Race and Diabetes: Are Minorities Getting the Care They Deserve?

In the United States, diabetes may impact minority communities at an unprecedented rate in the next 3 decades.

“The burden of diabetes represents an even greater challenge among racial/ethnic minorities in the United States, which are predicted to comprise half of the total population in the country by the year 2050,” said Dr. Sandra Weber, past president of the American Association of Clinical Endocrinologists.

In 2017, the nonprofit T1D Exchange launched a study to explore variations in A1C levels observed in different populations based on race that were consistently reported in adults and children with both type 1 and type 2 diabetes. Results showed Black people had higher A1C levels than white people.

The study identified disparities in outcomes between the two populations relating to glucose control possibly based on the glycation of hemoglobin. Results showed that A1C levels were about 0.8 percent higher in Black patients compared with white patients. It’s important to note that the study was limited in that there were not enough participants with A1C levels below 6.5 percent to extend the generalized outcome to those patients.

A lack of follow-up care is another reason for diminished health outcomes in minority populations.

A language barrier is one obstacle that can negatively impact follow-up care.

A study from the American Diabetes Association (ADA) noted the limitations in follow-up care for patients whose first language isn’t English in phone-based disease management programs.

Research indicated that patients who spoke a first language other than English but went to a primarily English-speaking clinic might have a barrier to participating in their care — even when they had access to translators.

Although phone-based programs met patients where they were, they still did not reduce disparities, or improve diabetes care and outcomes for patients.

Education and self-management are other areas where People of Color with diabetes feel left behind.

In a Centers for Medicare and Medicaid Services (CMS) study, Black patients were as likely to perform diabetes self-management checks as White patients.

Still, they were less likely to report having the knowledge they needed to keep their blood sugar in range.

Additionally, health-related outcomes like high blood pressure and eye problems were worse for minorities, even though minority patients reported more doctors’ visits each year.

These kinds of barriers present a real problem for patients over time.

In fact, this 2021 study points to higher rates of diabetes complications in racial and ethnic minority populations in the United States, with authors noting that while complication trends have improved in general for all patients in the past 20 years, the “proportionate disparities among minority populations have remained unchanged.”

“In the long term, this may affect people with diabetes through higher rates of complications, earlier morbidity, and mortality,” Weber says. “It’s a real issue.”