Type 2 diabetes—a chronic condition that affects the way the body processes blood sugar (glucose)—is one of the leading causes of heart disease in Black communities.¹

Black people are disproportionately impacted by diabetes and as a result, have an increased risk of heart disease. In addition, Black people living with diabetes experience more severe medical complications and death compared to the next highest risk group, non-Hispanic White Americans.²

Differences in genetics, high rates of obesity, insulin resistance, and living in an underserved neighborhood are just some of the factors contributing to this disparity.

This article will review diabetes as a risk factor for heart disease and how finding care and using an integrative treatment approach can lower your diabetes risk. 

Facts About Race and Diabetes

According to the Department of Health and Human Services' Office of Minority Health, 13.4% of Black men and 12.7% of Black women over the age of 18 are diagnosed with diabetes.³

Black people get diabetes at a 60% higher rate than White people.³

Diabetes is a condition that usually shows few, if any, symptoms early on.³ Therefore, these figures are likely an underestimation, and more Black people may be living with diabetes before it is diagnosed.

Why Diabetes Is a Risk Factor for Heart Disease 

Diabetes and heart disease are two independent medical conditions with many connection points.

The Connection Between Diabetes and Heart Disease

Having one of these conditions puts you at higher risk for the other.⁴

If you or a loved one has diabetes, good heart health is just as important as blood sugar management. 

Chronically high blood glucose levels over time can damage the blood vessels and nerves that control the heart, leading to heart disease.

While the role of your genes in this process is largely unknown, behavioral factors can accelerate this process, including:

• Unhealthy eating
• Lack of exercise
• Smoking

Underlying Cause of Diabetes Disparities

Type 2 diabetes affects Black communities more than other groups.⁵

Differences in health status, access to health care, and income are largely the main drivers of these health disparities.

Social and economic barriers make accessing care more difficult for many Black people.

High healthcare costs coupled with lower insurance rates mean that many Black people cannot afford quality medical care and prescription medications, so conditions such as diabetes are not managed as well as they could be and subsequently result in poorer outcomes.

Why Racism Is a Risk Factor

Systemic racism is the root of the widening racial wealth gap and predatory junk food marketing that is experienced by teens and people of color in the United States.⁶

These practices make it nearly impossible for those who are most vulnerable to make the changes they need to change or improve their health.

Other Risk Factors 

You are more likely to develop type 2 diabetes if you:⁷

• Are age 45 or older
• Have a family history of diabetes
• Have high blood pressure
• Have a low level of HDL cholesterol or a high level of triglycerides
• Have a history of gestational diabetes or gave birth to a baby weighing 9 pounds or more
• Low physical activity
• Have depression
• Have polycystic ovary syndrome (PCOS)
• Have acanthosis nigricans (dark, thick, and velvety skin around your neck or armpits)
• Have a history of heart disease or stroke

Finding Care

Your healthcare team is an incredibly important part of your diabetes management.

Lack of Black Healthcare Providers

As of 2018, 5.4% of physicians identified as Black despite Black Americans making up 13.4% of the U.S. population.⁸

Many Black people report that they are more likely to feel comfortable with Black healthcare providers and more likely to follow preventive measures delivered by Black healthcare providers.⁹

Finding a Black Healthcare Provider

If you are trying to find a Black healthcare provider, websites like Blackdoctor.org and FindABlackDoctor.com have created search engines that can help.

Questions to Ask

Choosing the right healthcare provider isn’t easy. It requires you to ask yourself and the office staff many important self-reflective and open-ended questions to ensure that they are right for you. 

Some introspective questions you might ask yourself include:

• How far am I willing to travel to see my healthcare provider?
• How important is it that my healthcare provider looks like me?
• Will a healthcare provider who does not look like me but provides culturally competent care suffice?
• How does this healthcare provider fit into my schedule? Do they have after-hours services?
• What kind of primary care healthcare provider am I looking for?
• I really like this healthcare provider, but they do not take my insurance. Am I willing to pay out of pocket?

Some questions you may want to ask your healthcare provider directly include:

• Have you worked with Black patients before? 
• What does culturally competent care mean to you? How do you ensure that your care is culturally competent?
• Do you provide genetic testing?
• How long is a typical appointment?

