How Does Type 2 Diabetes Affect People of Color?

Diabetes is a disease that happens when your blood glucose (blood sugar) is too high. According to the Centers for Disease Control and Prevention (CDC), more than 37 million Americans have diabetes, with most having type 2 diabetes. Type 2 diabetes is most often diagnosed in adults. However, diagnoses in adolescents and children are increasing.

The CDC also reported that from 2018 to 2019, the rate of adults in the United States diagnosed with diabetes was highest among people belonging to certain ethnic and racial groups, including American Indians and Alaska Natives, non-Hispanic Blacks, people of Hispanic origin, and non-Hispanic Asians. These are also groups that experience high levels of systemic racism, which research links to increased likelihood of developing type 2 diabetes.

This article explores how type 2 diabetes disproportionately affects these populations, risk factors and complications for type 2 diabetes, and how early screening and detection will help with the overall treatment of type 2 diabetes.

How Common Is Type 2 Diabetes in Black and Brown People?

In 2019, about 1 in 10 people of all ages in the United States had diabetes. Additionally, an estimated 96 million adults (about one in three) have prediabetes. Prediabetes is blood sugar that is higher than normal but not yet high enough to be diagnosed as diabetes.

Among adults in the United States, the rate of diagnosed diabetes in 2019 was 5.7 per 1,000 adults, which is just slightly lower than in 2000, which was 6.2 per 1,000 adults.

However, among adolescents from 2002 to 2015, the rate of type 2 diabetes remained stable among non-Hispanic Whites but significantly increased for all other race/ethnic groups, particularly non-Hispanic Blacks.

It’s projected that by 2030 the prevalence of diabetes (type 1 and type 2) will increase by 54% to more than 54.9 million Americans.

Type 2 Diabetes By Ethnicity

Research suggests that people of certain ethnicities are at higher risk of developing type 2 diabetes. Research links this increased risk to experiences of systemic racism. This increased risk is reflected in the rates of diagnosed diabetes in American adults, broken down by ethnicity: 

• American Indians and Alaska Natives: 14.5%
• Non-Hispanic Blacks: 12.1%
• Hispanic: 11.8%
• Non-Hispanic Asians: 9.5%
• Non-Hispanic Whites: 7.4%

Among adults of Hispanic origin, those with origins in Mexico and Puerto Rico had the highest prevalence at 14.4% and 12.4%, respectively. The prevalence in people with origins in Central or South America was 8.3%, and those with origins in Cuba had a 6.5% prevalence.

Among non-Hispanic Asians, those with origins in India and the Philippines had the highest prevalence at 12.6% and 10.4%, respectively, with a 5.6% prevalence in those with origins in China. There was a prevalence of 9.9% in other Asian groups combined.

Causes of Type 2 Diabetes in Black and Brown People

Socioeconomic status and related modifiable risk factors directly contribute to the differences in the rate of diabetes prevalence seen between Black and White adults in the U.S.

Having a close family member (such as a parent or sibling) with type 2 diabetes increases your risk of developing type 2 diabetes. However, there are additional factors beyond genetics that play a role in the development of type 2 diabetes.

Other risk factors include:

• Being physically inactive
• You are 45 or older
• Having had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds

Black and Brown people often are disproportionately affected by these common risk factors.

A high intake of mainly processed foods high in sugar and sodium and low in fiber promotes fat formation in the liver, which starts the cascade that results in diabetes and metabolic disease. This is also more common in some Black and Brown communities, such as Black Americans and Mexican Americans, due the ways systemic racism limits access to healthy foods in their neighborhoods.

Some studies have shown that, regardless of weight, compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans have more insulin resistance, as well as increased amounts of insulin being released in the body, and higher than normal insulin in the blood.

Additional studies have shown similar changes in glucose metabolism in other ethnic groups. For example, many studies suggest that Asian Americans have increased insulin resistance and decreased insulin output compared to non-Hispanic Whites.

Another study showed that Native Americans with diabetes had decreased insulin sensitivity compared with non-Hispanic Whites, non-Hispanic Blacks, and Hispanic Americans.

