Connecticut’s diabetes rate ranks lower than the national average, but Hispanics and African-Americans are more than twice as likely to have the disease compared with their white neighbors and are at greater risk of dying from diabetes-related causes.
Approximately 250,000 Connecticut adults (8 percent) have been diagnosed with Type 2 diabetes and an estimated 83,000 state residents don’t realize they have the disease, according to 2011-13 data from the U.S. Centers for Disease Control and Prevention (CDC). Nationally, 29.1 million people (9.3 percent) have diabetes and 8.1 million people don’t know they have the disease, reports the CDC.
Connecticut’s Hispanics (14.6 percent) and African-Americans (14.1 percent) have significantly higher rates of diabetes than whites (6.7 percent). In addition, adults with annual household incomes below $25,000 are 2.3 times more likely to have diagnosed diabetes compared with adults with household incomes over $75,000, according to the CDC.
Health experts cite multiple barriers to comprehensive diabetes care, including inadequate prescription coverage for costly medications and testing supplies; a shortage of Spanish-speaking medical specialists and community health workers; insensitivity among health care providers to cultural food preferences; a lack of neighborhood markets offering healthy foods; and a dearth of safe recreational opportunities.
“We need a more comprehensive set of solutions that happen at the neighborhood level to get at the root causes of diabetes,” said Dr. Mehul Dalal, chronic disease director for the state Department of Public Health. He said the data show “shocking disparities.”
The “Silent Killer”
Diabetes occurs when blood sugar (also known as glucose) levels remain abnormally high because the body doesn’t produce insulin (Type 1 diabetes) or doesn’t use insulin properly (Type 2 diabetes). About 95 percent of people with the disease have Type 2 diabetes, reports the American Diabetes Association (ADA).
Health experts often call diabetes the “silent killer” because people do not experience symptoms during the early years of the disease. But the long-term complications of diabetes can be deadly and costly. Diabetes can lead to serious health issues such as blindness, kidney failure, lower extremity amputations, stroke and heart disease. One report estimates the total cost of diabetes in Connecticut at $2.43 billion annually, reports the ADA.
Research shows some ethnic and racial groups are genetically predisposed to developing diabetes, including Hispanics, African-Americans, Asians and Native Americans.
In Connecticut, blacks and Hispanics are more likely to die from diabetes and experience higher rates of diabetes-related hospitalizations and amputations than whites, according to data from DPH.
• Black adults had 4.2 times the rate of hospitalizations for diabetes and four times the rate of diabetes-related lower extremity amputations compared with white adults.
• Hispanic adults had 2.2 times the rate of hospitalizations for diabetes and nearly twice the rate of diabetes-related lower extremity amputations compared with white adults.
• Black adults had the highest diabetes and diabetes-related mortality rates, followed by Hispanic residents.
“Diabetes is one of the most serious health problems that African-Americans and Hispanics face today,” said Lindsay Scheinblum, manager for fundraising and special events with the Connecticut chapter of the American Diabetes Association. The ADA offers outreach programs to increase awareness among Hispanics and blacks.
While genetics play a role in the onset of diabetes, lifestyle issues such as obesity and physical inactivity are the main culprits behind the increased prevalence of Type 2 diabetes among people of all ages, said Dr. Raul Arguello, chairman of the Pediatric Department at Danbury Hospital and chief of the Pediatric Endocrine and Diabetes Program.
“There has been an explosion of Type 2 diabetes in teenagers nationwide,” said Arguello, a pediatric endocrinologist who noted that diabetes in children was “practically nonexistent” two decades ago. “Now it is a fact of life for many families.”
Expensive Medications
Dr. Bismruta Misra, an endocrinologist at Stamford Hospital, sees some “positive trends” in her medical practice, where up to 60 percent of all patients have diabetes. More people are seeking medical care after gaining health insurance with passage of the Affordable Care Act. Primary care physicians are actively working to identify patients with pre-diabetes — those with high blood sugar levels at risk of becoming diabetic.
But many patients can’t afford the expensive medications and blood sugar testing supplies that are crucial for managing the disease. People with diabetes spend an estimated $7,900 a year on medication and supplies, reports the ADA.
“People living on a fixed income may have to choose between paying for their insulin or paying their rent,” Misra said. “They have health insurance to see a doctor. But their prescription coverage is terrible or they don’t have any at all.”
Other challenges include “structural barriers” that make it difficult for urban and rural residents to manage diabetes, Dalal said. These hurdles include a shortage of neighborhood markets that carry fresh produce and few recreational options in communities that lack sidewalks or aren’t safe.
“For a while, we thought we weren’t getting the right messages across,” he said. “But telling people to eat healthy food and stay active only goes so far. Many patients at higher risk for diabetes live in neighborhoods where that simply is not an option.”
Cultural Barriers
A shortage of medical providers who understand the cultural and language preferences of their patients can create barriers to care, said Arguello, a native of El Salvador who speaks English with his pediatric patients and Spanish with their parents. “People feel more comfortable when they can communicate in their own language,” he said.
Understanding cultural food preferences is also key. For example, white rice — which the body metabolizes as sugar — is the basis of many meals for Hispanics and Asians. Fried foods enjoyed by African-Americans and other ethnic groups increase the risk for obesity. Even Sunday dinners that bring Italian families together can pose a health threat because pasta is a carbohydrate that acts like sugar in the body.
“Certain cultural food staples are not always ideal,” Misra said. “But asking people to stop eating a food that has been a part of their family traditions for years doesn’t work.” Educating patients about portion control, nutrition labels and ways they can limit — not eliminate — certain foods from their diets are more effective strategies, she said.
Home-based Interventions
Home-based interventions with specially trained bilingual community health workers can help low-income residents achieve their Type 2 diabetes goals, said Sofia Segura-Perez, associate director of the Center for Community Nutrition at the Hispanic Health Council in Hartford.
In a recent study, patients who were linked to community health workers successfully attained better blood glucose control. The workers provided education about nutrition, grocery shopping, medications, exercise and diabetes medical management, in addition to assisting with translation services and transportation to doctor visits. The HHC study was conducted in conjunction with the University of Connecticut and Hartford Hospital.
“Community workers can identify things at home that make it difficult for people to adhere to a regimen,” said Segura-Perez. These include “social stressors” such as lacking money to buy food, worrying about eviction, or raising grandchildren because the parents are absent. “These are things that the doctor doesn’t see during an office visit.”
Other studies show that Hispanics who immigrated to the United States are at a greater risk of developing diabetes the longer they live in America. “Acculturation seems to be another factor among Latinos that may impact their risk for diabetes,” she said.
Looking Ahead
Experts point to prevention and self-management initiatives underway to help stem the prevalence of diabetes. State health officials are working with the state Department on Aging to increase the use of diabetes self-management programs in community settings and to offer programs in Spanish and English.
Local organizations, such as YMCAs, are offering evidence-based intervention programs to reach at-risk residents. More health care systems are using health information technology to identify and track patients who would benefit from diabetes prevention and self-management education programs.
Segura-Perez looks forward to a time when insurers cover home-based strategies that help diabetics avoid more costly complications such as hospitalizations and amputations.
“My hope is that people will recognize the value of home-based interventions to the individual and society,” she said.
Information on diabetes is available at these websites:
Connecticut Department of Public Health (diabetes prevention and control program)
American Diabetes Association, Connecticut Chapter
Centers for Disease Control and Prevention (Diabetes Home page)