Here are some diabetes-specific questions you may want to ask:

• Is diabetes a “curable” disease? 
• A family member (mom, dad, sister, brother, grandparent, etc.) has diabetes. Does that mean I will get it too?
• Can I reverse diabetes with lifestyle modifications?
• I have diabetes, will I need to take insulin? If so, do I have to take it for the rest of my life?

You may also want to ask the staff and other people who have previously worked with your potential healthcare provider about their experience. While you cannot, and should not, base your decision solely on the opinion of others, sharing what you know can add perspective to this very important decision. 

An Integrative Treatment Approach

Treating diabetes may include a mix of lifestyle changes and medication.

Lifestyle 

Type 2 diabetes is largely thought of as a lifestyle disease. No matter your age, it’s never too early to start an anti-diabetes lifestyle that includes:¹⁰

• Losing excess weight: Losing weight can decrease insulin resistance, allowing the body to better utilize the hormone. Research has shown that losing a small amount of weight can lower your risk of type 2 diabetes. A small amount of weight loss means around 5% to 7% of your body weight or just 10 pounds (lbs) to 14 pounds for a 200-pound person.
• Boosting physical activity: Regular physical activity means getting at least 150 minutes a week of brisk walking or similar activity. Biking, running, swimming, and hiking are highly recommended activities. Most healthcare professionals suggest 30 minutes of moderate-intensity exercise—that means enough to break a sweat—five days a week.
• Eating healthily: An excess of refined, simple carbohydrates and a lack of fiber both contribute to obesity and may lead to a diagnosis of diabetes.

The American Diabetes Association recommends that most adults begin diabetes screening at the age of 45. The U.S. Preventive Services Task Force recommends screening for people 35 and up who are overweight or obese.¹¹

If you have prediabetes or early-stage type 2 diabetes, changing your diet may help you reverse course.

There are some diets, sometimes called “diabetic diets”—such as the Mediterranean and DASH diets—that have been proven to keep blood sugars within a healthy range.

These diets all encourage:

• High fiber intake
• Little or no added sugar
• Complex carbs
• Avoidance of foods high in trans and saturated fats

The goal is to provide you with the macronutrients you need while cutting the simple carbs that lead to spikes in blood sugar and LDL, or bad cholesterol, which puts you at higher risk of cardiovascular disease. 

Eating healthy also provides the added benefit of weight loss or healthy weight maintenance. Coupling a heart-healthy diet with routine exercise can lead to a precipitous drop in your heart disease risk. 

Medication

Daily insulin via injection or an insulin pump is the mainstay of treatment for type 1 diabetes.

Oral medications, such as metformin, that regulate blood sugar levels by changing the way the body makes or uses sugar, are much more common in type 2 diabetes.

Over time, a person with type 2 diabetes may need to add insulin to their treatment regimen if the combination of lifestyle modifications and oral medication does not control blood sugar levels. 

Resources

The following programs are tailored to Black communities at high risk for type 2 diabetes:

• The Center for Black Health and Equity
• Council on Black Health
• National Diabetes Education Program
• New Beginnings: A Discussion Guide for Living Well with Diabetes
• Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention
• Feeding America

Summary

Black people are disproportionately impacted by diabetes and as a result, heart disease. Differences in genetics, high rates of obesity, insulin resistance, and living in underserved neighborhoods are just some of the factors that contribute to this disparity. 

A Word From Verywell 

People who adopt healthy behaviors are less likely to develop type 2 diabetes, but anyone can develop the condition at some point in their life.

Fortunately, diabetes and its related complications often can be controlled with appropriate health care and patient self-management techniques. However, this isn’t always the case for Black people, especially those who live in underserved areas.

Even when socioeconomic status is equal, Black people often face barriers to quality care that hinder their ability to meet treatment goals, underscoring the need for systemic changes in society that address the inequities that hinder Black people from achieving their best health.

