The 1986 report of the Secretary’s Task Force on Black and Minority Health called notice to the upsetting excess morbidity as well as mortality from chronic illnesses for instance non-insulin-dependent diabetes mellitus (NIDDM), cancer, and heart disease that exists in minorities in the United States. Besides the added disease burden, restricted research in the area of minority health has exacerbated the problem in the African-American population by reducing the knowledge essential for understanding the contributing factors plus planning effective intervention strategies.
Diabetes mellitus, one of the diseases targeted for augmented investigate focus among minorities, carries on to have overwhelming consequences on the African American population. It is anticipated that about 1.8 million African Americans are affected with the disease (Report of the Secretary’s Task Force on Black and Minority Health, 1985). Furthermore, the occurrence and mortality from diabetes are almost double as high among African Americans as in the U.S. White population (CDC, 1990). Consequently, there remains a critical need for research intended to explain the aspects contributing to the augmented diabetes-related morbidity as well as mortality in this ethnic group.
Biomedical definition and Epidemiology of Diabetes Mellitus
Diabetes mellitus is a heterogenous group of disorders that are typified by an abnormal augment in the level of blood glucose. It is a chronic disorder of carbohydrate metabolism ensuing from inadequate production of insulin or from insufficient utilization of this hormone by the body’s cells (Professional Guide to Diseases 1998:849). Diabetes mellitus takes place in 4 forms classified by etiology: Type I (insulin-dependent), Type II (noninsulin-dependent), other special types (genetic disorder or exposure to certain drugs in chemicals), as well as gestational diabetes (occurs during pregnancy).
When studies are performed to evaluate the epidemiology and public health impact of diabetes mellitus on the African-American population, non-insulin-dependent diabetes mellitus (NIDDM) plus insulin-dependent diabetes mellitus (IDDM) are most frequently considered. Though, further forms of glucose intolerance have as well been studied, together with impaired glucose tolerance (IGT), gestational diabetes (GDM), and other atypical diabetes syndromes. Categorization of these diabetes subtypes is usually footed on standards published by the National Diabetes Data Group (NDDG) (1979) and the World Health Organization (WHO) (1980). The analysis of diabetes is recognized by a finding of fasting plasma glucose (FBS) value greater than 140 mg/dl or a value of 200 mg/dl 2 hours after a 75-gram glucose challenge on the oral glucose tolerance test (OGGT).
Non-Insulin-Dependent Diabetes Mellitus
The initial estimates, footed on national samples, of the incidence of diabetes in African Americans came from data collected on male World War II registrants age eighteen to forty-five, which recommended that the occurrence of diabetes was greater in White than Black males (Marble, 1949). Since these data were collected over age ranges with a prevalence of distribution toward younger age, where diabetes rates may mainly reveal insulin-dependent diabetes mellitus, they may not offer a factual picture of the occurrence of NIDDM in the races at that time.
More current and dependable data from the National Center for Health Statistics point out that, in the United States, the occurrence of known diabetes is higher among African Americans than White Americans mainly among individuals age forty-five to sixty-four, when the rate for Blacks is 50.6 percent higher (Harris, 1990). The occurrence of diabetes augments with age for U.S. Black adults and is about 1.2 times higher for females (Harris, 1990). Among African Americans, the occurrence of diabetes is inversely associated to educational achievement and is highest among individuals in the low income group.
Insulin-Dependent Diabetes Mellitus
The occurrence of insulin-dependent diabetes mellitus pursues a different racial prototype from that of NIDDM: White children have approximately twice the rate of Black children. (Lipman, 1991). Across the United States, there is much greater inconsistency in the occurrence of IDDM for African-American children than White children. It is probable the variability in IDDM incidence among African-American children might consequence from variations in degree of White admixture in the different registry locations.
There is proof that White admixture differs by geographic region in the United States with greater admixture in northern areas than in the south. This is reliable with the drift for more European-American genetic admixture in Allegheny County, Pennsylvania, where the occurrence of IDDM in African Americans is higher, than in Jefferson County, Alabama (Reitnauer et al., 1982) and the incidence of IDDM is lower.
