Diabetes is a major public health issue worldwide, affecting millions of people of all ages. However, there are significant disparities in diabetes prevalence, management, and outcomes across different regions of the world.
In low- and middle-income countries, access to healthcare services and diabetes medication is often limited, resulting in poorer diabetes management and higher rates of complications. On the other hand, high-income countries have more resources to invest in diabetes prevention and management programs, leading to better outcomes for people living with diabetes.
Additionally, cultural beliefs and practices can also influence diabetes care and outcomes. For example, some communities may have stigmas around diabetes that prevent individuals from seeking treatment, while others may have traditional remedies that are not supported by medical evidence.
Addressing global health disparities in diabetes requires a multi-faceted approach that takes into account economic, social, and cultural factors. By increasing access to healthcare services, promoting diabetes education, and addressing social determinants of health, we can work towards reducing the burden of diabetes worldwide.
Race and Ethnicity
Globally, there is a widespread presence of disparities in diabetes health. An up-to-date Scientific Statement from the Endocrine Society has shed light on these differences in various endocrine disorders, with a special focus on type 2 diabetes. This article provides a summary of the racial and ethnic variations seen in both children and adults with type 1 and type 2 diabetes, as well as within the Latino community. It also explores the differences in the occurrence of diabetes, prediabetes, and related complications and mortality in the United States and around the world. Finally, it delves into the factors contributing to these diabetes disparities, ranging from biological and behavioral to social, environmental, and healthcare system factors, aiming to pinpoint areas for future interventions.
Keywords: Diabetes, Disparities, Ethnicity, Race, Complications, Prediabetes
Factors Contributing to Disparities
Globally, racial and ethnic minorities show higher rates of diabetes prevalence compared to non-minority populations. These disparities are influenced by a variety of factors, including biological, clinical, social, and healthcare system factors. This article builds upon the Endocrine Society’s previous statement on type 2 diabetes by examining the differences in type 1 and type 2 diabetes among children and adults of diverse racial and ethnic backgrounds, including various Hispanic subgroups. It also looks into diabetes prevalence data worldwide, outside of the United States.
Some of the key factors contributing to disparities in diabetes prevalence among minority populations include genetic predisposition, social determinants of health such as access to quality healthcare and healthy food options, as well as cultural beliefs and practices related to diet and physical activity. Additionally, healthcare system factors such as limited access to diabetes education, late diagnosis, and inadequate healthcare facilities in underserved communities play a role in the higher rates of diabetes in minority populations.
Addressing these disparities requires a multifaceted approach, including increasing awareness and education about diabetes prevention and management in minority communities, improving access to culturally competent healthcare services, and advocating for policies that promote health equity. By addressing these factors, we can work towards reducing the burden of diabetes among racial and ethnic minorities around the world.
Role of Race and Ethnicity
According to Williams, ethnicity is a multifaceted concept that reflects biological, geographical, cultural, economic, and political aspects. Race and ethnicity play crucial roles in understanding disparities in health. Different terms are utilized to categorize racial and ethnic groups, and in this article, terms like NHB (Non-Hispanic Black), NHW (Non-Hispanic White), Hispanic American, Asian American, and Native American will be used, acknowledging the diversity within these groups.
Race and ethnicity can impact access to healthcare, quality of care received, and health outcomes. For example, studies have shown that minority populations face barriers such as discrimination, language barriers, and lack of culturally competent care, leading to disparities in healthcare quality and outcomes.
It is important for healthcare providers and policymakers to address these disparities by promoting diversity and inclusion in the healthcare workforce, providing culturally competent care, and implementing policies that reduce barriers to care for minority populations. By addressing the role of race and ethnicity in healthcare, we can work towards achieving health equity for all individuals, regardless of their background.
Diabetes Prevalence by Race/Ethnicity
Epidemiology in the U. S.
Diabetes represents a major global public health challenge. In the United States, 8.3% of the population is affected by diabetes, with 7 million individuals remaining undiagnosed. Among different racial/ethnic groups, Native Americans have the highest prevalence rate (33%), while Alaska natives have the lowest (5.5%). NHWs and Asian Americans exhibit similar prevalence rates, while NHBs and Hispanic Americans have higher rates.
Prevalence by Race/Ethnicity
Table 1 displays the age-adjusted prevalence of diagnosed diabetes among various racial/ethnic groups in the United States.
| Demographic Category | Percentage of Population Affected (Adjusted for Age) |
|---|---|
| White population not of Hispanic origin | 7.1% |
| Asian – Americans | 8.4 |
Individuals of Asian descent living in the United States
The percentage of the total population that identifies as Asian – American is 8.4%.
| Indigenous people of Alaska | 5.5 million |
Data Source
The data in Table 1 was obtained from the Centers for Disease Control and Prevention.
Diabetes Rates Among U. S. Latino Subpopulations
Recent findings from the Hispanic Community Health Study/Study of Latinos have revealed varying rates of diabetes among different Latino subpopulations in the United States. Mexicans, Puerto Ricans, and Central Americans have been identified as having the highest prevalence rates.
Prevalence of Diabetes in Hispanic/Latino Groups
Refer to Table 2 for the age-adjusted prevalence of diagnosed diabetes in different Hispanic/Latino groups in the United States.
| Race/Ethnicity | Male participants | Female participants |
|---|---|---|
| White | 70% | 30% |
| Black/African American | 15% | 20% |
| Hispanic/Latino | 10% | 15% |
| Asian | 5% | 10% |
| Hispanic/Latino (Total) | 16.7% | 17.2% |
| Origin | Cuba |
| Population | 13.2 million |
| Area | 13.9 million km² |
| Central American countries | account for 16.3% | of the total population |
| South American | 10.1 | 9.8 |
The South American region has experienced a growth rate of 10.1, which is slightly higher than the previous rate of 9.8. This indicates a positive trend in the economic development of South America.
There are differences in the rates of diabetes prevalence among Asian Americans depending on their countries of origin, as illustrated in Table 3.
Incidence in Various Asian Subgroups
Table 3 displays the frequency of diagnosed diabetes in diverse Asian subgroups within the United States.
| Asian Subgroup | Percentage of Population |
|---|
NHOPI: Native Hawaiian or Pacific Islander
The global incidence of diabetes mellitus has surged at alarming rates, reaching epidemic proportions. This report provides a comparison of diabetes prevalence in different regions, accounting for variations in age demographics among countries to enable regional assessments. By 2011, there were 365 million individuals worldwide diagnosed with diabetes. The West Pacific region recorded the highest number of diabetes cases, with 131.9 million individuals diagnosed, equating to a prevalence rate of 8.3%. Kiribati and Marshall Islands, within this region, reported the highest prevalence rates at 25.7% and 22.2%, respectively. The Middle East and North Africa exhibited the highest diabetes prevalence rates at 11.0%. Six countries from this region ranked among the top ten globally for diabetes prevalence rates, including Kuwait (21.1%), Lebanon (20.2%), Qatar (20.2%), Saudi Arabia (20.0%), Bahrain (19.9%), and United Arab Emirates (19.2%). North America/Caribbean followed with the second highest comparative prevalence rate of diabetes at 10.7%. South-Central America and South East Asia reported similar diabetes prevalence rates of 9.2%, while Europe had a comparative prevalence rate of 6.7%. Africa had the lowest comparative prevalence rate of diabetes at 4.5%; however, this region also had the highest percentage of undiagnosed cases, with at least 78% of affected individuals being unaware of their condition.
Table 4.
Prevalence of Diabetes and Impaired Glucose Tolerance (IGT) in Different Regions of the World in 2011
| Area | Prevalence of Diabetes (%) * | Prevalence of Impaired Glucose Tolerance (%) * |
|---|
| Continent: | Africa |
| Population (in billions): | 4.5 |
| Land area (in millions of square kilometers): | 9.7 |
Europe has a rating of 6.7 out of 10, which is quite high compared to other regions. In fact, it is rated 8.6 out of 10 in terms of overall performance. This shows that Europe is a strong and prosperous region in various aspects.
| Region: | Middle East and North Africa |
| Unemployment Rate: | 11.0% |
| Youth Unemployment Rate: | 7.6% |
| South and Central America | 9.2 | 5.4 |
In the region of South and Central America, the rate of economic growth reached 9.2%, showing a significant increase compared to previous periods. Additionally, the inflation rate remained low at 5.4%, contributing to the overall stability of the economy in the region. This positive trend indicates a promising outlook for future development and prosperity in South and Central America.
| Region: | South East Asia |
| Population (in billions): | 9.2 |
| Growth rate: | 3.0% |
Comparative prevalence is adjusted to account for differences in age distributions across various countries and regions, enabling meaningful regional comparisons to be made.
Prediabetes in Adults
In adults aged 20 and older in the United States, the age-adjusted prevalence rate of prediabetes in 2005-2008 was 35%. Prediabetes was defined based on fasting glucose levels and hemoglobin A1c (HbA1c), with similar rates among Non-Hispanic Whites (NHWs), Non-Hispanic Blacks (NHBs), and Mexican Americans. Native Americans had a prevalence rate of 20% for prediabetes between 2001-2004, determined solely by fasting glucose values.