SOURCES

1. Osei K, Gaillard T. Disparities in cardiovascular disease and type 2 diabetes risk factors in blacks and whites: dissecting racial paradox of metabolic syndrome. Front Endocrinol. 2017;0. doi:10.3389/fendo.2017.00204
2. Haw JS, Shah M, Turbow S, Egeolu M, Umpierrez G. Diabetes complications in racial and ethnic minority populations in the USA. Curr Diab Rep. 2021;21(1):2. doi:10.1007/s11892-020-01369-x
3. Office of Minority Health. Diabetes and African Americans.
4. Leon BM, Maddox TM. Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World Journal of Diabetes. 2015;6(13):1246-1258. doi:10.4239/wjd.v6.i13.1246
5. Rodríguez JE, Campbell KM. Racial and ethnic disparities in prevalence and care of patients with type 2 diabetes. Clin Diabetes. 2017;35(1):66-70. doi:10.23372Fcd15-0048
6. Eaton TM, Kumanyika S, DiSantis KI, Yadeta K, Grier S. Black community conversations about opposing ethnically targeted marketing of unhealthy foods and beverages. J Racial and Ethnic Health Disparities. 2021. doi:10.1007/s40615-021-01133-1
7. National Institute of Diabetes and Digestive Kidney Disease. Type 2 diabetes.
8. Association of American Medical Colleges. Diversity in medicine: facts and figures 2019.
9. Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60-e76. doi:10.2105/AJPH.2015.302903
10. National Institute of Diabetes and Digestive Kidney Diseases. Symptoms & causes of diabetes.
11. US Preventive Services Task Force. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. JAMA. 2021;326(8):736–743. doi:10.1001/jama.2021.12531

Diabetes is a disease that happens when your blood glucose (blood sugar) is too high. According to the Centers for Disease Control and Prevention (CDC), more than 37 million Americans have diabetes, with most having type 2 diabetes.¹ Type 2 diabetes is most often diagnosed in adults. However, diagnoses in adolescents and children are increasing.

The CDC also reported that from 2018 to 2019, the rate of adults in the United States diagnosed with diabetes was highest among people belonging to certain ethnic and racial groups, including American Indians and Alaska Natives, non-Hispanic Blacks, people of Hispanic origin and non-Hispanic Asians.² These are also groups that experience high levels of systemic racism, which research links to increased likelihood of developing type 2 diabetes.³

This article explores how type 2 diabetes disproportionately affects these populations, risk factors and complications for type 2 diabetes, and how early screening and detection will help with the overall treatment of type 2 diabetes.

How common is type 2 diabetes in Black and Brown people?

In 2019, about 1 in 10 people of all ages in the United States had diabetes.⁴ Additionally, an estimated 96 million adults (about one in three) have prediabetes.⁵ Prediabetes is blood sugar that is higher than normal but not yet high enough to be diagnosed as diabetes.

Among adults in the United States, the rate of diagnosed diabetes in 2019 was 5.7 per 1,000 adults, which is just slightly lower than in 2000, which was 6.2 per 1,000 adults.⁶

However, among adolescents from 2002 to 2015, the rate of type 2 diabetes remained stable among non-Hispanic Whites but significantly increased for all other race/ethnic groups, particularly non-Hispanic Blacks.

It’s projected that by 2030 the prevalence of diabetes (type 1 and type 2) will increase by 54% to more than 54.9 million Americans.⁷

Type 2 diabetes by ethnicity

Research suggests that people of certain ethnicities are at higher risk of developing type 2 diabetes.⁸ Research links this increased risk to experiences of systemic racism.³ This increased risk is reflected in the rates of diagnosed diabetes in American adults, broken down by ethnicity: 

• American Indians and Alaska Natives: 14.5%
• Non-Hispanic Blacks: 12.1%
• Hispanic: 11.8%
• Non-Hispanic Asians: 9.5%
• Non-Hispanic Whites: 7.4%

Among adults of Hispanic origin, those with origins in Mexico and Puerto Rico had the highest prevalence at 14.4% and 12.4%, respectively. The prevalence in people with origins in Central or South America was 8.3%, and those with origins in Cuba had a 6.5% prevalence.