Atypical diabetic syndromes, typified by normoglycemic reduction with ensuing periods of hyperglycemic deterioration, generally needing insulin for glycemic control, have been explained in African-American and further Black populations. Winter et al. (1987), accounted an atypical diabetes in young African Americans that shows with features typical of IDDM however lacks the HLA association’s trait of the disease.
The insulin dependence in this syndrome was irregular or steadily declined all through the course of the illness. Diabetic syndromes presenting in adulthood with alike phasic insulin dependence have as well been reported. Whereas further forms of diabetes together with protein deficient pancreatic diabetes and fibrocalculus pancreatic diabetes take place in some Black African populations, so far they have not been revealed to be important for African Americans.
Type I diabetes reports for three percent of all new cases of diabetes diagnosed every year in the United States. Type I can build up at any age, thus far the majority cases are diagnosed when the individual is under thirty. Type II, the more widespread form of the disease, normally has a steady start, generally appearing in adults over the age of forty (Managing Your Diabetes 1991).
It has an effect on an estimated ninety percent of the six million Americans diagnosed with diabetes yearly. The probability of developing Type II is about the same by sex however is greater in African Americans, Hispanics, and Native Americans. Main risk factors comprise a family history of diabetes, obesity, being age forty or over, hypertension, gestational diabetes, or having one or more infants weighing more than 9 pounds at birth (Professional Guide to Diseases 1998).
Diabetes mellitus is a main clinical as well as public health problem in the African American community. African American men have an occurrence of diabetes that is eighty percent higher than that for European American men, whereas African American women have occurrence ninety percent higher than that for European American women (Herman et al. 1998:147). These diabetes statistics point out that not merely are there characteristic differences between African Americans and European Americans in the occurrence and hospitalization rates related with diabetes however as well that research is required to find out if any other factors, for instance social and cultural, may be causative to the large difference of diabetes-related problems (Bailey 2000).
Cultural Perceptions of Diabetes Mellitus
In a study to find out differences in self-reported adherence to a dietary routine, Fitzgerald et al. (1997) analyzed one hundred and seventy-eight African American and European American patients at a Michigan suburban endocrinology clinic from 1993 to 1994. They establish that the 2 groups of patients with non insulin-dependent diabetes (NIDDM) reported similar adherence to dietary recommendations; similar on the whole adherence, beliefs, plus attitudes as calculated by their diabetes care profile scale; and a similar percentage of ideal body weight (Fitzgerald et al. 1997:46).
Further analyses, though, exposed that African Americans and European Americans differed in the opinion of diabetes and the view of adherence to the dietary routine for diabetes. Fitzgerald et al. (1997) speculated that among African American women the inspiration to lose weight frequently is not for health reasons however for improved look. The significance of weight loss to one’s diabetic condition is de-emphasized, and more significance is placed upon losing weight for better look. If weight loss does not take place, then unconstructive beliefs and attitudes may reduce the individual’s inspiration and endorse a “why bother” attitude, in that way causing nonadherence to the dietary regimen for diabetes (Fitzgerald et al. 1997:46).
To work against this “why bother” attitude as it affects weight loss and dietary adherence, Fitzgerald et al. (1997) recommended that health educators require to assist patients distinguish their feelings regarding diabetes, recognize the habits that their feelings influence their behaviors, and build up tactics for managing with their feelings. The cultural/social functions of food and what food “means” plus “represents” to the individual must be measured when developing meal plans and educational interventions for the African American diabetic patient.
So as to study more of the fundamental cultural health beliefs related with diabetes mellitus, Maillet et al. (1996) carried out a focus group of African American women with NIDDM and those endangered for this disease. Six African American women susceptible for noninsulin-dependent diabetes mellitus contributed in the northeastern urban medical university in a tranquil and relaxed classroom.
