Research suggests that type 2 diabetes disproportionately affects people of color. Disparities may have links to access to healthcare, socioeconomic status, and systemic racism.

The Centers for Disease Control and Prevention (CDC) estimate that approximately 34 million people in the United States have diabetes, and about 90% to 95% of these people have type 2 diabetes. The CDC also indicate that the prevalence of diabetes varies significantly by race.

Other research also suggests that African American, African, Hispanic, and Asian people are statistically more likely to have type 2 diabetes than white Americans.

Medical News Today asked some experts to explain the reason for these disparities and identify opportunities to close the diabetes healthcare gap for people of color.

“At the national level, for adults, there are major differences observed in the frequency of diabetes for individuals of color compared [with] white individuals,” explained Dr. Leonard Egede, the chief of the Division of General Internal Medicine at the Medical College of Wisconsin, who studies health disparities related to race and ethnicity for chronic medical conditions.

The CDC’s 2020 report estimates the following rates of diagnosed, undiagnosed, and total diabetes in adults in the United States as:

  • 16.4% of Black non-Hispanic people
  • 14.9% of Asian non-Hispanic people
  • 14.7% of Hispanic people
  • 11.9% of white non-Hispanic people

The frequency of clinical diabetes diagnoses is highest among American Indians and Alaskan Natives, at 14.7%. In comparison, 7.5% of white Americans have received an official diabetes diagnosis.

Large-scale health data collection efforts have routinely understudied American Indians and Alaskan Natives, so it is more challenging to estimate the prevalence of undiagnosed diabetes in this population.

According to an older study, people of color are also more likely to experience complications from type 2 diabetes. (The paper uses the following terms to define specific race or ethnic groups: non-Hispanic Black, non-Hispanic white, Hispanic American, Asian American, East Asian, Southeast Asian, Pacific Island, and Native American).

  • heart disease and heart failure
  • retinopathy, which is a type of eye disease
  • neuropathy, or nerve damage
  • kidney disease

According to the CDC, a family history of type 2 diabetes is a risk factor for the disease. However, this does not necessarily mean that higher rates of type 2 diabetes in some populations are necessarily due to genetics.

Mercedes Carnethon, Ph.D., a professor of preventive medicine at Northwestern University in Chicago, IL, noted that families don’t just share genes. “The home environment is perhaps more likely to contribute to who develops diabetes,” she said.

Beyond having a close relative with type 2 diabetes, the CDC list several other factors that can increase the risk of a diabetes diagnosis. These include:

  • overweight
  • having obesity
  • exercising less than three times per week

However, other factors independent of having overweight or obesity can also lead to diabetes among non-Hispanic white, non-Hispanic Black, and Mexican American people. These factors include higher insulin resistance, increased insulin secretion, and higher than normal insulin levels in the blood.

Where a person lives and their access to certain resources significantly impacts their health outcomes. Research suggests that factors, including socioeconomic status, systemic racism, and culture, may all play a role in the increased rates of type 2 diabetes among people of color.

“Race and ethnicity are social and cultural concepts,” Dr. Egede said. “The health disparities that we observe are largely a function of our social structure and can be linked to the historical marginalization that individuals of color have experienced.”

Social risk factors and socioeconomic status

Social determinants of health are the conditions and environments where people are born, grow, live, work, and play. These factors have an invisible but important role in health outcomes, for better or for worse.

Some social determinants of health may adversely impact a person’s health, such as exposure to crime, violence, and racial segregation.

Other social determinants create a safe and stable living environment, such as access to:

  • healthy food
  • quality and affordable healthcare, including health insurance
  • education
  • economic and job opportunities
  • affordable and safe housing
  • social support

A person’s social determinants largely depend on their income and socioeconomic status.

“Socioeconomic resources determine where one lives and the types of resources that they have available to protect their health,” Dr. Carnethon said.

Without a safe environment and access to basic necessities, people may struggle to exercise or eat fresh foods regularly. This can, in turn, increase a person’s risk for type 2 diabetes.

People who are Black and Hispanic are significantly more likely to live in poverty than white people. According to 2019 data from the U.S. Census Bureau, 18.8% of Black and 15.7% of Hispanic Americans lived in homes with incomes below the federal poverty line, compared with 7.3% of non-Hispanic white Americans.

The COVID-19 pandemic has widened these gaps, with research suggesting that Hispanic and Black Americans have been hit the hardest by job and income losses.

“Our research has shown that markers of lower socioeconomic status…contribute significantly to the disparities in diabetes that we see between Black and [white] adults,” said Dr. Carnethon.

She noted that socioeconomic determinants of health likely play a role in disparities observed in other communities of color, such as Hispanic and indigenous populations.

