Joslin offers culturally appropriate diabetes care and education, research, community outreach and provider education to improve health outcomes for African Americans and their families living with diabetes or those who are at risk for developing the disease.
- Provider Education: Joslin has extensive experience in serving and understanding African Americans affected by diabetes; included in these services aregroup diabetes education programs.
- Research: A team of investigators conducts research designed to strengthen our knowledge and understanding of the needs, characteristics and challenges of African Americans living with or at risk for diabetes.
- Community Outreach: Community outreach provides a key link between Joslin Clinic providers and their counterparts at the community health centers in and around Boston by providing train-the-trainer opportunities as well as church-based diabetes screening and education.
Why is Culture an Important Part of Healthcare Education?
Culture can affect what symptoms you consider to be a problem and your comfort level with the way healthcare providers communicate with you. Today, diabetes is one of the most serious health challenges in the United States. The following statistics illustrate the magnitude of this disease among African Americans:
- 2.8 million African Americans have diabetes.
- On average, African Americans are twice as likely to have diabetes as Caucasian Americans of similar age.
- Approximately 13 percent of all African Americans have diabetes.
- African Americans with diabetes are more likely to develop diabetes complications and experience greater disability from the complications than Caucasian Americans with diabetes.
- Death rates for people with diabetes are 27 percent higher for African Americans compared with Caucasians.
- The highest incidence of diabetes in African Americans occurs between 65 and 74 years of age. Twenty-five percent of these individuals have diabetes.
- Obesity is a major medical risk factor for diabetes in African Americans, especially for women. Type 2 diabetes may be prevented with weight control through healthy eating and regular exercise.
- People at high risk for type 2 diabetes, including African Americans, can prevent or delay diabetes with modest weight loss and regular physical activity.
In some people, blood glucose levels are higher than normal but not high enough for them to be diagnosed with diabetes. These individuals are described as having pre-diabetes.
Gestational Diabetes (GDM)
About 2 to 5 percent of pregnant women develop mild abnormalities in glucose levels and insulin secretion and are considered to have gestational diabetes. Although these women's glucose and insulin levels often return to normal after pregnancy, as many as 50 percent may develop type 2 diabetes within 20 years of the pregnancy.
Above Normal Insulin Levels
Above normal levels of fasting insulin are associated with an increased risk of developing type 2 diabetes—this often predates diabetes by several years. A recent study showed that insulin levels were higher in African Americans than in Caucasians, particularly African American women, indicating their greater predisposition for developing type 2 diabetes. Another study showed a higher rate of above normal levels in African American adolescents compared with Caucasian adolescents.
Being overweight is a major risk factor for type 2 diabetes. African American adults have substantially higher rates of being overweight than Caucasian Americans. The location of the excess weight is also a risk factor for type 2 diabetes. Excess weight carried above the waist is a stronger risk factor than excess weight carried below the waist. African Americans have a greater tendency to develop upper-body fat, which increases their risk of diabetes. Weight alone accounts for this population's higher prevalence of diabetes. Even when compared withCaucasian Americans with the same levels of obesity, age and socioeconomic status, African Americans still have higher rates of diabetes. Other factors, yet to be understood, appear to be responsible.
Regular physical activity is a protective factor against type 2 diabetes.Lack of physical activity is a risk factor for developing diabetes. Researchers suspect that a lack of exercise is one factor contributing to the high rates of diabetes in African Americans. In a nationwide survey, 50 percent of African American men and 67 percent of African American women reported that they participated in little or no leisure time physical activity.
Compared with Caucasian Americans, African Americans experience higher rates of diabetes complications such as heart disease, eye disease, kidney failure and amputations. They also experience greater disability from these complications. Some factors that influence the frequency of these complications, such as high blood glucose levels, abnormal cholesterol levels, high blood pressure and cigarette smoking, can be influenced by proper diabetes management.
People with diabetes are more than twice as likely to develop heart disease than people who don't have diabetes. And people with diabetes are five times more likely to have a stroke than those who don't have diabetes. Many people with diabetes have few symptoms of heart disease until the advanced stages. But by managing blood glucose, high blood pressure and cholesterol, African Americans with diabetes can lower their risk.
Diabetic retinopathy is a deterioration of the blood vessels in the eye caused by high blood glucose. It can lead to impaired visionand ultimately to blindness. A nationwide study showed that frequency of diabetic retinopathy is 40 to 50 percent higher in African Americans thanCaucasians. Retinopathy may also occur more frequently in African Americans than in Caucasians because ofa higher rate of hypertension in African Americans.
African Americans with diabetes experience kidney failure, also called end-stage renal disease (ESRD), about four times more often than Caucasians with diabetes. Diabetes is the leading cause of kidney failure and accounted for 43 percent of the new cases of ESRD among African Americans during 1992–1996. Hypertension, the second leading cause of ESRD, accounted for 42 percent of cases. In spite of their high rates of ESRD, African Americans have better survival rates after they develop kidney failure than Caucasians.
Based on the U.S. hospital discharge survey, there were about 13,000 amputations among African Americans with diabetes in 1994, which involved 155,000 days in the hospital. African Americans with diabetes are much more likely to undergo a lower-extremity amputation thanCaucasian or Hispanic Americans with diabetes. The hospitalization rate of amputations for African Americans was 9.3 per 1,000 patients in 1994, compared with 5.8 per 1,000 Caucasian patients. However, the average length of hospital stay was lower for African Americans (12.1 days) than forCaucasians (16.5 days).
How Joslin Can Help You:
Major studies show that diet and physical activity can significantly prevent, delay or slow the progression of diabetes complications. Joslin Diabetes Center has more than 100 years of experience in treating diabetes. Our centers have several providers in one location:
- Endocrinologists are specialists in diabetes care and can work with your primary care physician to manage your diabetes and keep control of your blood glucose. They are there to adjust your treatment plan as needed.
- Nurses, certified diabetes educatorsand registered dietitians will help you understand how to manage your diabetes.
Call 617-732-2440 for more information or to make an appointment.
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Page last updated: February 16, 2019