The main themes that appeared from the focus groups were the significance of family and social support, a tendency to binge or overindulge when food limitations were placed by family members, difficulties with dietary changes, incapability to build up an exercise program due to multiple barriers, lack of clarity regarding diabetes complications, value for however lack of knowledge regarding prevention of complications, as well as a need for future programs that are ethnically responsive to African American women (Maillet et al. 1996:44).
Additionally, a constant theme of this focus group was that family support or a lack of support had an impact on one’s stated capability to make dietary alterations. Particularly, Maillet et al. recommended that older African American women discover it hard to make dietary changes for the reason that altering their diet disturbs a lifetime of culture within the context of family. Culture may directly manipulate diabetes education and have to be understood and included into intervention programs to persuade success (Maillet et al. 1996:45).
Consequently, when providing care to African American women of all ages, Maillet et al. recommended that the primary health care providers have to be sensitive to the role that culture plays in diet, weight loss, plus diabetes self-management. By means of qualitative and quantitative data collection techniques to examine health beliefs and health care-seeking outlines of African American and Euro-American diabetics, the fieldwork project was performed in 2 phases at the diabetes clinic in the Regenstrief Health Center at Indiana University, Indianapolis. The qualitative phase 1 occurred from June to August 1991, and the quantitative phase 2 from June to December 1992 (Bailey 2000:178). From 9 total site visits over the 5 months, the following noteworthy themes come into view regarding the African American diabetic patient:
- Appraise the source of the patient’s diabetes;
- Effort to dispel any delusions of diabetes;
- Make active the patient for self-care of diabetes;
- Carry on to reeducate the patient on blood glucose monitoring as well as insulin injection; and
- Hearten social and familial support for devotion to diabetic regimen.
Besides, other qualitative results pointed out that physicians required to (1) recognize the sociocultural restraints of a patient’s keeping appointments; (2) regulate the dietary alteration of the patient to his or her lifestyle and cultural dietary pattern; (3) build up more permanence of care; (4) find out new skills to build up understanding and trust with patients; and (5) give emphasis to the significance of the diabetic condition to the patient (Bailey 2000:182).
Phase 2 (Bailey 2000) consisted of performing qualitative and quantitative observations and interviews of African American and Euro-American diabetic patients. For instance, during the six-month period of phase 2, African American patients shared the following comments:
Patient Informant #1 (African American female): I’m not sure what caused my diabetes. I know that there is a family connection to diabetes and my weight has something to do with it, but I don’t take all of it too seriously.
When asked to assess her capability to pursue the doctor’s set diabetic dietary regimen, patient informant #1 stated:
My sons and husband want their meals the way they normally have it. They don’t want no unseasoned meals, so what am I supposed to do?
Patient Informant #2 (African American female): I was on those diabetic pills, but I had to be placed on insulin injections. I hate taking these injections, but I have to do it.
Fascinatingly, patient informant #2 was placed on diabetic pills and told to watch her diet years ago. Though, she stopped taking the pills on a regular basis and did not stick to the diabetic diet routine. Now that she is on insulin injections and closely adhering to the diabetes dietary routine, her insulin injections have slowly been reduced.
Patient Informant #3 (African American male): I was really not shocked when I was diagnosed with diabetes simply because my father and aunt have diabetes and I knew it was a matter of time before I would develop it.
Diabetes is widespread among African Americans and this is because of dietary eating pattern—fried foods and not sufficient vegetables.
Even though patient informant #3 thought that it was a matter of time before he would build up diabetes, he is still unsure of the procedure and the reasons why he developed Type II diabetes. He came to the clinic merely to discover what was wrong with his stomach. To his shock, he was diagnosed with Type II diabetes. The qualitative findings that tend to be more related with the African American diabetic patients than with the Euro-American diabetic patients were as follows:
- The doubt of the real source of one’s diabetes;
- The lack of perceived importance of one’s diabetic condition;
- The perceived incapability to stick to the diabetic routine;
- The lower ranking of one’s health as compared to other social and family obligations.
These qualitative outcomes pointed out that numerous sociocultural issues still require to be further examined in the African American diabetic population (Bailey 2000:184).
