Diabetes Mellitus In African Americans
Diabetes (DM) is the fourth
leading cause of death in AA. About 2.3 million (approximately 10.8 per cent) of
African Americans in the United States have this disease, according to the
American Diabetes Association. This may be an underestimation; it is believed
that half of those who meet diagnostic criteria for DM are undiagnosed. Although
the age-adjusted death rates in 1995 were 117 percent higher for black men and
167 per cent higher for black women than for their respective white
counterparts, the prevalence of cardiovascular disease in blacks with DM appears
to be lower than in whites. Overall, however, when one considers Type II or
maturity-onset (non-insulin-dependent) DM, the prevalence in the 45-64 year age
group is 51 per cent higher for blacks than for whites.
In addition, African American
diabetics are characterized by the following features:
- A higher prevalence of microalbuminuria, which
is a marker for kidney involvement. The presence of renal insufficiency in DM is
indicated by microalbumin levels in excess of 200 g/L.
- DM is an independent risk factor for CHD. When
hypertension is also present, the risk is doubled. (HTN inDM)
- Greater body mass index (BMI) with earlier onset
of overweight and obesity and higher rates of centralized obesity which
correlates more with coronary heart disease. DM is almost 3 times more prevalent
in obese than in non-obese persons.
- More concomitant hypertension.
- Higher rates of amputation of the lower
extremities (1.5-2.5 times more common than in whites).
- AA have twice the rate of blindness due to
diabetic retinopathy as do whites.
- Babies born to black mothers with DM are at
higher mortality risk than whites.
- End-stage renal disease (ESRD) may be up to 17
times more prevalent in African Americans than in whites.