Type 2 Diabetes Complications Affecting People of Color

People of color are disproportionately impacted by type 2 diabetes. African American and Hispanic people are 60% and 70% more likely to be diagnosed with diabetes than non-Hispanic White people.

Several factors contribute to the differences in type 2 diabetes diagnoses and outcomes seen in people of color, including socioeconomics, environment, and access to care due to geography, language, or education barriers. In addition, people of color may experience discrimination, racism, and negative attitudes that affect the care they receive.

Managing symptoms of type 2 diabetes reduces the risk of complications, like heart disease, nerve damage, kidney disease, and foot and eye problems. This article discusses common type 2 diabetes complications that impact people of color.

High Blood Pressure

People with diabetes are twice as likely to have high blood pressure than those who don't since it can damage the blood vessels. Approximately 74% of adults with diabetes also have or develop high blood pressure. High blood pressure and diabetes put people at higher risk for heart disease and stroke.

A healthy diet and physical activity can help prevent and treat high blood pressure. However, environmental and socioeconomic conditions can make it difficult to adopt these healthy behaviors. People of color may be less likely to have access to healthy foods and safe outdoor spaces to exercise, which can contribute to the risk of diabetes and hypertension.

Stroke

People with diabetes are twice as likely to suffer an ischemic stroke, which is caused by a blocked artery cutting off the brain’s access to oxygen and nutrients. A major risk factor for stroke is a build-up of plaque, a sticky, fatty substance in the arteries. This condition, called atherosclerosis, is associated with diabetes. 

Diabetes causes dyslipidemia (an imbalance of lipids [fats] in the blood) and hyperlipidemia (high levels of fat in the blood). High blood pressure, atherosclerosis, dyslipidemia, and hyperlipidemia increase the risk of stroke.

According to the American Heart Association, stroke risk factors like high blood pressure and diabetes impact people of various races differently. High blood pressure has a more significant effect on stroke in African American men than in women or White people. Diabetes impacts African American men at a rate of 17.2% compared to White men at 10.5%. 

Coronary Artery Disease

Coronary artery disease is a type of heart disease that affects the arteries that bring blood to the heart. High blood pressure, fat build-up or imbalance in the blood, and plaque build-up in the arteries are risk factors for coronary artery disease. 

African American adults are more likely to have uncontrolled blood pressure and die from heart disease than non-Hispanic White adults. Poverty, unemployment, and barriers to receiving proper health care contribute to the high rate of this complication among people of color.

According to the U.S. Census Bureau, 21.2% of non-Hispanic Black people live in poverty compared to 9% of non-Hispanic White people. The unemployment rate is twofold among non-Hispanic Black people, who are less likely to have private health insurance, more likely to rely on Medicaid or public health insurance, and more likely to be uninsured than non-Hispanic White people.

Nerve Damage

Uncontrolled diabetes can affect the nerves and lead to a condition called diabetic neuropathy. The most common type of nerve damage occurs in the feet, legs, hands, and arms. This type of nerve damage affects about one-third to one-half of people with diabetes.

Neuropathy can also cause problems with:

• Internal organs
• Heart rate
• Blood pressure
• Digestive system
• Bladder

A 2015 study surveyed adults in the United States with diabetic neuropathy symptoms. The researchers found differences in how people with diabetic neuropathy experienced and perceived pain and interacted with healthcare providers. African American and Hispanic people reported experiencing lower pain severity and fewer symptoms than White people.

The difference in perceived pain may contribute to fewer African American and Hispanic people receiving a diagnosis and discussing their pain symptoms with their healthcare providers, resulting in delayed diagnosis and treatment and worse outcomes.

Foot Problems

Nerve damage in the feet can cause tingling, pain, and a loss of feeling, leading to unnoticed cuts and sores. Diabetes can decrease blood flow to the feet, making it hard for sores and infections to heal. An estimated 34% of individuals with diabetes develop diabetic foot problems.

Careful monitoring of symptoms is needed to prevent serious complications such as gangrene, which is tissue death caused by a lack of blood flow in the infected area. Unhealed gangrene and foot ulcers can lead to amputation of a toe, foot, or part of the leg.

Socioeconomic status, access to health insurance, and income level may contribute to the disparities in amputation rates among African American and Hispanic people compared to White people. When nerve damage progresses and is left untreated, irreversible complications and amputation are more likely.

Eye Damage

Type 2 diabetes is the leading cause of blindness. Over time, uncontrolled high blood sugar can cause damage to the blood vessels in the eyes (diabetic retinopathy). High blood sugar can also cause swelling (diabetic macular edema) leading to blurry vision.

People of color are more likely to experience eye damage due to diabetes. Screening to detect eye damage early is important to preventing blindness. Studies have shown that people of color may undergo screening less often than their White counterparts.

Barriers to screening include:

• Lack of access
• Health literacy
• Language barriers
• Distrust in the medical system
• Lack of insurance
• Problems scheduling appointments
• Long wait times for appointments

Kidney Damage

Another serious complication of high blood sugar is kidney disease. Type 2 diabetes is the leading cause of end-stage renal disease and 1 in 3 adults with diabetes also has kidney disease.

In 2017, non-Hispanic Black people were 3.2 times more likely to be diagnosed with diabetes-related end-stage kidney disease. In addition, Hispanic people were twice as likely to be hospitalized for diabetes-related end-stage kidney disease than non-Hispanic White people.

Current literature suggests that access to quality health care and other environmental factors may contribute to the racial difference in developing diabetes-related kidney disease.

Ketoacidosis & Diabetic Coma

Individuals with type 2 diabetes can develop ketoacidosis when the body doesn’t have enough insulin. Diabetic ketoacidosis can be life-threatening and lead to diabetic coma.

The lack of insulin prevents the body from transporting blood sugar into the cell for energy, so the liver begins to break down fat for energy by producing ketones. Too many ketones in a short period can be dangerous for the body.

Studies looking at diabetes-related deaths have found that non-Hispanic Black people have more than twice the risk of death compared to non-Hispanic White people. Poverty and segregation contribute to the difference in outcomes and lack of access to healthy food and quality health care in underserved communities.

Summary

People of color experience disparities in outcomes of type 2 diabetes. Socioeconomic status, environment, language and cultural barriers, distrust of healthcare providers, and discomfort in discussing symptoms and pain can contribute to delayed screening, diagnosis, and treatment of diabetes. This can lead to progressive damage to nerves and blood vessels and put people of color at a higher risk for developing severe diabetes-related complications.

A Word From Verywell

Learning to identify common signs and symptoms, seeking translation services if language is a barrier, and adopting healthy lifestyle changes can reduce the risk of type 2 diabetes complications in people of color. If health care costs prevent you from getting care, your local social services provider can refer you to free or low-cost clinics in your area. Find a trusted healthcare provider and discuss options to manage your blood sugar, blood pressure, and lipid levels.