Lastly, the former president of the National Medical Association, Yvonnecris Smith Veal (1996), utters that there are three fundamental causes why diabetes carries on to plague the African American community. First, there is the way of life and behavioral patterns related with African Americans for example poor eating habits, obesity, restricted access to enough medical care, and restricted funds.
African Americans generally tend to eat foods high in calories and loaded with saturated fats and sugar and to have an inactive lifestyle—all of which are causative factors to being overweight. Second, African Americans have a history of making foods with lard and other heavy oils. This sort of food preparation, together with the incapability to get a balanced diet, contributes to the risk factors related with diabetes. Third, African Americans require more choices to decide dietary diabetic routines that fit the preferences for certain foods plus eating practices among all segments of the African American population (Bailey 2000).
Factors Influencing the Occurrence of Diabetes in African Americans
Significant factors influencing the incidence of diabetes mellitus in African Americans comprise personal characteristics for instance genetics, age, sex, plus history of glucose intolerance (IGT, GDM). Further routine factors for instance physical activity plus obesity, which are related with altering socioeconomic as well as cultural climates within countries, to a great extent have an effect on the risk of developing the disease. Even though the exact etiological interactions remain arguable, it is definite that a mixture of most of these factors is accountable for precipitating the disease.
An individual’s risk of developing diabetes mellitus is significantly influenced by his/her hereditary background. Individuals who are first-degree relatives of diabetes patients are at noticeable augmented risk of developing the disease compared to unrelated individuals in the general population. (W.H.O. Multinational, 1991).
Proof from studies of identical twins specifies a concordance rate of about ninety percent for NIDDM and fifty percent for IDDM, representing that the influence of genetics is greater in the former than in the latter (Barnett, Eff, Leslie & Pyke, 1981). The investigation for the hereditary reasons that rates of diabetes fluctuate in different ethnic groups has caused hypotheses that try to report for the observed frequencies of NIDDM and IDDM in African Americans. (Tuomilehto, Tuomilehto- Wolf , Zimmet, Alberti & Keen, 1992)
Thrifty Gene Hypothesis
Neel (1962) recommended that populations exposed to intermittent food shortage would through natural selection augment the incidence of genetic traits, “thrifty genes,” that incline to energy conservation. These genes would augment survival during times of famine by permitting for adept storage of fat in times of abundance. In the absence of feast and famine cycles, in times of continued profusion, these genes would turn out to be detrimental, predisposing to the growth of obesity and an augmented frequency of NIDDM. This hypothesis would be constant with the observation of much higher rates of diabetes and obesity among African Americans and urban Africans compared to Black Africans residing in conventional environments.
Age and Sex
In the majority populations the occurrence of diabetes differs with age and sex. For African Americans, the peak age range for diagnosis of IDDM is about fifteen to nineteen years of age, whereas NIDDM occurs more often after age fifty-six, when it is 3 times more common than in the White population (Roseman, 1985). African-American females are more probable to build up IDDM compared to Black men are more probable to develop NIDDM than Black men, White women, and White men, correspondingly (Harris, 1990). The sex discrepancy for IDDM may be because of differences in vulnerability or experience to etiologic agents (Dahlquist et al., 1985). Differences in NIDDM by gender may be because of differences in the levels of related risk factors such as obesity plus physical activity.
Socioeconomic Status (SES)
Racial differences in disease rates may reveal socioeconomic differences. In the United States socioeconomic status and the frequency of NIDDM have a converse relationship. The impact of SES on NIDDM rates among African Americans may be particularly strong. Studies concerning socioeconomic status to the development of IDDM have been contradictory. Some studies establish a positive relationship. Others have found a negative (Colle et al., 1984) or no relationship at all. It appears improbable that socioeconomic status contributes considerably to racial differences in the frequency of IDDM in the United States.
Obesity, usually measured as body-mass index (BMI)), is the most important risk factor for NIDDM. Overweight is a severe problem for the African-American female, with the level of obesity (that is BMI > 27.3) being greater than fifty percent among women older than age forty-five (Van Itallie, 1985). Compared to White women, African-American women are more overweight. African-American men demonstrate a similar prototype of obesity when compared to White men (Van Italie, 1985).