Disparities in socioeconomic status also contribute to gaps in access to affordable health insurance and quality healthcare. These disparities have improved since the Affordable Care Act was passed, but as of 2018, Black and Hispanic Americans are 1.5 and 2.5 times more likely to be uninsured than white Americans, respectively.

Systemic racism

Systemic racism is a key contributing factor that perpetuates disparities in social risk factors for type 2 diabetes among communities of color.

A 2020 study found that toxic stress caused by poverty, discrimination, and racism had associations with a reduced quality of life among people of color with type 2 diabetes, particularly Black Americans.

“Racism locks people out of academic access and high-status occupations that provide less job stress and more financial resources,” said Dr. Carnethon. Groups who experience discrimination tend to live in communities “that promote stress and restrict access to healthy foods, safe spaces, and safe homes,” she added.

“When social mobility is limited, your economic capacity is also limited,” Dr. Egede said. “You may experience challenges in paying rent, buying food, and basic resources needed to maintain your health.”

All of these factors affect factors that increase the risk for type 2 diabetes, such as:

  • diet
  • exercise
  • sleep
  • stress

As Dr. Egede explained, “These factors create a perfect storm for the onset of chronic conditions, such as diabetes.”

Racism on an individual level can also affect the health of people of color. Research suggests that exposure to racism has associations with poor physical and mental health, particularly for Latino people with diabetes.

Culture and diet

Diet is an integral part of most cultures. It often informs the foods that people eat and how they prepare them. In communities of color, particularly among immigrants, changing that diet may increase the risk for diabetes.

Research on adults who have immigrated to the U.S. indicates that the process of acculturation and the adoption of the “American diet” predisposes [people who immigrate] to higher rates of diabetes,” Dr. Carnethon said.

People may give up their traditional diet in favor of a standard American diet to feel more assimilated into the predominant local culture. Dr. Carnethon explained that might mean people increase consumption of foods that are known to increase the risk for type 2 diabetes, including:

  • processed foods
  • meat
  • high fat dairy

Changes have to happen at the community and societal level to address the disparities observed in type 2 diabetes rates in people of color.

“Interventions that target the environment through policies are likely to have the biggest impact on behavior,” said Dr. Carnethon. “By changing the environment, the healthy choice becomes the easiest choice.”

Specific strategies she suggested include:

  • investing in community infrastructure
  • creating safe spaces for outdoor exercise
  • subsidizing healthy foods

“Affordable quality healthcare that is accessible to people in their communities and that prioritizes prevention can [also] target the risk factors for diabetes, such as obesity,” she added.

For people looking to get involved in addressing health inequities to type 2 diabetes, Jennifer Campbell, Ph.D., an assistant professor of medicine at the Medical College of Wisconsin who works with Dr. Egede, recommends checking out opportunities and recommendations from the American Diabetes Association.

Dr. Carnethon noted that the American Heart Association is also a leader in diabetes advocacy, given the fact that heart disease is the leading cause of death among those with diabetes. “The American Heart Association is additionally committed to eliminating [health] disparities.”

“Meaningful change takes time, but that does not mean individuals cannot take immediate action to improve their health and reduce their risk of diabetes,” said Dr. Campbell.

Our experts agreed that key steps people can take to reduce their risk for type 2 diabetes or help manage their existing disease include:

  • eating a healthy diet that includes a variety of foods
  • taking regular physical activity
  • getting regular and restorative sleep

“These small steps can add up to improvement in health over time,” Dr. Campbell explained.

Dr. Egede also encouraged people of color living with type 2 diabetes to participate in research to help address health disparities. Research can help healthcare providers identify ways to help people make healthier decisions that reduce their risk for type 2 diabetes.

“These studies create the evidence base for policy change. If we cannot have the voices of those most affected represented in this evidence base, it is hard to generate a policy that accounts for everyone’s lived experience,” said Dr. Egede.

If you’re interested in getting involved in research, you can find studies that are currently recruiting patients on the National Institutes of Health’s website or by talking with your doctor or another healthcare professional.

On a hopeful note, Drs. Egede and Campbell believe there’s an opportunity today to capitalize on the social momentum to address systemic racism in America in order to combat health disparities in communities of color, including the risk for type 2 diabetes.

“While the health disparities in diabetes are long-standing and multilevel, I am very optimistic about the future,” said Dr. Egede.

Black, Asian, and Hispanic populations in the United States experience higher rates of type 2 diabetes than white Americans. This stems from a long history of structural racism that has limited access to resources that promote good health.

The good news is that experts are hopeful that there’s positive momentum for these factors to change in the future.

Read this article in Spanish.