Type 2 Diabetes Management Barriers in People of Color

About 37.3 million people in the United States have diabetes, and nearly 95% of people diagnosed have type 2 diabetes, a chronic health condition affecting the way the body processes blood glucose (sugar). Black Americans are 60% more likely to be diagnosed with diabetes than White Americans. Experts have linked this disparity to systemic racism.

Type 2 diabetes must be managed daily, which often consists of blood glucose monitoring, diet, exercise, and other lifestyle factors. Without proper management, chronically elevated blood sugars (hyperglycemia) can cause damage to the body, including the eyes, heart, kidneys, and feet.

Black and Brown people are twice as likely to die from diabetes than White people. Diabetes disproportionately affects certain racial and ethnic groups, and many barriers to care further impacts their health negatively. Lower education levels, language barriers, socioeconomic status, and unavailability of nutritious food and health care are just some of the disparities that Black and Brown people face.

This article will highlight some barriers to diabetes management impacting Black and Brown people and how we can overcome them.

Racial Disparities

Black and Brown people account for 12.1% of people with diabetes, compared to 7.4% of non-Hispanic White people. Explanations of higher rates of diabetes include family history, some elements of genetics, and especially social determinants of health (SDOH), including places where people learn, work, live, and play.

Statistics demonstrate that Black and Brown people are more likely to be diagnosed with diabetes and are also at an increased risk of developing complications of diabetes than White people.

Non-Hispanic Black people with diabetes were 3.2 times more likely to be diagnosed with end-stage renal (kidney) disease and 2.3 times more likely to be hospitalized for lower limb amputations than non-Hispanic White people. They are also less likely to receive a dilated eye exam (more detailed than the standard exam), foot exam, and a measurement of hemoglobin A1C.

Food Deserts

A nutritious diet is a key element in maintaining blood glucose control and preventing diabetes complications. What you eat directly impacts your blood sugar, and eating simple carbohydrates can raise blood sugar levels. Carbohydrates are found in:

• Fruit
• Starches (including bread and pasta)
• Dairy products
• Legumes (including peanuts, peas, and beans)
• Sweets
• Snack foods

People with diabetes need to count or measure carbohydrates to keep their blood sugar at goal. To do this, people need access to safe, convenient, nutritious, and sufficient food.

A food desert is an area in which people have limited access to a variety of healthy and affordable food. More than 13.5 million people in the United States live in food deserts.

Newer research aligns with previous research indicating that predominantly Black neighborhoods are less likely to have equal access to healthy food and unhealthy food retailers than mostly White neighborhoods. Researchers also found that more Black residents have fewer supermarkets and more convenience stores and fast-food restaurants in their neighborhoods, which impacts diet quality.

Accessing Care

Underserved communities may have limited access to other services, including health care, transportation, and a lack of parks and recreational areas. Limited healthcare services, access to healthy food, and higher prices can result in poor diet and adverse health outcomes for residents in these areas.

People with diabetes need access to healthcare services, including self-management education (self-care for your diabetes). There are four crucial times when people with diabetes need education, which are:

• At diagnosis
• Annually
• When complications develop
• During the transition from adolescence to adulthood

Diabetes self-management education is linked to better glycemic control, fewer complications, reduced hospitalizations, and reduced cost of diabetes.

Language and Cultural Barriers

Culturally sensitive education (education that is inclusive of different cultures) is ideal for people with diabetes. Assessing a person's literacy, as well as their language and eating habits, help achieve good health outcomes.

Researchers collected data from a survey to examine racial and ethnic differences in self-reported measures on access to care, ability to seek care, self-care knowledge and behaviors, diabetes management, and complications among Medicare beneficiaries ages 65 and older.

The study found that although Black and Latino patients with diabetes reported seeing a healthcare provider when they were sick and had more diabetes-related medical visits each year than White patients with diabetes, their outcomes were worse. They also reported that they did not know how to take care of their diabetes or understand what supplies or education services were available.

Diabetes Education

Educational sessions or medical visits should be conducted with a healthcare provider who speaks the native language of a person with diabetes.

Researchers found that Latinos with diabetes who switched to a primary care provider who speaks their native language saw significant improvement in glycemic control and LDL (low-density lipoprotein, considered "bad") cholesterol control. Using colored pictures, limiting speech, and providing easy-to-understand education materials in a person's common language are also important.

Many organizations provide diabetes education materials in other languages. These include:

• Centers for Disease Control and Prevention (CDC)
• American Diabetes Association
• American Academy of Nutrition and Dietetics Diabetes Practice Group
• American Association of Diabetes Care and Education Specialists 
• National Institute of Health
• National Institute on Minority Health and Health Disparities
• Association of Clinicians for the Underserved

Summary

Black and Brown people are at an increased risk of developing diabetes and complications of diabetes. While many factors contribute to disease status and progression, social determinants of health play a role.

This is a complex and complicated issue, but health professionals and legislators are trying to do their part to help everyone achieve adequate health care, access to food, and appropriate education.