The development of NIDDM is not merely influenced by the presence of obesity however as well by where the body fat is distributed. The danger of developing NIDDM is greater for individuals with central or android obesity. African Americans have been accounted to have a greater propensity to store more fat in the trunk than Whites, which could clarify part of the excess occurrence of NIDDM in the Black population (Kumanyika, 1988).
There is proof that physical inactivity is an independent danger factor for developing NIDDM (Taylor et al., 1984). On the other hand, exercise perhaps a strong defensive factor against the development of the disease. On the whole there is a converse association between levels of obesity and physical activity. Consequently, higher levels of obesity among U.S. Blacks compared to Whites propose that reduced levels of physical activity among African Americans may donate to their higher rate of diabetes.
The danger of developing NIDDM is absolutely related with fasting levels of circulating insulin. It has been revealed that insulin resistance, typified by hyperinsulinemia, can predate the development of NIDDM for years. besides diabetes, insulin resistance causes numerous interrelated disorders together with hypertension, body fat mass and distribution, as well as serum lipid abnormalities (Ferrannini , Haffner, Mitchell & Stern, 1991). This has encouraged speculation that hyperinsulinemia and/or insulin resistance may be the phenotypic expression of the “thrifty genotype” anticipated by Neel (1962).
Impaired Glucose Tolerance (IGT) and Gestational Diabetes
Impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) are 2 types of glucose intolerance that are strong risk factors for developing NIDDM and IDDM. Gestational diabetes denotes the development of diabetes during pregnancy and a subsequent return to normal tolerance following parturition, whereas IGT is the class of glucose tolerance where fasting glucose values are between normal and diabetic. (O’Sullivan & Mahan, 1968).
The risk of developing obvious diabetes among individuals with IGT is associated to the severity of impaired tolerance plus presence of further risk factors, together with a positive family history of diabetes and obesity (Harris, 1989). Numerous risk factors for GDM have been recognized among African-American women, including age, gravidity, hypertension, obesity, plus family history of diabetes (Roseman et al., 1991).
At present, diabetes mellitus is the 3rd most recurrent cause of death from disease among African Americans. Higher rates of diabetes mortality in African Americans compared to the White population may partly be because of their higher occurrence of diabetes. When mortality among individuals who have developed diabetes is measured, though, it emerges that African Americans have a lower mortality rate than Whites with the disease (Harris, 1990). In recent years, there has been a leveling off in the rate of mortality from diabetes for both races.
Chronic diabetes mellitus is related with numerous overwhelming complications that reduce the quality of life and cause early mortality. These comprise hypertension, diabetic retinopathy, neuropathy, nephropathy, as well as macrovascular complications.
In the United States, African Americans with diabetes have higher rates of hypertension than Whites. The constancy of high rates of hypertension among African Americans and Afro-Caribbean populations (Grell, 1983) has caused the proposition that Western Hemisphere Blacks are offspring of a highly selected group of Africans who were efficient at retaining salt, which permitted them to uphold sodium homeostasis and survive the long sea voyages from Africa (Grim, 1988). Recent proof proposes that high rates of hypertension among African Americans might be associated to hyperinsulinemia plus abnormal renal sodium transport (Douglas, 1990).
Information on the incidence and impact of other diabetes-associated complications are limited. Though, retinopathy, neuropathy, and stroke emerge to be more recurrent in African Americans than Whites with diabetes (Roseman, 1985). The rate of lower limit amputations ensuing from diabetes has been reported to be considerably greater among U.S. Blacks than Whites.
Occurrence rates of diabetic end-stage renal disease (ESRD) have been revealed to be greater for African Americans than for Whites. After developing ESRD though, U.S. Blacks emerge to survive longer than Whites. There is as well some implication that certain cardiovascular complications including angina and heart attack may take place less often among African Americans than among Whites with diabetes (Harris, 1990).
