Diabetes and Heart Disease Risk in Black People

Type 2 diabetes—a chronic condition that affects the way the body processes blood sugar (glucose)—is one of the leading causes of heart disease in Black communities.

Black people are disproportionately impacted by diabetes and as a result, have an increased risk of heart disease. In addition, Black people living with diabetes experience more severe medical complications and death compared to the next highest risk group, non-Hispanic White Americans.

Differences in genetics, high rates of obesity, insulin resistance, and living in an under-served neighborhood are just some of the factors contributing to this disparity.

This article will review diabetes as a risk factor for heart disease and how finding care and using an integrative treatment approach can lower your diabetes risk. 

Facts About Race and Diabetes

According to the Department of Health and Human Services' Office of Minority Health, 13.4% of Black men and 12.7% of Black women over the age of 18 are diagnosed with diabetes.

Diabetes is a condition that usually shows few, if any, symptoms early on. Therefore, these figures are likely an underestimation, and more Black people may be living with diabetes before it is diagnosed.

Why Diabetes Is a Risk Factor for Heart Disease 

Diabetes and heart disease are two independent medical conditions with many connection points.

Chronically high blood glucose levels over time can damage the blood vessels and nerves that control the heart, leading to heart disease.

While the role of your genes in this process is largely unknown, behavioral factors can accelerate this process, including:

• Unhealthy eating
• Lack of exercise
• Smoking

Underlying Cause of Diabetes Disparities

Type 2 diabetes affects Black communities more than other groups.

Differences in health status, access to health care, and income are largely the main drivers of these health disparities.

Social and economic barriers make accessing care more difficult for many Black people.

High healthcare costs coupled with lower insurance rates mean that many Black people cannot afford quality medical care and prescription medications, so conditions such as diabetes are not managed as well as they could be and subsequently result in poorer outcomes.

Other Risk Factors 

You are more likely to develop type 2 diabetes if you:

• Are age 45 or older
• Have a family history of diabetes
• Have high blood pressure
• Have a low level of HDL cholesterol, or a high level of triglycerides
• Have a history of gestational diabetes or gave birth to a baby weighing 9 pounds or more
• Low physical activity
• Have depression
  
• Have polycystic ovary syndrome (PCOS)
• Have acanthosis nigricans (dark, thick, and velvety skin around your neck or armpits)
• Have a history of heart disease or stroke

Finding Care

Your healthcare team is an incredibly important part of your diabetes management.

Many Black people report that they are more likely to feel comfortable with Black healthcare providers and more likely to follow preventive measures delivered by Black healthcare providers.

Questions to Ask

Choosing the right healthcare provider isn’t easy. It requires you to ask yourself and the office staff many important self-reflective and open-ended questions to ensure that they are right for you. 

Some introspective questions you might ask yourself include:

• How far am I willing to travel to see my healthcare provider?
• How important is it that my healthcare provider looks like me?
• Will a healthcare provider who does not look like me but provides culturally competent care suffice?
• How does this healthcare provider fit into my schedule? Do they have after-hours services?
• What kind of primary care healthcare provider am I looking for?
• I really like this healthcare provider, but they do not take my insurance. Am I willing to pay out of pocket?

Some questions you may want to ask your healthcare provider directly include:

• Have you worked with Black patients before? 
• What does culturally competent care mean to you? How do you ensure that your care is culturally competent?
• Do you provide genetic testing?
• How long is a typical appointment?

Here are some diabetes-specific questions you may want to ask:

• Is diabetes a “curable” disease? 
• A family member (mom, dad, sister, brother, grandparent, etc.) has diabetes. Does that mean I will get it too?
• Can I reverse diabetes with lifestyle modifications?
• I have diabetes, will I need to take insulin? If so, do I have to take it for the rest of my life?

You may also want to ask the staff and other people who have previously worked with your potential healthcare provider about their experience. While you cannot, and should not, base your decision solely on the opinion of others, sharing what you know can add perspective to this very important decision. 

An Integrative Treatment Approach

Treating diabetes may include a mix of lifestyle changes and medication.

Lifestyle 

Type 2 diabetes is largely thought of as a lifestyle disease. No matter your age, it’s never too early to start an anti-diabetes lifestyle that includes:

• Losing excess weight: Losing weight can decrease insulin resistance, allowing the body to better utilize the hormone. Research has shown that losing a small amount of weight can lower your risk of type 2 diabetes. A small amount of weight loss means around 5% to 7% of your body weight or just 10 pounds (lbs) to 14 pounds for a 200-pound person.
• Boosting physical activity: Regular physical activity means getting at least 150 minutes a week of brisk walking or similar activity. Biking, running, swimming, and hiking are highly recommended activities. Most healthcare professionals suggest 30 minutes of moderate-intensity exercise—that means enough to break a sweat—five days a week.
• Eating healthily: An excess of refined, simple carbohydrates and a lack of fiber both contribute to obesity and may lead to a diagnosis of diabetes.

The American Diabetes Association recommends that most adults begin diabetes screening at the age of 45. The U.S. Preventive Services Task Force recommends screening for people 35 and up who are overweight or obese.

If you have prediabetes or early-stage type 2 diabetes, changing your diet may help you reverse course.

There are some diets, sometimes called “diabetic diets”—such as the Mediterranean and DASH diets—that have been proven to keep blood sugars within a healthy range.

These diets all encourage:

• High fiber intake
• Little or no added sugar
• Complex carbs
• Avoidance of foods high in trans and saturated fats

The goal is to provide you with the macronutrients you need while cutting the simple carbs that lead to spikes in blood sugar and LDL, or bad cholesterol, that puts you at higher risk of cardiovascular disease. 

Eating healthy also provides the added benefit of weight loss or healthy weight maintenance. Coupling a heart-healthy diet with routine exercise can lead to a precipitous drop in your heart disease risk. 

Medication

Daily insulin via injection or an insulin pump is the mainstay of treatment for type 1 diabetes.

Oral medications, such as metformin, that regulate blood sugar levels by changing the way the body makes or uses sugar are much more common in type 2 diabetes.

Over time, a person with type 2 diabetes may need to add insulin to their treatment regimen if the combination of lifestyle modifications and oral medication does not control blood sugar levels. 

Resources

The following programs are tailored to Black communities at high risk for type 2 diabetes:

• The Center for Black Health and Equity
• Council on Black Health
• National Diabetes Education Program
• New Beginnings: A Discussion Guide for Living Well with Diabetes
• Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention
• Feeding America 

Summary

Black people are disproportionately impacted by diabetes, and as a result, heart disease. Differences in genetics, high rates of obesity, insulin resistance, and living in under-served neighborhoods are just some of the factors that contribute to this disparity. 

A Word From Verywell 

People who adopt healthy behaviors are less likely to develop type 2 diabetes, but anyone can develop the condition at some point in their life.

Fortunately, diabetes and its related complications often can be controlled with appropriate health care and patient self-management techniques. However, this isn’t always the case for Black people, especially those who live in underserved areas.

Even when socioeconomic status is equal, Black people often face barriers to quality care that hinder their ability to meet treatment goals, underscoring the need for systemic changes in society that address the inequities that hinder Black people from achieving their best health.