Although there has been an uptick in reporting about racial and ethnic health disparities, the phenomenon is not new. As author Arleen Tuchman describes in her book, Diabetes: A History of Race and Disease, there is a long history of the medical field believing that there are biological differences between different races. This belief that race is a biological aspect of people has been disproven through the human genome project, but racial health disparities remain a significant challenge in the U.S. and throughout other parts of the world.1
Tuchman talks about how underdiagnosed type 1 diabetes has been throughout history in people considered to be in racial or ethnic minorities in the U.S. This continues to be a challenge for Black and Hispanic people in the U.S. to this day. Dr. Phyllisa Deroze was misdiagnosed with type 2 diabetes for eight years, and this misdiagnosis led her to go into DKA at the Coronado hotel during Friends for Life in 2019. She has been sharing her story to help others who might be questioning their own diagnosis to advocate for themselves, and to hopefully help healthcare providers look past their racial biases when making diagnoses.
Marginalized communities, including Black Americans , have been experiencing health disparities since the earliest days of U.S. history. These disparities are largely a result of structural racism that creates a lack of access to adequate healthcare, lack of resources such as safe housing and affordable healthy foods and other social determinants of health.2,3 It’s unfortunate that although these disparities have been consistent throughout history, many people are still experiencing the effects of them today. Harriet Washington’s book, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present provides a detailed historical account of some of these injustices not widely known today.
What is Happening to Promote Progress?
One of the first ways we can move the needle in healthcare is to collect data about the subject and try new ways to make improvements. The T1D Exchange Quality Improvement Collaborative has been focusing on health equity for people with type 1 diabetes. The group published a study in 2021 that found from a group of almost 20,000 people with type 1 diabetes, including children and adults, Non-Hispanic Black people had the highest rates of DKA, severe hypoglycemia and lowest rates of diabetes technology use.4
Other studies have been conducted on implicit bias and how it affects prescribing habits of physicians. There have been many studies showing that diabetes technologies are prescribed at higher rates for non-Hispanic White people compared to other races in the U.S.4,5,6 The more this data is shared and providers are made aware, the more these providers will hopefully offer and prescribe diabetes technologies to patients with diabetes outside of the non-Hispanic White population. There have been health disparity focused sessions at professional diabetes conferences throughout the last couple of years as well.
Dr. Deroze and her daughter, Jalanah, recently co-authored a book called Diabetes Helpers about children who help their family members with various types of diabetes. The book is very helpful for children of adults living with diabetes as well as families who have a child with diabetes. It’s an uplifting and inclusive look at real-life with diabetes. It is inclusive in several ways; first, in relationship of the characters to their loved one with diabetes; second, in the representation of different physical appearances of the characters; third, in the types of diabetes that people have; and fourth, it shows a range of access to diabetes technology. Despite the significant challenges in getting access to the right diagnosis and right care for herself, Dr. Deroze has made it her mission to educate others and help them avoid the dangers that lack of knowledge can cause.
For more information on health disparities in diabetes and to learn about ways you can help keep the needle moving in the right direction, check out the following resources:
- Tackling Health Disparities for Non-Hispanic Black Americans
- Diabetes and Health Disparities
- Recorded Screenside Chat with CWD: Talking About Diversity, Inclusion, and Getting More of Both in the DOC with Cherise Shockley
- Recorded Screenside Chat with CWD: Diversity in Diabetes, with Quisha Umemba
- Race Is a Social Construct, Scientists Argue
- Health Disparities
- Racism and Health
- Inequities in Health Outcomes in Children and Adults With Type 1 Diabetes: Data From the T1D Exchange Quality Improvement Collaborative
- Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients With Type 1 Diabetes in a U.S. Academic Medical Center
- A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Transatlantic Comparison
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES