Why Diabetes Is So Common in African Americans: Exploring Genetics and Lifestyle Factors

Diabetes is a medical condition where the blood sugar levels are higher than normal in the body causing lot of problems. It can affect people of all ethnicities and races; however, research shows that certain racial and ethnic groups can be more vulnerable towards this disease. For example, non-Hispanic Black Americans are at 60 percent higher risk for being diagnosed with diabetes when compared to non-Hispanic white Americans.⁽¹⁾

In this article, we will talk about why is diabetes more prevalent in African Americans, is there any way to reduce the risk of developing diabetes, and what are the genetic and lifestyle factors which increases the risk of diabetes in African Americans.

It is a fact that diabetes can affect individuals from any ethnic or racial group, but it is also a fact that it is found to occur more in people belonging to certain ethnic or racial backgrounds.

• According to the American Diabetes Association (ADA), the occurrence of diabetes in non-Hispanic Blacks is about 11.7% when compared to only 7.5% in non-Hispanic whites.⁽²⁾
• Asian Americans are at slightly more risk to get diabetes than white Americans, who have a prevalence of 9.2%.
• Highest rate of diabetes is seen amongst Hispanics and American Indians/Alaskan Natives being affected with diabetes at about 12.5% and 14.7% respectively.
• According to statistics from the Office of Minority Health, in the year 2018, amongst the non-Hispanic Black Americans, the occurrence of diabetes was about 13.4% in Black men versus 12.7% in Black women.⁽³⁾
• Moreover, along with the increased risk for diabetes, African Americans are also at higher risk for experiencing complications occurring from diabetes.
• For example, diabetic retinopathy is seen about 46% more in African Americans than non-Hispanic Americans.
• End stage renal disease from diabetes is also about 2.6 times higher in African Americans than non-Hispanic white Americans.

Diabetes is a broad term, which contains many conditions causing dysfunction in the ability of the body to secrete insulin, metabolize glucose or both.

When we eat food, our body takes glucose (sugar) from it and insulin is a hormone which is needed to utilize the glucose from the foods. This insulin is secreted by beta cells present in the pancreas. After the insulin reaches the cells, it gets attached to the receptors responsible for the cells identifying and using the glucose from the blood.

Type 1 diabetes is an autoimmune condition which commonly develops in childhood. In type 1 diabetes, beta cells of the pancreas are attacked by the body thus hindering their ability to produce insulin. Without sufficient insulin, the cells are not able to take in glucose resulting in increased blood sugar levels.

Type 2 diabetes is a chronic condition which commonly develops in adulthood. In type 2 diabetes, the body finds it difficult to identify insulin, which is known as insulin resistance. In the absence of sufficient insulin response, the cells struggle to take up glucose and this results in the blood sugar levels to rise.

The cause of type 1 diabetes is solely lack of insulin; whereas, the cause of type 2 diabetes can be caused by both lack of insulin and a sensitivity to insulin.

Research as old as 2005 has shown that an increased occurrence of type 2 diabetes in black Americans can be caused by both genetic and environmental factors.⁽⁴⁾ Let’s see what these contributing factors are towards diabetes that are seen more in Black Americans

Previously a theory known as the “thrifty gene” was put forward as an explanation for increased rates of diabetes in African Americans. This theory states that the previous populations who were exposed to long periods of famine were considered better equipped to efficiently store fat, more so in periods of plenty.

According to this theory, in today’s time, that is in modern America, this would equate to an increase in overall weight of body thus leading to the increased prevalence of diabetes in African Americans. However, this theory doesn’t necessarily hold up, as the fact of the matter is African Americans are an extremely diverse population, more so in the genetic department.

So, there was another theory that suggested that an increased prevalence of G6PD deficiency in Black males, in conjunction with the typical “Western diet” is a contributing factor to increased susceptibility towards diabetes in African Americans.

One of the major significant risk factors for the development of type 2 diabetes in African Americans is obesity. ⁽⁵⁾ According to statistics, Black Americans, especially Black women, have increased rates of obesity than white Americans. Research has shown that Black Americans also face inequities, such as limited access to nutritious food and lower socioeconomic status, which can easily contribute to these increased rates of obesity in African Americans. ⁽⁶⁾ This when paired with reduced levels of physical activity, especially in in Black adolescent girls and women greatly increases the risk of diabetes.

Research has also shown that there is also increased prevalence of insulin resistance in Black Americans, especially in Black adolescents. As insulin resistance is associated with the development of type 2 diabetes, this explains the increased risk of this condition in African Americans.

Socioeconomic factors greatly affect the risk of developing certain health conditions and the healthcare outcomes.

