Diabetes and Women of Color

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Today, diabetes is one of the most serious health challenges facing women in the United States, especially women of color. Complications from diabetes rank among the top 10 causes of death for all women.

Whether diabetes is an underlying cause or among multiple causes of death, the toll on women, especially women of color, is significant. For African American women, the diabetes death rates are the highest in terms of both underlying cause (49.6 per 100,000) and multiple causes (156.5 per 100,000).1 American Indian/Alaska Native and Latina women have high rates as well. The lowest rates are reported for Asian/Pacific Islander women.

Type 2 diabetes, previously referred to as adult onset, is a more serious problem for women of color, as indicated by the statistics below:¹

• Among African American women, this form of diabetes has reached epidemic proportions; for those age 20 years or older, the rate is 11.8%.
• About 1 in 4 black women over the age of 55 years of age has diabetes, nearly twice the rate of white women.
• 25% of Latina women have been diagnosed with type 2 diabetes, and about 33% of deaths among them list diabetes as the underlying cause. This rate has risen rapidly in the 30-year period from 1958 to 1987.
• American Indian/Alaska Native women have almost three times the risk of being diagnosed with diabetes as whites of similar age. The disease is common in many tribes, and the sickness and mortality can be very severe.

Older American Indian/Alaska Native and Mexican American women are among the most likely to have diabetes (32 and 30%, respectively), followed by black women (25%) and white women (15%).^{2, 3}

Diabetes-related health risks are twofold: health risks that can lead to diabetes and health risks that result from having diabetes. The diabetes-associated risks include loss of vision and blindness, foot ulcers, lower extremity amputations, and pregnancy and cardiovascular complications. In addition, diabetes is associated with birth defects, high blood pressure, nervous system damage,dental disease, kidney disease, stroke, and flu and pneumonia-related deaths.

Cardiovascular disease is the most costly complication of diabetes, accounting for more than $17.6 billion of the $91.8 billion annual direct medical costs for diabetes in 2002. Data about diabetes-related complications show disparities for women of color. For example, African Americans experience higher rates of diabetes complications such as eye disease, kidney failure, and amputations. They also experience greater disability from these complications.⁴

The link between diabetes and heart disease is especially critical for women of color. Several risk factors for diabetes, including overweight and high cholesterol, are risk factors for heart disease as well.^{5, 6, 7}

Unfortunately, women, even women with diabetes, are not well informed about the risks. They do not make the connection between diabetes and heart disease. Patients’ lack of awareness suggests that doctors are not communicating about the risks. In a recent survey, half of the respondents indicated that their health care providers did not discuss ways to reduce the risks for heart disease and stroke, such as lowering cholesterol or blood pressure.

The connection between diabetes and blindness also needs to be made. Diabetic retinopathy affects 40 to 45% of the 13 million Americans diagnosed with diabetes. Without treatment, more than 50% of patients with proliferative diabetic retinopathy, the most advanced stage, will become blind within 5 years. Yet, annual eye exams, timely treatment, and appropriate followup care can reduce the risk of blindness by 90%.

The Federal Diabetes Prevention Program (DPP) has shown that lifestyle change and/or medication can dramatically reduce the development of diabetes. Modifying lifestyle can reduce by half the number of new cases among adults at high risk. Women can reduce their diabetes-related risks by:

• Being physically active every day
• Eating a nutritious diet
• Making healthy choices

Excerpted and adapted from the National Women’s Health Information Center.

Reviewed by Francine Kaufman, MD. 4/08