A disparate burden  pg. 2

This disparity isn’t limited to African Americans. That population is joined by other racial and ethnic minority groups, including Hispanics, Native Americans, Asians and Pacific Islanders, in experiencing some of the highest incidences of diabetes and its complications, particularly type 2 diabetes. Though there is little doubt that genetics plays a part in this inequity, there is mounting evidence that lifestyle, cultural factors, and access to healthcare also strongly contribute to what is now a growing tsunami of new cases.

Reid has type 1 diabetes, which has an abrupt onset of characteristic symptoms, frequent urination and terrific thirst being two of them. It typically develops at a younger age and results from destruction of the insulin-secreting cells of the pancreas. Insulin, a hormone key to converting food into energy, must be injected to restore normal function.

Making the case

Type 2 diabetes differs in that it usually develops later in life and results from, essentially, an overworked pancreas. Insulin resistance in predisposed individuals causes the pancreas to pump out larger and larger amounts of the hormone each time food is eaten. Eventually, the insulin-secreting cells die a premature death, forcing the need for insulin injections.

Diabetes currently affects 20 million Americans, with about 90 percent of cases being type 2. An estimated one-third are unaware they have the disease. Since World War II, type 2 diabetes has mushroomed in this country, becoming one of the costliest and most devastating diseases in recent history.

While Caucasians suffer from the disease in high numbers, the disease is fiercest in its attack on those whose ancestors came from places other than Europe.

African Americans are at especially high risk for diabetes. The rate of type 2 diabetes in that population is 60 to 70 percent higher than that seen in Caucasian Americans, a tripling of the rate seen in 1963. Complications from diabetes are greater, too. African Americans suffer a two-fold higher rate of blindness and lower limb amputation, and a three- to five-fold higher rate of end stage kidney disease.

Hispanic Americans, the second largest and fastest growing minority group in the United States, are twice as likely as non-Hispanic whites to develop type 2 diabetes and, like African Americans, Hispanics also see higher rates of long-term complications.

Native Americans are the population in this country most disproportionately affected by diabetes, especially type 2 diabetes. The Pima Indians of the desert Southwest have one of the highest incidences known worldwide. The disease is so common—more than 50 percent of adults develop type 2 diabetes—that public restrooms on reservations are equipped with hazardous waste bins for safe disposal of insulin needles and lancets. Most Pimas grow up assuming it is their destiny.

The prevalence of type 2 diabetes is estimated to be about two to four times greater in Asians living in the U.S. than in those living in their native country, though that may be changing. Recent reports suggest a wave of obesity is sweeping through Asia as populations throng into burgeoning cities emulating the Western bent for fatty fast foods and urban conveniences.

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