A study from 2014, where research was done on the link between diabetes prevalence and poverty showed that Black Americans and poor white Americans have increased rates of diabetes than non-poor white Americans. ⁽⁷⁾

Additionally, it was discovered that under-resourced socioeconomic groups of people experience increased levels of stress, which in turn increases the risk of diabetes in individuals who are already predisposed to this condition.

There are many studies that have demonstrated links between acute stress as well as long-term stress and the development of diabetes.⁽⁸⁾ However, this still needs more research.

Still, one cannot pinpoint a single risk factor for diabetes, including in Black Americans.

One of the best ways to prevent the development of type 2 diabetes is going for regular checkups. During these checkups, multiple tests are done by the healthcare professional to assess the blood sugar levels and determine the risk of getting diabetes.

There are also many tests that can confirm if a person is diabetic and these are:

Fasting Blood Glucose Test A fasting blood glucose test measures the levels of blood sugar after a fasting period of 8 to 12 hours.

The normal range of this test is less than 100 milligrams per deciliter (mg/dL).

If it is between 100 to 125 mg/dL, then it means prediabetes.

If the test shows the levels that are higher than 125 mg/dL on two occasions, then it clearly indicates diabetes.

Oral Glucose Tolerance Test An oral glucose tolerance test is another test done to confirm diabetes where the blood sugar levels are monitored over a period of 2 hours after consuming a sugary drink. The following results indicate:

Normal range is when the reading is less than 140 mg/dL.

You are prediabetic if the values are between 140 to 199 mg/dL.

You are diabetic if the values are greater than 200 mg/dL.

An HbA1C test is done to measure the average blood sugar levels from the previous 2 to 3 months with results showing:

Normal range is less than 5.7 percent.

You are prediabetic if the values are between 5.7 and 6.4 percent.

You are diabetic if the values are greater than 6.4 percent.

If you are in the prediabetic range then the doctor will strongly recommend making lifestyle changes, such as eating healthy, exercising, sleeping on time, cutting down on stress to reduce risk of developing diabetes.

If the blood sugar levels confirm that you have diabetes, then your doctor will decide on the right course of action which is best suited to you for managing your diabetes.

When you find yourself at increased risk for developing type 2 diabetes, then there are certain effective steps that you can take to cut down your risk for this disease. ⁽⁹⁾

According to the Diabetes Prevention Program study, patients who followed and sticked religiously to certain lifestyle changes successfully lowered their risk of developing type 2 diabetes by 58% in a period of about three years and this was seen across all ethnic and racial groups. ⁽¹⁰⁾.

Some effective and beneficial lifestyle changes that will help in reducing your risk of diabetes are:

• Watching Your Weight: Being overweight greatly increases the risk of developing type 2 diabetes. Losing the excess body weight goes a long way in cutting down the risk of diabetes.
• Making Healthy Dietary Changes: Always follow a healthy balanced and well-rounded diet comprising of lean meat, fresh leafy vegetables, pulses, grains, nuts, seeds, fresh fruits and healthy fats to help with not only weight, but also for blood sugar management. Avoid processed junk food, fried food, foods that are high in trans-fats and sugar.
• Learn to Manage Stress: Studies indicate that chronic stress causes a lot of negative impact on mental and physical health and increases the risk of various health conditions including diabetes. Indulging in stress busting activities, such as deep breathing, mindfulness, yoga, meditation, journaling, gardening, talking to someone lessens the burden on you and helps with stress both short-term as well as long-term.
• Getting Regular Exercise: Getting regular workout as simple as going for a walk does wonders for one’s health, both physical and mental. Exercising also helps in reducing the risk of various chronic conditions, including type 2 diabetes.
• Getting Regular Health Checkups: If you have a family history of diabetes, then this makes you predisposed to developing type 2 diabetes, so it is of utmost importance to get regular health checkups with your doctor. Your doctor is the best person to guide you in making the lifestyle changes needed to help reduce the risk of diabetes.

There is no doubt that diabetes is more prevalent in certain ethnic and racial groups, including Hispanic, Indigenous and Black Americans. There are a gamut of contributing factors for this consisting of social factors, genetic, factors and health factors all of which can cause higher diabetes rates in Black Americans.

According to research, the biggest contributing factor comes from an increased rate of obesity among Black men and women. Poor socioeconomic status and lack of access to good food comes second and third in the way of causing the prevalence of diabetes in African Americans.

If you or your family member has these risk factors, then do not hesitate to reach out to your doctor who will counsel you accordingly and advise you on what steps can be taken to reduce this diabetes risk and lead a healthier life.

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