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Keywords: U.S. Department of Health and Human Services, American, Black, Latino, American Indian, diabetes, heart disease, stroke, type 2 diabetes, Mexican Americans

Diabetes affects 8 percent of the population, according to the U.S. Department of Health and Human Services. Of that, an alarming 90 to 95 percent have type 2 diabetes, and Blacks, Latinos and American Indians are more likely to get it and are more likely to suffer serious complications than whites.

So what is type 2 diabetes?

"Type 2 diabetes is a condition where the body is unable to use the insulin to metabolize or to use glucose [blood sugar] for energy," says Dr. Astrid T. Almodovar, assistant clinical professor of family medicine at the University of Medicine and Dentistry of New Jersey (UMDNJ). "Minority populations are disproportionately affected not only by higher rates of diabetes but also higher rates of diabetes complications, later diagnosis and poorer control."

In fact, Blacks are two times as likely to have type 2 diabetes as whites, with Black women especially at risk. Latinos are 1.5 times as likely as whites to have it, and the rate for Mexican Americans is almost twice that. An astonishing 26.7 percent of American Indians in the southeastern region of the United States suffer from type 2 diabetes.

"Even when studies have shown that people have access to the same information, they have worse outcomes," says Almodovar.

These disparities stem from cultural barriers such as lack of healthcare, limited English proficiency and lack of trust in the healthcare system.

"There's a big lack of trust," says Almodovar. "'They don't care about me. They're only here to harm me. They're in cahoots with the pharmaceuticals or they just want to give us drugs.' Anything that the hairdresser or the bodega owner or the neighbor tells them that is not in concordance with what the doctor said, unfortunately, they will prefer to listen to the layperson. The information is usually wrong--it's usually extremely alarmist and usually goes to the detriment of the outcome of the patient."

A public-health nurse who served low-income communities of traditionally underrepresented groups wrote in to DiversityInc to talk about health issues in these communities. Based on her experience, she believes that many Black patients resort to self care because of an inability to afford health insurance and that they distrust the medical system because of culturally incompetent physicians.

Almodovar says understanding the culture and habits of the patient and being able to work with them in a way that takes their culture into account are key in motivating a patient to control diabetes. "When you're talking about diabetes, you're talking about lifestyle, diet, exercise, frequent monitoring of your blood sugar, behavior changes that you must make today and not see any results until the future, if at all," states Almodovar. "The treatment or the approach to diabetes care is very complicated and it's multi-factorial. And certainly, 'one-size-fits-all' is not a good way to approach diabetes care."

It is also important to understand the various risk factors that make you more likely to get type 2 diabetes.

"Being overweight, especially the overweight that's in the waist--having a waist of over 35 inches for a woman, 40 inches for a man--is a marker, a flag for diabetes," says Almodovar. "Another one is having had a diagnosis of high blood pressure. The fact that you have high blood pressure puts you at a higher risk of diabetes."

There's also a genetic component, especially among Latinos, Blacks and American Indians. "If you have a father, a mother, a brother or sister with diabetes, that increases the risk, [but] I tell all my patients who are African American, Latino [or American Indian] that they already have a risk factor for being a diabetic because of our ethnic background," says Almodovar. "The environment makes that genetic predisposition so much worse and then diabetes comes to surface."

While heart disease and stroke account for about 65 percent of deaths in people with diabetes, there are several other complications associated with this disease. Left untreated, diabetes can lead to blindness, kidney disease, nervous-system disease, amputations, dental disease, sexual dysfunction and complications during pregnancy, among other things. And while there are symptoms of type 2 diabetes that you should be aware of, many people who have it experience no symptoms in the earlier stages.

"The classic symptoms of diabetes are a lot of thirst, a lot of hunger, and a lot of going to the bathroom. What happens is you have high levels of glucose in your body, so you're constantly thirsty, you're dehydrated and you're losing all the sugar in the urine, so that's why you're going to the bathroom a lot," Almodovar says. "[Other symptoms include] in women, vaginal infections that don't get better, any cut that doesn't heal, fatigue, blurry vision. The sad story is that a lot of people live with these symptoms for years and don't realize that they're ill. Most important is that, a lot of the time, we have no symptoms."

So if you have no symptoms, how do you know to even be concerned? Here is where communication comes into play between you and your doctor. You have to know the right questions to ask, the correct information to get and the right ways to follow up on that information.

"Open communication is critical, both ways, from the patient to the doctor and from the doctor to the patient," Almodovar stresses. "It's important for patients to ask what their ABCs are. A1c, blood pressure and cholesterol."

The hemoglobin A1c test is particularly important because it measures how effectively your blood sugar is being controlled over time. Knowing about tests like this indicates to the doctor that you have done your own research and are taking your health seriously.

"Ask the doctor, 'What's my hemoglobin A1c?' All of a sudden, a doctor who thinks you're stupid says 'This person knows what they're talking about,'" advises Almodovar. "You need to step up your game to someone who's a little more educated and knows what the goals should be: less than 7, preferably less then 6.5 [for A1c]. B for blood pressure, 'What's my blood pressure, doctor, and what should it be and what are we going to do about it?' C for cholesterol. Don't accept 'Your blood pressure's good. Your cholesterol is OK.' [Ask] 'What are the numbers? What should they be? What can I do to get them there, and when am I going to reevaluate this?'"

Almodovar says it's smart to take it a step further than the physician's office by asking for a referral to a certified diabetes educator who can be specific in terms of nutrition management and self care. Spending as little as 30 minutes of exercise most days of the week, along with a healthy diet low in fats and sugars, can mean a world of difference. By losing just 10 percent of your body weight, you can significantly reduce your risk of diabetes.

Almodovar also recommends making the task of cultivating a healthier lifestyle a family affair. Until recently, type 2 diabetes was almost exclusively an adult disease. Now it is being more frequently diagnosed among children and adolescents, particularly among Blacks, Latinos and American Indians.

"You cannot change your sex, you cannot change your age, you cannot change your ethnic background, but you can change your physical activity, you can change your waist circumference, you can lose weight," concludes Almodovar. "Definitely [diabetes] can be prevented, but it takes a little work. It's a lifelong effort. But it's going to be the difference between having a healthy, long life or being disabled very, very early."

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