User:Mariekedesev/sandbox

= Diabetes in African Americans =

Diabetes is a leading cause of death in African Americans. African American adults have the third highest age-adjusted prevalence of diagnosed diabetes (11.7%), following Native Americans/Alaska natives (14.7%) and Hispanic Americans (12.5%), according to the Centers for Disease Control and Prevention (CDC). High rates of overweight and obesity, racial differences in socio-economic status, and healthcare inequities contribute to the high morbidity and mortality rates and economic costs related to diabetes. Prevention strategies such as the Affordable Care Act and the Diabetes Prevention Program were implemented to improve diabetes-related outcomes.

Statistics

 * In 2018, 34.1 million adults (> 18 years) in the US were suffering from diabetes (13.0% of the total adult population
 * In 2018, 5.2 million African American adults (11.7%) were suffering from diabetes.
 * Diabetes is the fifth leading cause of death in African Americans, claiming approximately 15.000 deaths per year.
 * Women are disproportionately affected, with approximately 4 out of 5 African American women suffering from diabetes

Overweight and Obesity
Overweight and obesity are a major risk factors for developing diabetes. Compared to white Americans, African Americans are 1.3 times more likely to be overweight or obese, which is partially attributable to low physical activity. A lack of access to school-based programs for youths and low education and income levels of African Americans have contributed to half of the African American adults not meeting the federal physical activity guidelines in 2018. Women were less physically active than men, with almost two out of three of women not meeting the guidelines compared to two out of five men.

Socioeconomic factors
Socioeconomic status (SES) is also related to diabetes prevalence. Americans without a high school degree have significantly higher prevalences than those with a high school education or more. Large racial differences in socio-economic factors, including education and income, exist in the US, and African Americans are the worst off. This may affect the ability to afford healthcare and regular checkups, a healthy diet, and access to physical exercise, thereby increasing the risk to develop diabetes.

Healthcare inequities
A lack of access to appropriate treatment may contribute to the higher prevalence of diabetes diagnoses in African Americans. Contributing factors to the inaccessibility of appropriate care are:


 * African Americans are less likely to have health insurance than white Americans
 * Less wealthy areas, where many African Americans live, may have fewer healthcare centers
 * Healthcare professionals in areas with more African Americans can be of lower quality than those with mostly white Americans
 * The white-centric healthcare culture that has focused its research on the white population
 * Communication barriers between African-American patients and physicians from another race related to discrimination, internalized racism, and cultural discordance

Consequences
Diabetes increases the risk for complications and co-morbidities such as cardiovascular diseases, diabetic eye disease, diabetic kidney disease, and peripheral neuropathy increases, as well as mortality. It is the fifth leading cause of death in African Americans, who are twice as likely to die from diabetes compared to white Americans. Diabetes also leads to high economic costs. The total direct and indirect costs of diagnosed diabetes were estimated to be 327 billion dollars in 2017.

Prevention
Management strategies for diabetes and the associated complications focus on promoting a healthy lifestyle and body weight, including a healthy diet, physical activity, and smoking cessation. In addition, medication can be prescribed to regulate blood glucose levels. Studies show that effective control of blood glucose levels can be achieved through culturally appropriate strategies, such as counseling on physical activity, diet, and diabetes care. This remains a challenge, however, due to poor adherence to treatment and self-monitoring, healthcare-related costs, and sociocultural factors of the African American patients. Moreover, there may be less healthcare professionals at the healthcare centers in predominantly African American areas and they may be of less quality.

Several efforts have been undertaken in order to improve diabetes-related health outcomes in African Americans. Examples include the African American Diabetes Action Council set up by the American Diabetes Association (ADA) to guide advocacy efforts in their community and the Affordable Care Act implemented in 2014, which prohibits diabetes from being a reason for denying health insurance or care and specifically targets disproportionately affected populations. Furthermore, the Diabetes Prevention Program (DPP), a clinical trial that evaluated the safety and efficacy of interventions to delay or prevent development of diabetes, included 45% of its study population (22% African Americans) from minorities. Unfortunately, the study showed that the DPP was less effective for African Americans, further emphasizing the need for more research within this population.