It has been recommended that the on the whole higher rates of diabetes complications among African Americans might be associated to poorer metabolic control. Additionally, the high rate of hypertension among African Americans with diabetes may make worse or make haste the start of other complications for example retinopathy and nephropathy. Other significant risk factors for diabetes complications comprise age of onset, education, cigarette smoking, socioeconomic status, plus access to medical care (Roseman, 1985).
Prevention and Intervention Strategies
The main metabolic defect of type 2 diabetes is insulin resistance in association with a relative and progressive deficiency in insulin secretion. This insulin resistance, present in many tissues, makes its primary contribution to hyperglycemia by reducing peripheral glucose uptake in muscle and failing to suppress hepatic glucose output.
Additionally, resistance in adipose tissue to insulin-mediated suppression of lipolysis results in an elevation of free fatty acids (FFAs) and a further aggravation of hyper-glycemia. The degree of insulin resistance observed in diabetic subjects may vary according to a subject’s ethnic background, body mass index (BMI), and physical activity. Pharmacologic intervention with either metformin, a biguanide, or a thiazolidinedione (TZD) has been successful in reducing insulin resistance in subjects with type 2 diabetes.
In the management of the majority forms of diabetes, there is a need to be concerned concerning the acute complications of hypoglycemia and ketoacidosis and/or development of acute hyperosmolar crises. Hypoglycemia, a major treatment concern in type 1 diabetes, is much less frequent with type 2 diabetes and is discussed later in association with specific therapies. Although DKA and hyperosmolar crises have been reported in children with type 2 diabetes, they are uncommon, in our experience after initial presentation, but such crises have been reported. About 10-15% of children and adolescents with type 2 diabetes present at diagnosis with DKA, hyperosmolar crisis, or a combination of these states.
The long-term goals in the management of type 2 diabetes are twofold: first, the prevention of microvascular complications, including retinopathy, nephropathy, and neuropathy; secondly, the prevention of macrovascular complications such as atherosclerosis of the coronary, cerebral, and large arteries of the lower extremities. These lead to myocardial infarction, stroke, and amputation, and are the major causes of morbidity and mortality with type 2 diabetes. The development of these complications is multifactorial, but is influenced by associated hypertension, dyslipidemia, and hyperinsulinemia in addition to the effects of hyperglycemia.
The aim of therapy in type 2 diabetes is to specifically target the underlying metabolic defects of this disorder, which are obesity, abnormal insulin secretory function, and the insulin resistance present in the three primary insulin responsive tissues – skeletal muscle, fat, and liver. The first approach is to reduce obesity through lifestyle interventions in diet and exercise. In addition, the introduction of an α-glucosidase inhibitor may be considered to delay carbohydrate digestion and absorption, reducing peak postprandial hyperglycemia.
A second therapeutic approach is to address insulin secretory dysfunction with insulin secretagogues such as sulfonylureas or meglitinides. Alternatively, or if these secretagogues are ineffective, exogenous insulin can be initiated. A third approach is to address tissue-specific insulin resistance. Metformin can decrease hepatic glucose output and improve peripheral insulin sensitivity. Thiazolidinediones have been successful in improving peripheral insulin resistance in type 2 diabetes in adults; however, experience with these therapeutic agents is limited in children.
At present, diabetes mellitus remains a serious problem tackling the African Americans population. High diabetes mortality rates reflect merely part of the problem. The viewpoint of increasing diabetes occurrence rates casts a threatening shadow over the future for the African Americans community. The morbidity related with diabetic complications places a great financial burden on individuals and communities least able to bear the cost of such an illness. Evidently, the challenge of addressing the problem of diabetes mellitus in the African Americans population is great and will need a multidisciplinary approach involving government, researchers, educators, as well as members of the African Americans community.
Of main importance is the requirement for distribution of information regarding diabetes and its consequences into the African-American community. An uneducated African-American community may be inclined to undervalue the diabetes problem or to pay less attention to the signs and symptoms of its commencement. This may outcome in late diagnosis or care, thus raising the probability of rapid start of complications.
