Introduction
Today an alarming number of Americans indeed suffer from type 2 diabetes: the amount has reached epidemic levels, with more than 30 million diagnosed cases and about 88 million others at risk. The great majority of groups which are ethnic minorities, like African Americans, Hispanic Americans, Native Americans, and a part of Asian inhabitants (and Pacific, American, and Oceania population), demonstrate a great risk of developing type 2 diabetes and coping with its complications more often than non-Hispanic people. As such, African Americans are approximately 50% more likely than Hispanic whites to encounter diabetes. On top of that, diabetes is common among small ethnic groups and they are exposed to more severe illnesses at younger ages including kidney failure, blindness, amputations, and early death. The original topic is the substantial diabetes load that is getting added to the existing burden of diabetes that racial and ethnic minorities are facing; however, treatment of this could become a primary public health goal if careful consideration of cultural sensitivities is put into play through preventive, early detection, management and equitable access to treatment mechanisms.
My study, which aims to fully comprehend factors that are biological, behavioral, social, cultural, and make out health care systems, is one of the main reasons for the increased diabetes type 2 cases among the non-Hispanic minority communities in comparison to the whites. Accordingly, stakeholders will be educated with evidence-based (evidence-informed) and culturally appropriate interventions which in turn will help to bring down the diabetes burden, and therefore health equality will be improved among the diverse populations.
Background and Significance
Type 2 diabetes is a condition that is characterized by the body’s inefficient utilization of insulin, which inevitably leads to exaggerated levels of glucose in the blood. Therefore, it is a result of this equation: resistance to insulin effects, insufficient insulin secretion by pancreatic endocrine cells, and inadequate beta cell insulin secretion. After an uncontrolled period of high blood sugar over time the tissue cells of the body can be damaged irreversibly thus leading to several disabling and life-terminating complications such as heart diseases, stroke, kidney diseases, neuropathy, blindness, and amputations of lower limbs.
While type 2 diabetes prevalence has increased across all racial and ethnic groups over the past few decades, minority populations not only have significantly higher rates of type 2 diabetes compared to whites but also suffer worse health outcomes. According to Centers for Disease Control (CDC) statistics from 2018, the age-adjusted prevalence of diagnosed diabetes was 16.1% among American Indians/Alaska Natives, 12.5% among Hispanics, 11.7% among non-Hispanic blacks, 9.2% among Asian Americans, and 7.5% among non-Hispanic whites. Obesity is considered a major risk factor for developing insulin resistance and type 2 diabetes, which may underlie a portion of these disparities as obesity disproportionally impacts minority groups. However, differences in diabetes rates persist even when controlling for body mass index, indicating additional contributing factors to increased diabetes risk among these populations.
Furthermore, diabetes represents a leading cause of cardiovascular events, end-stage renal disease requiring dialysis, lower extremity amputations, and preventable blindness among African Americans, Hispanics, Native Americans, and certain Asian American subgroups like Pacific Islanders in the United States. Compared to non-Hispanic whites with diabetes, racial and ethnic minorities experience 2 to 6 times higher rates of these devastating diabetes-related complications, resulting in disability and early mortality. Closing both the diabetes diagnostic and treatment gap through culturally competent interventions represents a significant opportunity to advance health equality.
Biological and Genetic Factors
Type 2 diabetes has a heritable component, with family history representing a significant and common risk factor. Certain racial and ethnic minority groups have higher underlying genetic susceptibility due to the natural selection of “thrifty genes” that maximize calorie storage in environments with unstable food supplies. Some ancestry-specific genetic variants have been linked to both insulin resistance and impaired insulin secretion or beta cell function. For example, risk alleles in the TCF7L2 gene increase African American susceptibility to type 2 diabetes by nearly 20%. East Asians carry risk variants in genes such as KCNQ1 and UBE2E2 that are infrequent in Europeans. Studies indicate that Native American ancestry itself confers inherently higher diabetes genetic risk independent of socioeconomic status and lifestyle factors.
While genetics contribute to population differences in diabetes risk, genetics alone does not fully account for significant disparities in diabetes rates and outcomes between minority groups and whites living in the same country under similar environmental conditions. After adjusting for body mass index, differences in genetic risk factors were estimated to collectively explain less than 10% of the excess prevalence of type 2 diabetes in minority populations compared to European ancestry groups. This indicates environmental, socioeconomic, cultural, and healthcare system factors likely play a more substantial role in diabetes inequalities than genetics.
Behavioral and Socioeconomic Factors
The rapid increase in U.S. diabetes rates over the past 30 years cannot be explained by genetics alone as the gene pool shifts quite slowly over generations. Thus behavioral and environmental components are implicated. Research consistently shows that regular physical activity, healthy dietary patterns such as plant-based diets, and weight management can prevent or delay the onset of type 2 diabetes among high-risk individuals. However, adopting and maintaining positive lifestyle changes depends heavily on the surrounding social, physical, and economic environment.
Minority groups in the U.S. face more barriers to health-promoting behaviors that increase diabetes risks, including food insecurity, unstable housing, unsafe neighborhoods restricting outdoor activity, elevated psychological stress, targeted advertising of unhealthy products, and fewer community recreational resources. Hispanic, non-Hispanic black, and American Indian/Alaska Native adults all have substantially higher age-adjusted rates of obesity compared to non-Hispanic whites, ranging from 15-50% higher obesity prevalence depending on gender and ethnicity. While individual factors certainly play a role, these striking population-level disparities indicate unmet needs and inadequate support for healthy lifestyles in marginalized communities.
