Diabetes - Practice Your ABCs

By Terry Mahotière, MD, MPH

Diabetes is not an equal opportunity disease. If you are African American you are more likely to get it. And if you are black, live in New York City and are a senior, you are also less likely to receive some important tests to protect your health against the effects of this serious illness.

However, there are actions you can take to protect yourself. Find out if you are at risk for diabetes and its complications, and partner with your doctor to practice the ABCs of good diabetes care.

African Americans at Risk

The statistics on the impact of diabetes on the African-American community are startling. Nearly 3 million -- or 13% -- of all African Americans have diabetes, compared to 6% of the total population. One in four African Americans between 65 and 74 have the disease. Black women have a 40% higher death rate, and black men with diabetes have a 20% higher death rate, than their white counterparts.

African Americans are also at an increased risk for heart disease and stroke, and uncontrolled diabetes raises that risk even more. They are more at risk for developing disabilities from diabetes-related complications, and more than twice as likely to get lower limb amputations. In addition, African Americans with diabetes are far more likely to suffer from end-stage renal (kidney) disease and from diabetic eye disease.

There are also disparities in testing people with diabetes. Data recently released by IPRO, an independent organization that evaluates the quality of health care services, show that New York African American Medicare beneficiaries who have diabetes are less likely to be given tests for blood fats such as cholesterol. Some neighborhoods in Brooklyn, such as Coney Island and Sheepshead Bay, have disparities between blacks and whites as high as 22%.

Why are African Americans at greater risk? Experts think three factors play a decisive role: genetics, lifestyle and access to care. We may not be able to control our genes, but we stand a chance of doing something about lifestyle and access to diabetes care.

But first we must educate ourselves about diabetes.

What is Diabetes?

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that converts sugars, starches, and other food groups into energy. Many people refer to diabetes as "having sugar."

There are three major types of diabetes:

Type 1 diabetes, which results from the body's failure to produce insulin. Some 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes, which used to be known as "juvenile diabetes."
Type 2 diabetes, which results from a condition in which the body fails to properly use insulin, combined with relative insulin deficiency. The vast majority, 90-95% of Americans diagnosed with diabetes, have type 2. This type used to be known as "adult-onset diabetes."
Gestational diabetes, which affects about 4% of all pregnant women, about 135,000 women in the U.S. each year.

The cause of diabetes is still a medical mystery. Heredity and lifestyle factors, including obesity and lack of exercise, appear to contribute to getting the disease.

Know the Warning Signs

Diabetes often goes undiagnosed because many of its symptoms are considered harmless. Some symptoms include frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability and blurry vision.

Early detection of diabetes symptoms and treatment can decrease the chance of developing major health complications. And maintaining a healthy lifestyle can help a person keep diabetes in check, and reduce risk of major health problems by as much as 50%. Good nutrition, exercise, weight control and stress reduction go a long way toward protecting against the ravages of this disease.

Know Your Diabetes ABCs

If you have diabetes, you can reduce your risk of health complications by practicing the ABCs of good diabetes care. Talk with your doctor to make sure you get these tests.

A - for A1c: Get the A1c blood test at least twice a year, so you can control blood sugar (glucose) levels. For every 1% drop in A1c, the risk for developing complications in the small blood arteries (microvascular disease) decreases by 35%.
B - for blood pressure: Have your blood pressure checked at each doctor visit. Your blood pressure should be below 130/80. Blood pressure control can reduce heart disease and stroke by up to half and can reduce microvascular disease by more than a third.
C - for cholesterol: Have your cholesterol checked at least every year. Improved control of cholesterol and other blood fats (lipids) can reduce heart complications by 20-50%. Ideally, your Low Density Lipoprotein (LDL) should be below 100.

Also, make sure you get a comprehensive (dilated) eye exam, foot exam and flu shot every year. And don't smoke.

Now is the time to get checked for diabetes or keep your diabetes in check. Even minor steps can have a major impact on your health.

For more information on diabetes, contact the American Diabetes Association at 1-800-DIABETES (1-800-342-2383), or on the Web at http://www.diabetes.org

For information about Medicare coverage for diabetes services and equipment call 1-800-633-4227.

Terry Mahotière, MD, MPH, is Medical Officer at IPRO, an independent health care quality improvement organization based in Lake Success, New York. For more information about the Diabetes Disparities Project visit providers.ipro.org