Among non-Hispanic Asians, those with origins in India and the Philippines had the highest prevalence at 12.6% and 10.4%, respectively, with a 5.6% prevalence in those with origins in China. There was a prevalence of 9.9% in other Asian groups combined.²

Causes of type 2 diabetes in Black and Brown people

Socioeconomic status and related modifiable risk factors directly contribute to the differences in the rate of diabetes prevalence seen between Black and White adults in the U.S.⁹

Having a close family member (such as a parent or sibling) with type 2 diabetes increases your risk of developing type 2 diabetes.⁸ However, there are additional factors beyond genetics that play a role in the development of type 2 diabetes.

Other risk factors include:

• Being physically inactive
• You are 45 or older
• Having had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds

Black and Brown people often are disproportionately affected by these common risk factors.

A high intake of mainly processed foods high in sugar and sodium and low in fiber promotes fat formation in the liver, which starts the cascade that results in diabetes and metabolic disease. This is also more common in some Black and Brown communities, such as Black Americans and Mexican Americans, due the ways systemic racism limits access to healthy foods in their neighborhoods.¹⁰

Some studies have shown that, regardless of weight, compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans have more insulin resistance, as well as increased amounts of insulin being released in the body and higher than normal insulin in the blood.¹¹

Additional studies have shown similar changes in glucose metabolism in other ethnic groups. For example, many studies suggest that Asian Americans have increased insulin resistance and decreased insulin output compared to non-Hispanic Whites.¹¹

Another study showed that Native Americans with diabetes had decreased insulin sensitivity compared with non-Hispanic Whites, non-Hispanic Blacks and Hispanic Americans.¹¹

Racial and ethnic minorities are also more likely to be affected by systemic racism, which negatively impacts social determinants of health. Not having access to healthy food, health insurance or safe housing and neighborhoods, or having limited educational opportunities is linked to poorer health outcomes.

Without access to fundamental necessities and a safe environment, Black and Brown people may struggle to obtain healthy foods or participate in physical activity on a regular basis. As a result, a person’s risk for type 2 diabetes is increased.

Black and Brown people are significantly more likely to live in poverty than White people. According to the Census Bureau, in 2019, Black people had an 18.8% poverty rate, and Hispanic Americans had a 15.7% poverty rate, compared to 7.3% of non-Hispanic Whites.¹²

Complications of type 2 diabetes in Black and Brown people

According to a 2013 study, Black and Brown people have a higher chance of developing complications from type 2 diabetes. These complications include:¹¹

• Heart disease and heart failure (the heart does not pump enough blood to meet the body's needs)
• Retinopathy (eye disease)
• Neuropathy (nerve damage) and amputation due to neuropathy
• Kidney disease

The CDC reports that racial and ethnic minority groups in the U.S. have higher rates of illness and death across a wide range of health conditions, including diabetes, when compared to White Americans. Additionally, the life expectancy of non-Hispanic Black Americans is four years less than White Americans.¹³

One reason for the risk of increased complications may be due to socioeconomic status and lack of health insurance or access to care. The social determinants of health can impact the risk of type 2 diabetes for Black and Brown people, as well as their ability to get the proper education, care, and treatment they need to prevent complications from occurring.

Although socioeconomic status certainly plays a role, no conversation on health and diabetes status in Black and Brown people would be complete without recognizing and challenging racism in America.

One study reported that toxic stress in Black and Brown people with type 2 diabetes caused by poverty, discrimination and racism was correlated with decreased quality of life, especially in Black Americans.¹⁴

Screening and early detection of type 2 diabetes in Black and Brown people

Early screening and detection are critical with the overall prevention and treatment of type 2 diabetes. Attending regular check-ups with a healthcare provider can help with early identification and treatment.

The U.S. Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who are overweight.¹⁵

They also suggest screening at an earlier age in people from groups with higher incidence and prevalence of diabetes, including American Indian/Alaska Native, Asian American, Black, Hispanic/Latinx or Native Hawaiian/Pacific Islander people.

Additionally, they recommend earlier screening in people who have a family history of diabetes and those who are underweight.

Addressing health disparities at a community and societal level is vital to the overall health and well-being of Black and Brown people. Obtaining access to health care, affordable medications, fresh foods, quality education and safe environments for regular physical activity is fundamental to improving quality of life.

More research is needed on the effects of screening on health outcomes that include populations that reflect the rate of diabetes in America, especially racial and ethnic groups that have a higher rate of diabetes compared to White people.