Consequently, ethnically sensitive strategies intended to get involved and educate African Americans on the subject of the behavioral and environmental risk factors for diabetes plus its complications are necessary. Undoubtedly, in order for African Americans to take steps to lessen the diabetes linked morbidity and mortality in their communities they have to have the capability to make informed decisions regarding the disease.
Cooperative Efforts for Provision of Health Services
Rates of diabetes mortality and complications may depend on the accessibility and permanence of care. There is some sign that African Americans with diabetes may be underserved regarding medical care (Harris, 1990). Cautious study of this problem is needed, and innovative solutions have to be developed. The African-American community must as well become empowered to expect and demand the essential care they deserve.
To have an effect on such change, community based institutions, for instance the church, can build up programs for using the health professionals within their congregations to offer care or therapy to diabetics and their families. Organizations concerned with minorities, for instance the UrbanLeague, can comprise diabetes and further health problems in their national agendas to generate concern and act at the community and national levels.
Governmental agencies and institutions engaged in training health professionals, for example medical schools and schools of public health, must institute action to augment the pool of African Americans in the professions concerned with the care of individuals with diabetes. Federal agencies, for instance the National Institutes of Health, may as well offer special grant programs to hearten submission of research grants to study diabetes in African Americans and to improve the growth of minority researchers in the area.
The inadequate data presently accessible on diabetes among African Americans raise numerous questions however deliver few answers regarding the etiology and natural history of diabetes plus its complications in this racial group. Up to now, a small number of studies of diabetes in the United States have included representative samples of African Americans. This inadequacy has to be addressed if future studies are to give way valid conclusions concerning the factors accountable for the incidence of the disease in the African-American population. In the Report of the Secretary’s Task Force on Black and Minority Health (1985), numerous research priority areas for addressing the health disparity between Black and White Americans were recognized.
These areas are mainly pertinent to diabetes mellitus and comprise the following: (1) investigation into risk-factor recognition, (2) investigation into risk-factor occurrence, (3) investigate into health education intrusions, (4) investigation into prevention services interventions, (5) investigation into treatment services, as well as (6) investigation into sociocultural factors and health outcomes. The recognition of these target areas for investigation and other recent efforts by the Department of Health and Human Services to endorse the study of diabetes in the African-American population (Sullivan, 1990) are significant steps toward addressing the gap in awareness of how diabetes have an effect on African Americans. In the future we have to translate the knowledge achieved from new and continuing studies into efficient preventive action.
Bailey, Eric (2000). Medical Anthropology and Africans American Health. Westport, CT: Bergin & Garvey.
Centers for Disease Control (CDC). (1990). Diabetes surveillance: Annual 1990 report. U.S. Department of Health and Human Services, Centers for Disease Control, Division of Diabetes Translation, Atlanta GA
Colle E., Siemiatycki J., West R., Belmonte M. M., Crepeau M. P., Poirier R., & Wilkins J. (1984). “Incidence of juvenile onset diabetes in Montreal–demonstration of ethnic differences and socioeconomic class differences”. Journal of Chronic Disease, 34, 611-616.
Dahlquist G., Blom L., Holgren G., Hogglof B., Larsson Y., Sterky G., & Wall S . (1985). “The epidemiology of diabetes in Swedish children 0-14 years: A six year prospective study”. Diabetologia, 28, 802-808.
Douglas J. G. (1990). “Hypertension and diabetes in blacks”. Diabetes Care, 13 (Supp. 4), 1191-1195.
Ferrannini E., Haffner S. M., Mitchell B. D., & Stern M. P. (1991). “Hyperinsulinemia: The key feature of a cardiovascular and metabolic syndrome”. Diabetologia, 34, 416-422.
Fitzgerald, James, R. Anderson, M. Funnell, M. Arnold, W. Davis, L. Aman, S. Jacober, and Grunberger (1997). “Differences in the Impact of Dietary Restrictions on Africans and Caucasians with NIDDM.” The Diabetes Educator 23: 41-47.
