressed the importance of journalists helping tell personal stories of success, such as changes people have made and the positive impacts of those steps.

“Start with a personal story,” Louard said. “You can do the stats, and they’re daunting, but they’re just that, daunting. They don’t give people a way to improve outcomes and help neighbors.”

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Kellie Schmitt is a health reporter at The Bakersfield Californian and was a 2012 AHCJ-Rural Health Journalism Fellow.