Studies have revealed that low family income and education level are the causes of higher deaths due to type 2 diabetes when they are considered as obesity and other risk factors. [People] Of the sort ethnic belonging to poor and have less educational background, such individuals are less capable of obtaining nutrition information and accessing prevention resources. In addition, an altered glycemic control in neighborhood poverty, even after considering some individual-level socioeconomic status characteristics, has been reported. These educators normally find social factors always play a leading role in late diagnosis and diabetes self-management.
Cultural Beliefs, Behaviors, and Structural Racism
Native traditions, ideas, and ways of life put more diabetes risk and outcomes among minority populations through families and communities too. For instance, the traditions of some of the Hispanic subgroups such as heavy emphasis on food as the central element of social activities are strong. Abandoning the plate after the host serves you a high-carb or high-fat dish would mean that you are denying the host at the same time. Additionally, pow wows and feasts in Native American customs would centric around the foods that are rich in calories. This compliance with dietary recommendations for diabetes patients requires cultural competency practices on the side of practitioners about culture-specific food traditions which serve as the core of cultural identity and values. Moreover, the ideas of healthy body image and the correct weight vary depending on culture. Therefore, they affect motivation for different types of changes. The various body shapes that may have higher BMI can be socially considered influential or even desirable among the Black communities. Researchers’ recommendations include creating interventions based on ideals of beauty or aging for elderly women and reframing weight loss conversations around health as opposed to the aesthetics of the body.
Although discrimination is no longer a part of the activities of the healthcare system, history, and the past continue to have an impact on minority engagement and access to vital systems. The fact that most African Americans remain skeptical toward health public endeavors and drug research inventions due to the Tuskegee experiments is another underlying cause for the inequality in healthcare among women of all types of races. Hispanic immigrants without papers are reticent to obtain care due to fear of being deported or incapable of paying. It makes the conditions worsen as the disease continues to progress until the complications become overt. The sad practice of the federal government through Indian boarding schools was they were forced to leave their own culture to attend the schools. Historical oppression (intertwined with a pragmatic system of racism) sustains the healthcare quality gap as of now.
Proposed Interventions
Results integration across epidemiological, community-based participatory research and interview analysis will give us a blueprint for crafting intervention strategies that would be tripartite institutional, behavioral, and educational for each minority group to halt diabetic disparities. Potential comprehensive intervention components may include: Potential comprehensive intervention components may include:
– Adopting culturally adapted diabetic nutrition, fitness, and self-management programs by incorporating traditional foods, dance styles, and community outreach and teaching programs provides the chance.
– Community-born health staff such as linkage workers may be in the difficult terrain of medical mistrust and other cultural impossibilities towards the care provision through their awareness and support approach.
– System-level interventions such as; cultural competence training and interpreter service designed to enrich provider skills on how to deal with patients from diverse backgrounds.
– We shall conduct an extended diagnosis of diabetes amongst undiagnosed through the effort of community outreach at faith-based institutions and another community event.
– Policy revisions aiming for better healthcare access, coverage, and affordability by minority groups.
– Members of the media need to counter adversity which is caused by weight stigma and promote healthy images of the body that are consistent with common beauty ideals.
– Efforts at multiple levels ranging from health care infrastructure, public health, and non-traditional players in the community to building trust and response to community needs that put them at risk.
It is a community-based participatory research approach that has a fundamental function as a key enabler for us to push further our mission of helping individuals and families in poor-performing minority communities. We are going to use not only the short-term indicators but also the long-term health indicators for the temporal tracking, as well. This scientific research is approached from a multifaceted perspective ranging from cellular to structural aspects. Therefore, it is believed that it has real potential to fight against racial/ethnical inequalities in the diabetes epidemic among the U.S. population.
Conclusion
In conclusion, racial and ethnic minority groups in the United States disproportionately bear the burden of type 2 diabetes, suffering from higher prevalence rates, earlier age of onset, worse complications, and increased disability and mortality compared to non-Hispanic whites. While genetics play a role, structural racism and social determinants including poverty, education gaps, neighborhood disadvantage, and inadequate access to affordable healthy lifestyles perpetuate the majority of these marked disparities. Cultural attitudes, behaviors, and distrust stemming from past discrimination also negatively impact engagement in preventative care and self-management.
This research proposal outlines an approach combining big data analytics, community-based participatory research, and in-depth interview techniques to thoroughly investigate the causes of diabetes health inequalities across high-risk minority populations. The findings will inform multi-level intervention development targeting gaps and inequities uncovered across individual, provider, organization, community, and policy domains. Only by addressing all contributing factors across this full socioecological framework can we achieve diabetes health equity and eliminate disparities experienced by marginalized groups. This research has the potential to close both the diabetes diagnosis and treatment gap while empowering communities to support positive lifestyle changes. Our goal is equitable opportunity for minority populations to achieve full health potential, including the prospect of living long and healthy lives unburdened by preventable diabetes complications.
References
CDC. (2020). National Diabetes Statistics Report, 2017 Estimates of Diabetes and Its Burden in the United States Background. In CDC. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Centers for Disease Control and Prevention. (2023). By the numbers: Diabetes in America. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html
Khan, M. A., Hashim, M. J., King, J., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends. Journal of Epidemiology and Global Health, 10(1), 107–111. https://doi.org/10.2991/jegh.k.191028.001
O’Connell, J. M., & Manson, S. M. (2019). Understanding the Economic Costs of Diabetes and Prediabetes and What We May Learn About Reducing the Health and Economic Burden of These Conditions. Diabetes Care, 42(9), 1609–1611. https://doi.org/10.2337/dci19-0017
Zawudie, A. B., Daka, D. W., Teshome, D., & Ergiba, M. S. (2022). Economic Burden of Diabetic Mellitus Among Patients on Follow-up Care in Hospitals of Southwest Shewa Zone, Central Ethiopia. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08819-0
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