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Diabetes and Health Disparities

February 24, 2021
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Diabetes is a disease that affects people of all types, and while there are many factors that affect how well diabetes is managed, some of them are not modifiable, such as race. Although the pandemic has brought the racial health disparities in the United States to the headlines, there is still so much work to be done.

The data
Back in 2004, the CDC reported data that was collected from 1979-2004 on people ages 1-19 years with diabetes. The data showed that the death rates were significantly higher for Black youth than white youth, and when the death rate declined for white youth between 1994-2004, it actually increased for Black youth.1 The report stated the research did not show why the death rate increased, and that further research and education needed to be done to help these alarming findings.1 

The collection of data on racial disparities in diabetes has been done by many publications, including the T1D Exchange, an organization in the United States. In 2013, authors published an article about incidence of severe hypoglycemia and diabetic ketoacidosis (DKA) amongst people between 2-26 years old.2 The data showed that those who have lower household income, are of non-white race, and do not have private insurance are at a higher risk of experiencing a severe hypoglycemic event and DKA.2

In August 2020, another study was published that collected data from 300 young adults with T1D, showing racial inequities in HbA1c, technology use, diabetes distress, and diabetes self-management.3 This study included young adults who were 33% white, 32% Black and 34% Hispanic.3 Even more worrying, the study showed that when the data was controlled for socio-economic status, the young adults who were Hispanic showed similar glycemic control to the white young adults, but the Black young adults continued to have poor glycemic control.3

Where do we go from here?
We cannot ignore the fact that racism continues to cause extensive and needless suffering of people of color in the United States.4 There are many very big picture things that will need to change in order to make things more equitable for people of color.

But for diabetes, there are people who are doing research to find better ways to serve communities of color with diabetes, and to improve outcomes. Dr. Ashby Walker at University of Florida Gainesville is a medical sociologist who has spent her career devoted to reducing health disparities in diabetes. One of her ongoing projects is called All for ONE (Outreach, Networks, Education) and it involves pairing mentors in college with adolescents with public health insurance to help improve their glycemic control, as well as their outlook for the future.5

The study was conducted with 42 teenagers and 22 mentors, where 20 teens were in a control group.5 The results were encouraging with improvements in HbA1c, increased hope, and increased likelihood to attend scheduled doctor’s appointments.5

A modified version of the All for ONE program is now being used in the Extension for Community Health Outcomes (ECHO) Diabetes program in the states of Florida and California, where Diabetes Peer Support Coaches work with people living with diabetes who are seen for care at Federally Qualified Health Centers (FQHCs).  This program reaches medically underserved and racially diverse communities with diabetes who are often not able to see endocrinologists on a regular basis.

While we still have a long way to go and a lot of work to do, there are a lot of people doing work in diabetes health disparities. We hope you will join us as we have more discussions about race and diabetes at CWD conferences and through our digital outreach. We are hosting a panel of people living with diabetes and a pediatric endocrinologist who does research on racial health disparities at our upcoming FREE & Virtual Friends for Life Spring Refuel 2021 conference.

Check out these other organizations:

  1. Diversity in Diabetes – a group who solely focuses on reducing health disparities
  2. Kyler Cares – an organization focusing on getting supplies to those who are unable to pay for them, which is often people of color
  3. The Association of Diabetes Care & Education Specialists has a page about being a health care professional and helping decrease racism and health disparities.
  4. The American Diabetes Association has committed itself to Health Equity and created a Health Equity Bill of Rights and other resources.

We also have some recorded Screenside Chats about diversity in diabetes:

  1. Cherise Shockley Talks about Diversity & Inclusion in the Diabetes Online Community.
  2. Quisha Umemba who founded Diversity in Diabetes participated in a Screenside Chat with CWD.

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES

References:

  1. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5645a2.htm#fig
  2. https://pubmed.ncbi.nlm.nih.gov/23469984/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457963/
  4. https://www.cnn.com/2020/06/01/health/racism-public-health-issue-police-brutality-wellness-bn/index.html
  5. https://onlinelibrary.wiley.com/doi/abs/10.1111/pedi.12935