Grim C. E. (1988). “On slavery, salt and the greater prevalence of hypertension in black Americans”. Clinical Research, 36, 426A.
Harris M. I. (1990). “Noninsulin-dependent diabetes mellitus in black and white Americans”. Diabetes Metabolism Review, 6, 71-90.
Herman, William, T. Thompson, W. Visscher, R. Aubert, M. Engelgau, L. Liburd, D. Watson, and T. Hartwell (1998). “Diabetes Mellitus and Its Complement in an Africans American Community: Project DIRECT.” Journal of National Medical Association 90: 147-156.
Kumanyika S. (1988). “Obesity in black women”. Epidemiology Review, 9, 31-50.
Lipman T. H. (1991). The epidemiology of Type I diabetes in children 0-14 years of age in Philadelphia. Doctoral dissertation, University of Pennsylvania, Pennsylvania.
Report of the Secretary’s Task Force on Black and Minority Health. ( 1985). Volume 1: Executive Summary. DHHS Publication No. 017-090-00078. Washington, DC: Government Printing Office.
Maillet, Nancy, G. Melkus, and G. Spollett (1996). “Using Focus Groups to Characterize the Health Beliefs and Practices of Black Women with Non-Insulin Dependent Diabetes.” The Diabetes Educator 22: 39-46.
Marble A. (1949). “Diabetes mellitus in the U.S. Army in World War II”. The Military Surgeon, 105, 357-363.
National Diabetes Data Group (NDDG). (1979). “Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance”. Diabetes, 26, 1039-1057.
Neel J. V. (1962). “Diabetes mellitus–A thrifty genotype rendered detrimental by progress?” American Journal of Human Genetics, 14, 353-362.
O’Sullivan J. B., & Mahan C. M. (1968). “Prospective study of 352 young patients with chemical diabetes”. New England Journal of Medicine, 278, 1038-1041.
Professional Guide to Diseases (1998). Springhouse, PA: Springhouse.
Reitnauer P. J., Go R. C. P., Acton R. T., Murphy C. C., Budowle B., Barger B. O. , & Roseman J. M. ( 1982). “Evidence of genetic admixture as a determinant in the occurrence of insulin-dependent diabetes mellitus”. Diabetes, 31, 532-537.
Roseman J. M., Go R. C. P., Perkins L. L., Barger B. D., Beel D. A., Goldenberg R. L. , DuBard M. B., Huddlestone J. F., Sedacek C. M., & Acton R. T. ( 1991). “Gestational diabetes among Africans American women”. Diabetes and Metabolism Review, 7, 93-104.
Sullivan L. (1990). Opening remarks. Diabetes Care, 13 (Supp. 4), 1143.
Taylor R., Ram P., Zimmet P., Raper R., & Ringrose H. ( 1984). “Physical activity and the prevalence of diabetes in Melanesian and Indian men in Fiji”. Diabetologia, 27, 578-582.
Tull E. S., LaPorte R. E., Vergona R. E., Gower I., & Makame M. H. ( 1992). “A two-fold excess mortality among Africans American IDDM cases compared withWhites: The Diabetes Epidemiology Research International experience”
Van T. B. Itallie (1985). “Health implications of overweight and obesity in the United States”. Annals of Internal Medicine, 103, 983-988.
Veal, Yvonnecris (1996). “Africans Americans and Diabetes: Reasons, Rationale, and Research.” Journal of the National Medical Association 88: 203-204.
WHO Multinational Project for Childhood Diabetes. (1991). “Familial insulin-dependent diabetes mellitus (IDDM) epidemiology: Standardization of data for the DIAMOND Project”. World Health Organization Bulletin OMS, 69, 767-777.
Winter W. E., Maclaren N. K., Riley W. J., Clarke D. W., Kappy S., & Spillar R. P . (1987). “Maturity-onset diabetes of youth in black Americans”. New England Journal of Medicine, 316, 285-291.
World Health Organization. (1980). “Report of expert committee on diabetes mellitus”. Technical Report, Series no. 646. Geneva: World Health Organization.