Diabetes and the African American Population - Essay Example

Diabetes and the African American population - Diabetes and the African American Population Introduction A disease of antiquity, diabetes mellitus, is a metabolic disorder which is characterized by chronic hyperglycemia. The disease has multiple etiologies and patient experiences disturbances in carbohydrate, fat and protein metabolism. Diabetes occurs as a result of either defective insulin action or secretion, or both. The onset of diabetes is associated with a number of complications such as the development of specific microvascular complications of retinopathy. Microvascular complications of retinopathy are particularly dangerous because they can lead to blindness. Moreover, diabetes is also associated with the development of nephropathy with potential renal failure, autonomic dysfunction, and foot ulcers. Thirst, polyuria, blurring of vision, and weight loss are the characteristic clinical presentation of diabetes. Diabetes can lead to ketoacidosis and hyperosmolar non-ketotic coma. Individuals with diabetes are often asymptomatic and some patients experience mild symptoms. For many centuries, there has been an awareness of different types of diabetes with varying severity. At the beginning of the 20th century, the possibility that there are two distinct types of diabetes emerged. The two types of diabetes are Type 1 diabetes (beta-cell destruction), which is an idiopathic and autoimmune disease, and Type 2 diabetes, which is characterized by insulin resistance and insulin hyposecretion (Holt, 2010). Type 1 diabetes occurs as a result of beta-cell destruction and mild insulin resistance. Insulin is required for survival after the patient survives the initial stages of the disease. Type 2 diabetes is characterized by insulin resistance with relative insulin deficiency. Type 2 diabetes is the dominant form of the disease around the world (T. Metcalf & G. Metcalf, 2008). Diabetes in African Americans Diabetes Epidemiology Diabetes is particularly quite prevalent in the United States of America. According to the 2000 US Census, there are 37.4 million African American individuals in America which constitute approximately 12.3% of the total population. In African American children, the rates of Type 1 diabetes are lower compared to American children. The African American population has an incidence rate of 5 to 8 per 100,000 per annum. On the other hand, the incidence rate of diabetes in white population is 14 to 17 per 100,000 per year. (Joslin & Kahn, 2006).The different proportions of racial admixture, particularly with the white populations, might be the reason for the distinct incidence rates among the black population. A significant role is played by genetic factors in the development of Type 1 diabetes. In the African American population, the association of major histocompatibility genes with the development of Type 1 diabetes is infrequent. In African American population, the prevalence of Type 2 diabetes is higher compared to non-Hispanic white population. However, the incidence rates bear a resemblance to the rates in Hispanic Americans. According to the most recent national data collected by the NHANES III Survey, in African American population, above 20 years of age, the prevalence rate of diagnosed diabetes is 8.2% whereas, on the other hand, the prevalence rate among the white population is 4.8%. The Survey revealed that the prevalence rate of diagnosed diabetes among blacks falling in the age group of 40 to 74 years is 18.2% compared with 11.2% for American white population (Joslin & Kahn, 2006).Therefore, among the African American population the prevalence of Type 2 diabetes is approximately 1.6 times higher compared with the white population. The number of African American people diagnosed with diabetes has significantly increased over the past three decades. From 1976 to 1980, the total diabetes prevalence in the African American population was 8.9%, but from 1988 to 1994, the rate drastically accelerated to 18.2%. Recent research has shown that the prevalence of diabetes is distinctly higher in the black population than in the whites (Joslin & Kahn, 2006). Among the black population, the rates for undiagnosed diabetes and IFG are also higher than in whites. According to a recent research, there is one undiagnosed diabetic case for every two diagnosed cases in the African American population. A major risk factor in the development of diabetes in the black population is age. The risk of development of diabetes increases with age among the black individuals. The risk increases by 21% for individuals falling in the age group of 60 to 74 years. On the other hand, the risk is less than 2% for black people younger than 39 years old (Joslin & Kahn, 2006). In the black population, the risk of development of Type 2 diabetes is particularly high in children and adults. An interesting fact was revealed by the NHANES 111 Survey about the prevalence of diabetes in black population. The survey found that the prevalence rate of diagnosed diabetes is more common in women of all ages compared with men. According to the survey, the prevalence rate of undiagnosed diabetes is 4.5% for women compared with 2.7% in men (Joslin & Kahn, 2006). Mortality The seventh leading cause of death in the world is diabetes. In African American population, diabetes is the fifth leading cause of death. The mortality associated with diabetes is higher in all age groups of black population compared with white individuals. The overall mortality rates for African American women are 40% higher than white population. On the other hand, the overall mortality rate for black men is 20% higher than white population. An interesting fact revealed by the NHANES III survey is that diabetes associated mortality rate is higher for black individuals who reside in high income areas (Joslin & Kahn, 2006). Insulin Resistance According to the NHANES III survey, a higher degree of insulin resistance has been found in African American population. The insulin levels are higher in African American individuals than white individuals without diabetes. Hyperinsulinemia is an indirect measure of insulin resistance because it is a compensatory mechanism for overcoming peripheral insulin resistance. Hyperinsulinemia is evident in African American population which inevitably proves that insulin resistance is consistently higher in African American women and men. In non-diabetic African American individuals, the significantly high levels of circulating insulin and acute insulin response are two of the most important reasons for the higher prevalence rate of diabetes in black population (Joslin & Kahn, 2006). Obesity The prevalence of obesity among African American population is consistently higher than in white population. The risk for diabetes increases with obesity; therefore, the incidence rate of diabetes in black population is higher than in whites. However, it is not wise to consider that obesity alone is the reason for high prevalence rates in African American population because higher diabetes diagnosis rate has also been observed in healthy black individuals. Therefore, obesity is one of the risk factors for diabetes development in African American population but certainly it is not the only reason for increased prevalence rates (Joslin & Kahn, 2006). Conclusion The incidence of diabetes is higher in African American population than the white population. Numerous studies have shown that the increased prevalence rates are critically related to numerous factors including increased insulin resistance, obesity, and deficient insulin secretion. Am important pathophysiologic element in the development of diabetes is insulin resistance. An analysis of the African American population reveals that they are more prone to hyperinsulinemia which reflects the fact they are more vulnerable to the development of insulin resistance. The risk of diabetes increases with age in black population. Owning to the mentioned fact, the prevalence rate of diabetes is consistently higher in African American population compared with the white population. References Holt, R. I. G. (2010). Textbook of diabetes. Chichester, West Sussex: Wiley-Blackwell. Joslin, E. P., & Kahn, C. R. (2005). Joslins diabetes mellitus. Philadelphia: Lippincott Williams & Willkins. Metcalf, T., & Metcalf, G. (2008). Diabetes. Detroit: Thomson/Gale. Read More