By Daniel DeNoon
WebMD Feature
Reviewed By Brunilda Nazario

Black Americans and Diabetes

Black Americans -- and Mexican-Americans -- have twice the risk of diabetes as white Americans. In addition, blacks with diabetes have more serious complications -- such as loss of vision, loss of limbs, and kidney failure -- than whites, notes Maudene Nelson, RD, certified diabetes educator at Naomi Barry Diabetes Center at Columbia University.

"The theory is that maybe it is access to health care, or maybe a cultural fatalism -- thinking, 'It is God's will,' or, 'My family had it so I have it' -- not a sense of something I can have an impact on so it won't hurt me," Nelson tells WebMD. "But more and more there is thinking it is something that makes blacks genetically more susceptible. It is hard to tell how much of it is what."

The Forgotten Killer

There is, indeed, evidence that African-Americans may have a genetic susceptibility to diabetes. Even so, Nelson says, the real problem is empowering patients to keep their diabetes under control.

"Patients often have the sense that they are not as much in charge of managing their diabetes as their doctor," Nelson says. "Where I work, in various settings, there is an emphasis on patients. We say this is what your blood sugar is; this is what influences your blood sugar; you have to remember to take your meds. So as a diabetes educator I know there has to be an emphasis on patients putting out more effort to manage their own health."

It's easy to say people with diabetes should learn how to control their disease. But the tools for this kind of self-empowerment often aren't available in black neighborhoods, says Elizabeth D. Carlson, DSN, RN, MPH. Carlson, a postdoctoral fellow in the division of cancer prevention and education at the University of Texas M. D. Anderson Cancer Center in Houston, studies the social determinants of health.

"I go to this black neighborhood 20 minutes from my house in a white neighborhood, and the health education they get in school is much worse than the health education my kids get," Carlson tells WebMD. "It is not just formal education, but everyday things. It's being afraid to go out and exercise because you live in a high-crime neighborhood. It's not having transportation to your health care provider. It's not having decent fresh fruits and vegetables in the local grocery."