"Unfortunately, access to care is a huge barrier within our Black and Brown communities," says Northwestern Medicine Internal Medicine Physician Kimbra A. Bell, MD. "Additionally, the inability to afford quality medical care and prescription medications can be a hindrance as well. So, conditions such as diabetes are not managed as well as they could be and subsequently result in poorer outcomes."

Types of Diabetes

There are three main types of diabetes, which all stem from the body's inability to regulate blood sugar.

• Type 1 diabetes is an autoimmune disorder that typically shows up early in life. In Type 1 diabetes, the immune system attacks and destroys the insulin-producing cells in the pancreas. Approximately 5% to 10% of people who have diabetes have Type 1. It is not preventable.
• Type 2 diabetes is largely diet-related and develops over time. It is preventable and can be reversible with a healthy diet and exercise. This is the most common diabetes that affects people from racial and ethnic minority communities. About 90% to 95% of people with diabetes have Type 2.
• Gestational diabetes develops in people who are pregnant. This puts the baby at higher risk for health problems. Gestational diabetes usually goes away soon after pregnancy ends, but people who have this type of diabetes are more likely to develop Type 2 diabetes after pregnancy.

When blood glucose levels are higher than normal but not high enough to be diagnosed as Type 2 diabetes, a person is considered to have prediabetes. More than one in three U.S. adults have prediabetes. Of those, more than 84% are unaware they have it.

Risk Factors for Type 2 Diabetes

People at highest risk for Type 2 diabetes include those who:

• Have a family history of diabetes in parents or siblings
• Are overweight
• Have a history of impaired fasting glucose
• Have high blood pressure
• Identify with certain racial and ethnic minority groups (African American, Hispanic American, Native American, Asian American, Pacific Islanders)

Why Black People Are at Higher Risk for Diabetes

Black adults in the U.S. are 60% more likely than white adults to be diagnosed with diabetes. In 2018, non-Hispanic Black people were found to be twice as likely as non-Hispanic white people to die from diabetes. A study done by Northwestern University Feinberg School of Medicine found that biological risk factors for diabetes, such as body mass index (BMI), fasting glucose level and blood pressure, accounted for most of the health disparities within Black communities.

People in racial and ethnic minority communities are most affected by diabetes because they are more likely to live in under-resourced neighborhoods. Factors called "social determinants of health" like poverty, lack of access to healthy food, restrictions on safe physical activity, inadequate employment and limited educational opportunities can result in negative health outcomes in such communities.

 "Our Black and Brown communities are more likely to have an abundance of fast food restaurants and markets stocked with unhealthy processed foods as opposed to our white counterparts, where there tends to be a greater number of grocery stores and markets with an abundance of fresh fruits and vegetables," says Dr. Bell. "A lack of access to healthy, nutritious foods results in poorer health outcomes."

Dr. Bell says there is a critical need to acknowledge health inequities and seek a greater understanding to address them. "Deeply rooted social inequities that have existed since times of slavery play a huge role in the health disparities that are prevalent amongst our Black and Brown communities," she says. "Every individual deserves an equal opportunity to try and live a healthy, full, productive life. When equal opportunity is not given to a class of persons based on the color of their skin, this leads to social inequities and health disparities."

Promoting Prevention

It is possible to prevent or delay Type 2 diabetes even if you are at high risk. Dr. Bell suggests the following:

• Get regular exercise. "One subtle lifestyle change that could make a huge difference is to simply get moving. If a sedentary person decided to begin taking a 30- to 40-minute brisk walk most days of the week, this could play a very significant role in preventing obesity and diabetes as well as cardiovascular disease."
• Follow a healthy eating plan. "Eating more fresh fruits and vegetables and decreasing intake of red meat, fried food and fast food would play a significant role in preventing obesity, diabetes and heart disease."
• Get a blood test to catch prediabetes. "Begin screening for diabetes at age 40, or earlier if you are in a high-risk category."