Racial and ethnic minorities are also more likely to be affected by systemic racism, which negatively impacts social determinants of health. Not having access to healthy food, health insurance, or safe housing and neighborhoods, or having limited educational opportunities is linked to poorer health outcomes.

Without access to fundamental necessities and a safe environment, Black and Brown people may struggle to obtain healthy foods or participate in physical activity on a regular basis. As a result, a person’s risk for type 2 diabetes is increased.

Black and Brown people are significantly more likely to live in poverty than White people. According to the Census Bureau, in 2019, Black people had an 18.8% poverty rate, and Hispanic Americans had a 15.7% poverty rate, compared to 7.3% of non-Hispanic Whites.

Complications of Type 2 Diabetes in Black and Brown People

According to a 2013 study, Black and Brown people have a higher chance of developing complications from type 2 diabetes. These complications include:

• Heart disease and heart failure (the heart does not pump enough blood to meet the body's needs)
• Retinopathy (eye disease)
• Neuropathy (nerve damage) and amputation due to neuropathy
• Kidney disease

The CDC reports that racial and ethnic minority groups in the U.S. have higher rates of illness and death across a wide range of health conditions, including diabetes, when compared to White Americans. Additionally, the life expectancy of non-Hispanic Black Americans is four years less than White Americans.

One reason for the risk of increased complications may be due to socioeconomic status and lack of health insurance or access to care. The social determinants of health can impact the risk of type 2 diabetes for Black and Brown people, as well as their ability to get the proper education, care, and treatment they need to prevent complications from occurring.

Although socioeconomic status certainly plays a role, no conversation on health and diabetes status in Black and Brown people would be complete without recognizing and challenging racism in America.

One study reported that toxic stress in Black and Brown people with type 2 diabetes caused by poverty, discrimination, and racism was correlated with decreased quality of life, especially in Black Americans.

Screening and Early Detection of Type 2 Diabetes in Black and Brown People

Early screening and detection are critical with the overall prevention and treatment of type 2 diabetes. Attending regular check-ups with a healthcare provider can help with early identification and treatment.

The American Diabetes Association recommends that all people be screened regularly for diabetes and prediabetes beginning at age 35. Adults who are overweight or obese and who have certain risk factors should be screened earlier. This includes people from groups with higher incidence and prevalence of diabetes, including American Indian/Alaska Native, Asian American, Black, Hispanic/Latinx, or Native Hawaiian/Pacific Islander people.

Addressing health disparities at a community and societal level is vital to the overall health and well-being of Black and Brown people. Obtaining access to health care, affordable medications, fresh foods, quality education, and safe environments for regular physical activity is fundamental to improving quality of life.

More research is needed on the effects of screening on health outcomes that include populations that reflect the rate of diabetes in America, especially racial and ethnic groups that have a higher rate of diabetes compared to White people.

In addition to regular visits with a healthcare team, lifestyle interventions that focus on improving diet and increasing physical activity can also help prevent or delay the progression to diabetes in Black and Brown people.

Even though there may be genetic factors that predispose a person to disease, lifestyle interventions are an important tool for prevention.

Summary

Black and Brown people are disproportionately affected by type 2 diabetes due to systemic racism. Certain races and ethnicities in the U.S. experience significantly higher rates of diabetes, including Native Americans, Alaska Natives, non-Hispanic Blacks, people of Hispanic origin, and non-Hispanic Asians.

Also, Black and Brown people have a higher chance of developing diabetes complications. Early screening and detection can play a pivotal role in the overall prevention and treatment of type 2 diabetes in Black and Brown people.

A Word From Verywell 

Positive turns in promoting cultural competency and anti-racism in health care, as well as improving access to health care, healthful foods, and safe environments, can promote future change.

Advocating for yourself is vital to your success and health as an individual and Black or Brown person. Forming a good rapport with a healthcare team and getting annual check-ups can help you prevent or effectively manage a diagnosis of type 2 diabetes, enabling you to do the things you love and live a high quality of life.