Prevalence of Type 2 Diabetes in Underserved Communities

By Trey Woods, LWDI Intern

What is Diabetes?

     Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel.(1)  This long-term condition results in too much sugar circulating in the bloodstream. Prolonged high blood sugar levels can lead to various health complications such as neuropathy, blindness, kidney problems, heart disease, or diabetic foot infections. 

Symptoms of Type 2 Diabetes

     Signs and symptoms of type 2 diabetes usually develop slow. People can often be living with type 2 diabetes and not even realize they have it. Some of the signs and symptoms include:

  • Increased thirst
  • Frequent urination
  • Increased hunger
  • Unintended weight loss
  • Fatigue
  • Blurred vision
  • Slow-healing sores
  • Frequent infections
  • Numbness or tingling in the hands or feet
  • Areas of darkened skin, usually in the armpits and neck

Risk Factors for Type 2 Diabetes

     Some individuals are at greater risk of developing type 2 diabetes than others. Risk factors include:

  • Weight: Being overweight or obese
  • Family history: The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
  • Race and ethnicity: Although it’s unclear why, people of certain races and ethnicities — including Black, Hispanic, Native American and Asian people, and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
  • Age: The risk of type 2 diabetes increases as you get older, especially after age 45.
  • Prediabetes: Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  • Pregnancy-related risks: Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds (4 kilograms).

Diagnostic Criteria 

A1C

     The A1C test measures your average blood sugar for the past two to three months. The advantages of being diagnosed this way are that you don’t have to fast or drink anything.

  • Diabetes is diagnosed at an A1C of greater than or equal to 6.5%

Fasting Plasma Glucose (FPG)

     This test checks your fasting blood sugar levels. Fasting means after not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.

  • Diabetes is diagnosed at fasting blood sugar of greater than or equal to 126 mg/d

Oral Glucose Tolerance Test (OGTT)

     The OGTT is a two-hour test that checks your blood sugar levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar. Diabetes is diagnosed at 2 hour blood sugar of greater than or equal to 200 mg/dl. If diabetes symptoms are present and blood glucose is 200 mg/dl or greater, diabetes can be diagnosed with the one test. Otherwise, two tests (A1C, FPG or OGTT) are required for diagnosis.

ResultA1CFasting Plasma Glucose (FPG)Oral Glucose Tolerance Test (OGTT)
Normalless than 5.7%less than 100 mg/dlless than 140 mg/dl
Prediabetes5.7% to 6.4%100 mg/dl to 125 mg/dl140 mg/dl to 199 mg/dl
Diabetes6.5% or higher126 mg/dl or higher200 mg/dl or higher

(2) 

Prevalence in Underserved Communities

     According to a 2017 study by the American Diabetes Association, nearly 30 million children and adults have been diagnosed with diabetes, an additional 86 million have prediabetes.(3) The study found low-income populations with limited health literacy were more likely to be diagnosed due to a variety of environmental factors: 1)limited access to healthy food choices, 2) limited access to health care, and 3) limited access to health-promoting resources. The prevalence of type 2 diabetes among racial/ethnic minorities (8.0–15.1%) is greater than that of non-Hispanic whites (7.4%).(4) Another factor affecting the prevalence of type 2 diabetes in the underserved community is the ability to self manage the condition. Without the proper healthcare to provide to the underserved community, there will always be an issue with the people being able to self manage their condition.(5) Without proper educators, it will be more difficult for people to learn how to manage their condition. Without education classes, the population is reliant on using the internet to self educate on their condition, and internet services may not be available or affordable to underserved communities.

Prevention in Underserved Communities

     Both randomized clinical trials and real world implementation studies have proven that structured lifestyle change programs, such as the National Diabetes Primary Prevention Program, can help prevent or delay type 2 diabetes by 60% in people with prediabetes.(6) In order to prevent the higher prevalence in underserved communities, there needs to be more Diabetes Prevention Program (DPP) resources in place. DPPs are not very common in the underserved communities which is why we are seeing them have higher incidences of diagnoses. In order to step up prevention, the DPPs could be tailored towards a certain demographic setting. For example, get feedback from the community on where classes could be held, frequency of the meetings, and what topics should be discussed.

  • For the racial/ethnic minority groups, there were better outcomes when the educators were from the local community, bilingual, and had a racial/ethnic match to the participants. 
  • For rural communities, there has been more of a telehealth effort into providing DPPs. The healthcare availability is still low for rural areas, so providing telehealth over the internet is a way to help with the prevention of type 2 diabetes in those communities. 

Low income individuals may be less likely to get screened for type 2 diabetes or to live near options for healthy eating or physical activity. This is why it is imperative that we strive to create more opportunities to provide DPPs in these underserved communities. Making resources both available and affordable should make a significant impact on the prevalence of type 2 diabetes.

References

  1. “Type 2 Diabetes”. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
  2. “Diagnosis”. American Diabetes Association. Retrieved from https://www.diabetes.org/a1c/diagnosis
  3. “Providing Diabetes Care to Underserved Populations”. CareMessage. Retrieved from https://www.caremessage.org/blog/post/diabetes-care-underserved
  4. AuYoung, M., Moin, T., Richardson, C. R., Damschroder, L. J. “The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World”. Diabetes Spectr. 2019 Nov. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858084/#:~:text=Although%20the%20Centers%20for%20Disease,in%20the%20Southwest%20(2).
  5. Reyes, J. et all, “Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes”. Sage Journals. 14 Jun. 2017. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2333393617713097

Albright, A. “How Effective Are Diabetes Prevention Programs?”. CDC. 13 Aug. 2014. Retrieved from https://www.cdc.gov/diabetes/prevention/pdf/transcript_doctor_albright_medscape.pdf.

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