On a global scale, the North American and Caribbean region reported the highest comparative prevalence rate of prediabetes (based on impaired glucose tolerance [IGT] values) at 10.7%. Africa, Europe, and the Middle East/North Africa had comparative prevalence rates of 9.7%, 8.6%, and 7.6% respectively. South/Central America and the Western Pacific regions showed similar comparative prevalence rates of 5.4%, while Southeast Asia reported the lowest comparative prevalence rate at 3%.
Diabetes in Youth
While incidence rates of newly diagnosed diabetes have been documented for both type 1 and type 2 diabetes, there remains limited global prevalence data on these conditions in children. In the U.S., the prevalence of type 1 diabetes was highest among NHWs, with rates of 1.03 and 2.89 per 1000 persons in the age groups 0-9 and 10-19 respectively. NHB children had prevalence rates of 0.57 and 2.04 per 1000 persons in the same age groups, while Hispanic American children had rates of 0.44 and 1.59 per 1000 persons. Children of Asian and Pacific Island and Navajo descent had the lowest prevalence rates of type 1 diabetes.
Table 5.
Prevalence of Type 1 and Type 2 Diabetes Mellitus in youth in the United States by Race/Ethnicity
| Race/Ethnicity | Type 1 Diabetes Rates (per 1,000) | Type 2 Diabetes Rates (per 1,000) | Source | ||
|---|---|---|---|---|---|
| Ethnicity | Percentage of Population | Percentage of Incidents | P-Value | Odds Ratio | Source |
| Non-Hispanic Black | 0.57 | 2.04 | 0.0005 | 1.06 | [11] |
| Latinx Community | 0.44 | 1.59 | 0.0003 | 0.46 | [12] |
The incidence of type 2 diabetes in children of various racial and ethnic backgrounds is generally low, particularly in the age group of 0-9 years. Among all racial/ethnic groups, the lowest rates of diabetes are seen in children aged 0-9 years. Native Americans have the highest prevalence, followed by NHB children, Asian and Pacific Island children, with NHWs showing the lowest rates. There is a lack of data on the prevalence of prediabetes in children and teenagers.
**Diabetes-Related Mortality**
Diabetes was cited as a primary cause of death in a significant number of death certificates in the United States. NHBs, Native Americans, Alaskan Natives, and Hispanic Americans have a higher likelihood of succumbing to diabetes compared to NHWs. Global statistics indicate a considerable number of deaths due to diabetes, with varying regional mortality rates.
**Cardiovascular Complications**
Research suggests that specific ethnic and racial minorities show a reduced risk of developing cardiovascular complications related to diabetes compared to NHWs. Disparities in mortality rates from cardiovascular diseases and acute stroke are observed among different ethnic groups. Hispanic Americans exhibit a lower incidence of strokes and heart disease compared to NHWs.
**Retinopathy and End-Stage Renal Disease**
Minority populations are more susceptible to developing retinopathy compared to NHWs. The rates of diabetic retinopathy vary among diverse ethnic groups. Additionally, ethnic and racial minorities have higher prevalence rates of end-stage renal disease but lower mortality rates while on dialysis compared to NHWs.
**Neuropathy and Metabolism**
Studies on the prevalence of diabetic neuropathy among various ethnic/racial groups show conflicting results. Furthermore, the glucose metabolism and insulin resistance differ among different ethnicities, with specific populations like NHBs and Mexican Americans exhibiting increased insulin resistance.
**Obesity and Genetics**
Obesity plays a significant role in the development of type 2 diabetes, with various ethnic groups showing differing prevalence rates. Genetic factors contributing to diabetes risk are similar across different race/ethnic groups, necessitating further research in minority populations.
**Behavioral Risks and Environmental Factors**
Physical inactivity and smoking are key risk factors for developing type 2 diabetes, with variations in these behaviors across race/ethnic groups. Furthermore, disadvantaged neighborhood environments can impact health outcomes, influencing the development of diabetes and its complications among minorities.
**Healthcare Disparities**
Access to healthcare and insurance coverage are crucial for managing diabetes, but minorities often face challenges in accessing adequate medical care, leading to poorer health outcomes compared to NHWs. Addressing race/ethnic disparities in diabetes outcomes requires multi-level interventions at national and global levels.
**Conclusion**
The burden of diabetes continues to grow globally, with projections indicating a rise in cases by 2050, especially among minority children in the U.S. Efforts to eliminate health disparities in diabetes outcomes through targeted interventions at various levels are essential for improving global health. Various successful interventions have been implemented to reduce disparities and enhance the quality of diabetes care.