African Americans Health Focus on Diabetes (Part 4 in a Series)

For people with diabetes mellitus, the risks are real, and there can be many complications.

It’s important to understand the risks and be proactive about keeping healthy. This is especially important for the African American community, which is affected disproportionately by diabetes.

• According to the U.S. Department of Health and Human Services, African American adults are 60% more likely than non-Hispanic white adults to be diagnosed with diabetes
• Non-Hispanic blacks have been 3.5 times more likely than non-Hispanic whites to be diagnosed with end-stage renal disease, often connected with a diabetic condition
• Non-Hispanic blacks have been 2.3 times more likely than non-Hispanic whites to be hospitalized for lower limb amputations—also associated with diabetes
• Nationwide, African Americans have been twice as likely as non-Hispanic whites to die as a result of diabetes

A more dramatic statistic: about 8.3 percent of residents of the District of Columbia are diagnosed with diabetes, similar to the national rate of 8.7 percent. However, the diabetic death rate for blacks in the District can be as much as five times that of whites.

Also at higher risk are people of Hispanic and Asian ancestry. We don’t have a detailed understanding of what causes these demographic disparities, although it may well be a combination of genetics, socio-economic factors and access to care.

At MedStar Washington Hospital Center, we are committed to reaching at-risk populations, providing education and increasing access to needed medical services. Following expert guidelines from the American Diabetes Association and others, we’re enabled to tailor treatment to each patient’s individual profile.

Along with representatives from MedStar medical centers across Baltimore and Washington, D.C., our team members also participate in a regional diabetes council, where we exchange knowledge and innovations to better serve at-risk populations and deliver the best possible treatment at the lowest possible costs.

Type 1 and Type 2

Our bodies (e.g., GI tract, liver) convert food to glucose, which fuels our cells. But, when diabetes is present, the body has difficulty getting glucose into the cells that need it. The glucose builds in the blood instead, causing problems like:

• Retinal abnormalities and bleeding into the retina, which can lead to blindness
• Increased risk for kidney disease and kidney failure
• Blood vessel damage, with the potential for lower limb amputation, heart attack and stroke
• Fatty liver disease

In Type 1 diabetes mellitus, the immune system malfunctions and attacks the pancreas, interfering with insulin production, the chemical the body needs to convert glucose to energy. In type 2 diabetes mellitus, the pancreas makes insulin, but the cells of the body become resistant to it.

Type 1 strikes at random, and we don’t yet know how to prevent it. The type 1 diabetic is generally young and thin and presents with ketoacidosis, a form of blood poisoning caused when the body cannot process glucose and instead taps its fat reserves for energy.

The much more common Type 2 accounts for about 90 percent of the disease in the U.S. and worldwide. And it is on the rise. The causes are not completely known, but it is linked to obesity, lack of exercise, poor diet and genetics. And, although it generally affects those over 45, it’s becoming more frequent in children, teens, and young adults.

Type 2 occasionally presents with excessive thirst and urination, or weight loss despite consuming a normal diet. Other symptoms may include blurred vision; cuts or bruises slow to heal; tingling or numbness in the hands and feet; and recurring skin, gum or bladder infections.

But usually, Type 2 builds slowly over a period of years, often without the patient realizing it.

By the Numbers

Our blood sugar changes throughout the day, with eating, exercise, sleep and time. The glucose self-test that diabetics perform offers a snapshot of what’s happening in the moment, important for short-term management of their blood sugar.

For assessment of longer-term control of a patient’s diabetes, we assess their hemoglobin A1C using a laboratory test that indicates glucose levels over the previous three months. For most patients, A1C is the prime determinant for long-term management of their diabetes.

• A normal A1C should be below 5.7
• Between 5.7 and 6.4 is considered prediabetes
• 6.5 or above indicates diabetes

Prediabetes

When prediabetes is present, blood sugar throughout the day is higher than it should be, a warning sign to the patient to make changes. The term can be confusing, because it implies it will inevitably progress to diabetes. But not everyone with prediabetes gets diabetes. In most people, prediabetes is reversible via weight loss and increased activity; sometimes medication (such as metformin) is given. Maintaining these healthy habits is critical, as prediabetics are at greater risk for complications.

Treatment of Diabetes

An A1C of 6.5 or above indicates diabetes, and we typically prescribe treatment with an oral medication or insulin. In addition, every few months, we monitor the patient’s blood glucose, A1C, and liver and kidney function.

We generally begin with an oral agent, such as metformin, that increases the cells’ sensitivity to natural insulin, made in the body. This and other oral medications are well tolerated and have fewer side effects than older sulfonylurea drugs. We also have new, extended-release injectables that can work for up to several days (called IGF1 receptor inhibitors).

Insulin injection is still reliable and available in long- and short-acting formulations. An insulin pump can reduce or eliminate multiple injections each day.  And helpful technologies continue to evolve, including continuous glucose monitoring (CGM) devices that reduce the need for finger sticks.

Lifestyle modifications continue to be critical as well. Although exercise and weight loss may not eliminate the need for medication completely, they may decrease the likelihood of complications and make disease management less challenging, requiring fewer drugs in lower doses. Eating healthy and understanding how different foods affect blood glucose are also key for a patient to normalize blood sugar.

Weight

The more we learn about Type 2 diabetes, the more we acknowledge how truly complex it is. For most, it’s safe to say that maintaining a healthy weight can prevent diabetes from starting and make it easier to control if it does occur. Multiple studies show that losing even a small amount of weight can have an impact.

Weight management is so important that many healthcare organizations offer lifestyle modification programs. For example, the Diabetes Boot Camp program led by Dr. Michelle McGee, director of the MedStar Diabetes Institute, combines self-care education with intensive medication management. Designed for diabetics who have trouble controlling their A1C, it pairs the patient with a diabetes educator who tracks blood sugar in real time through a virtual, cloud-based protocol, combined with personalized recommendations. Long-term follow-up helps diabetic patients stay on track.

Weight loss surgery is also an option. The Hospital Center has an excellent program, headed by Dr. Timothy Shope, Chief of Advanced Laparoscopic and Bariatric Surgery. Dr. Shope’s team offers a variety of procedures, with companion support and counseling. Such programs can be very effective for glucose control in people unable to moderate weight through diet and exercise.

How We Support You

Residents of the Washington, D.C., area can look to MedStar Washington Hospital Center as a reliable partner in managing their diabetes. Our team of diabetes support specialists includes experienced and qualified endocrinologists, led by Dr. Meeta Sharma, as well as specially trained and certified diabetic educators.

Our holistic approach incorporates medical, lifestyle and educational considerations. For example, our registered dietitians can educate the patient in how carbohydrates, fat and protein affect glucose levels and help them select appropriate foods. Our social work and financial teams help overcome barriers to care by navigating insurance and improving access to medication, equipment, testing and follow-up care.

Don’t Delay

Like many diseases, diabetes is best managed early, before patients experience possibly irreversible complications.

It’s critical to take care of yourself and see your healthcare provider regularly. Get the recommended lab tests, monitor blood sugar regularly and stick to your recommended diet and exercise regimen. This is particularly important during the COVID-19 pandemic, and especially for African Americans and others at highest risk.

With our user-friendly telehealth program, you can see your provider without leaving home. And for in-person visits, we are strictly adhering to all COVID-19 protocols so that we are able to provide the safest possible environment for patients and staff.

You’re never far from an expert who can help.