3 Barriers to Effective Diabetes Management for People of Color
People of Color in the United States face many obstacles when it comes to treating their type 2 diabetes, leading to worse outcomes and a greater impact to quality of life than that experienced by white people with diabetes. Racial bias, difficulty accessing healthy food, and challenges gaining access to diabetes care can take a toll. However, support is available. Finding a culturally competent doctor, working with a dietitian, and leaning on community tools can empower people and provide them with resources to bridge the gaps.
Type 2 diabetes is a serious chronic condition that occurs when your body cannot use insulin properly, causing high blood sugar levels. Possible complications include nerve damage, heart disease, and even death. It affects more than 34 million people in the U.S., and 1.5 million more get a diagnosis each year. However, the burden of this condition weighs more heavily on some groups of people than others.
Studies suggest that People of Color in the U.S. are significantly more likely to die from diabetes (including type 1 and type 2) than non-Hispanic white people. Research indicates that non-Hispanic Black people are 2.3 times more likely to die from diabetes than non-Hispanic white people. Native Americans and Alaskan Natives are 1.9 times more likely, and Hispanic Americans are 1.5 times more likely. These racial disparities in healthcare present obstacles to People of Color trying to manage their diabetes, but there are resources available to help bridge the gaps.
Racism, implicit bias, and avoidance of care (due to mistrust based on the history of abuse by healthcare professionals) contribute to racial disparities in healthcare. While high profile examples of abuse and racism like the Tuskegee Study and Henrietta Lacks have become calling cards for differences in care, subpar treatment resulting from implicit bias is more insidious.
Implicit racial bias impacts healthcare professionals’ treatment decisions as well as the relationship they have with their patients. This is further complicated by a lack of representation among healthcare professionals. While People of Color represent around 30% of Americans, they only make up 9% of doctors. This makes it exceedingly difficult for People of Color to receive care from a doctor whom they identify with, and they’re less likely to experience an interaction with a healthcare professional who understands (and respects) their culture.
Healthcare professionals can improve patient outcomes and experiences by learning about the social and cultural norms for People of Color, as well as consistently utilizing interpreters to communicate with patients who speak another language — all of which are hallmarks of culturally competent care. Training in cultural competence provides healthcare professionals with additional context to understand how cultural attitudes about food may impact diabetes, as well as clearly communicating treatment plans to improve medication adherence among those with type 2 diabetes.
To overcome disparities in treatment, People of Color should seek out healthcare professionals they trust. And healthcare professionals need to practice culturally competent patient care, which improves both patient experiences and quality of care for People of Color. You can use resources like BlackDoctor.org, healthinherhue.com, or huedco.com to find doctors who look like you or speak the same language as you to help improve your experience. Your health insurance provider may also be able to connect you with a culturally competent physician; You can view their online physician directory and filter by background and language, or you can call them directly for more personalized assistance.
If you prefer to see a doctor who speaks Spanish, you can search online at Healthgrades.com and use the language filtering tool, which can be found on the search results page within “All Filters.”
Planning healthy meals in advance can help people with diabetes manage their symptoms. However, it’s harder for People of Color to access healthy options. People of Color are more likely to face food insecurity — lack of access to healthy food due to cost — regardless of socioeconomic status.
Without reliable access to nutritious food choices, people with diabetes who experience food insecurity have higher blood sugar levels. This leads to a higher risk of complications and death from diabetes.
Communities need to address both food insecurity and the systemic and institutional racism behind it. Ensuring that everyone has access to a grocery store within a reasonable distance from their home can lead to better outcomes for People of Color with diabetes.
In the meantime, people with diabetes can do their best to avoid processed foods. Choosing whole fruits, vegetables, and proteins when they are available may help prevent or manage diabetes symptoms. And asking your diabetes doctor for a referral to a dietitian can help equip you with strategies for making the most of the food available to you with your diabetes in mind.
Healthcare services in the U.S. are more expensive than in any other developed country in the world, which makes it difficult for people with lower socioeconomic status to access quality care for diabetes. Due to institutionalized racism, many People of Color are lower on the socioeconomic scale than white people in the U.S.
Lack of access to adequate healthcare contributes to subpar care for Black people as well as Hispanic people. Managing diabetes requires careful monitoring of several health indicators, including blood sugar levels and cholesterol, as well as regular foot and eye exams. Black people and Hispanic people with diabetes are less likely than white people to have at least two blood sugar tests and an eye exam performed by their doctor each year as recommended. This is due, in part, to a lack of health insurance, which is also more common among People of Color. Socioeconomic status only contributes slightly to this burden. People of Color are only 4 to 5% less likely to have health insurance than white people, even among those with the same level of income.
Resources are available for people seeking diabetes care, despite the many challenges. Nonprofits and medical clinics in your community may offer free or low cost diabetes screening, treatment, and education. Many support organizations offer tools and resources to People of Color, such as the Association of Diabetes Care & Education Specialists, Diabetes Sisters, and the Alliance to Reduce Disparities In Diabetes.
If you are a Person of Color with diabetes, support is available to help you overcome obstacles.