In addition to regular visits with a healthcare team, lifestyle interventions that focus on improving diet and increasing physical activity can also help prevent or delay the progression to diabetes in Black and Brown people.

Even though there may be genetic factors that predispose a person to disease, lifestyle interventions are an important tool for prevention.

Summary

Black and Brown people are disproportionately affected by type 2 diabetes due to systemic racism. Certain races and ethnicities in the U.S. experience significantly higher rates of diabetes, including Native Americans, Alaska Natives, non-Hispanic Blacks, people of Hispanic origin and non-Hispanic Asians.

Also, Black and Brown people have a higher chance of developing diabetes complications. Early screening and detection can play a pivotal role in the overall prevention and treatment of type 2 diabetes in Black and Brown people.

A word from Verywell 

Positive turns in promoting cultural competency and anti-racism in health care, as well as improving access to health care, healthful foods and safe environments, can promote future change.

Advocating for yourself is vital to your success and health as an individual and Black or Brown person. Forming a good rapport with a healthcare team and getting annual check-ups can help you prevent or effectively manage a diagnosis of type 2 diabetes, enabling you to do the things you love and live a high quality of life.

Frequently asked questions

Has type 2 diabetes gotten better or worse in Black and Brown communities in the last 20 years?

A troubling statistic is seen among youth ages 10 to 19, comparing the period from 2002 to 2010 to the period from 2011 to 2015. The incidence of type 2 diabetes did not change for non-Hispanic White youth. But the incidence increased significantly for other racial/ethnic groups, especially in non-Hispanic Black youth.¹⁶

What are potential complications for poorly treated diabetes?

Complications of poorly treated diabetes include problems with feet, oral health, vision, hearing, mental health, heart disease, chronic kidney disease and nerve damage.¹⁷

What is the mortality rate of type 2 diabetes in Black and Brown people?

In 2018, non-Hispanic Black Americans were twice as likely as non-Hispanic White Americans to die from diabetes. Additionally, the age-adjusted death rate from diabetes among non-Hispanic Black adults was 47.6% among males and 33.1% among females.¹⁸

SOURCES

1. Centers for Disease Control and Prevention. Type 2 diabetes.
2. Centers for Disease Control and Prevention. Prevalence of diagnosed diabetes.
3. American Journal of Managed Care. Recognizing the Role of Systemic Racism in Diabetes Disparities.
4. Centers for Disease Control and Prevention. Prevalence of both diagnosed and undiagnosed diabetes. 
5. Centers for Disease Control and Prevention. Prevalence of prediabetes among adults.
6. Centers for Disease Control and Prevention. Incidence of newly diagnosed diabetes.
7. Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: insights from yesterday, today, and future trends. Popul Health Manag. 2017;20(1):6-12. doi:10.1089/pop.2015.0181
8. Centers for Disease Control and Prevention. Diabetes risk factors.
9. Bancks MP, Kershaw K, Carson AP, Gordon-Larsen P, Schreiner PJ, Carnethon MR. Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood. JAMA. 2017;318(24):2457-2465. doi:10.1001/jama.2017.19546
10. The Guardian. Food Apartheid: The Root of the Problem with America's Groceries.
11. Spanakis EK, Golden SH. Race/ethnic difference in diabetes and diabetic complications. Curr Diab Rep. 2013;13(6):814-823. doi:10.1007/s11892-013-0421-9
12. United States Census Bureau. Poverty rates for blacks and hispanics reached historic lows in 2019.
13. Centers for Disease Control and Prevention. Racism and health.
14. Nkwata AK, Song X, Zhang M, Ezeamama AmaraE. Change in quality of life over eight years in a nationally representative sample of US adults with heart disease and type 2 diabetes:minority race and toxic stress as key social determinants. BMC Public Health. 2020;20:684. doi:10.1186/s12889-020-08842-y
15. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for prediabetes and type 2 diabetes: US preventive services task forcerRecommendation statement. JAMA. 2021;326(8):736-743. doi:10.1001/jama.2021.12531
16. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.
17. Centers for Disease Control and Prevention. Prevent diabetes complications.
18. US Department of Health and Human Services Office of Minority Health. Diabetes and African Americans.