Advances in diabetes for the millennium: diabetes in minorities

Diabetes shows an increased prevalence among minority groups, including Asians, African Americans, Hispanics, Native Americans, and Pacific Islanders. The sedentary lifestyle and high-fat diet of modern industrialized societies promote obesity at an early age. There is a strong correlation between the development of diabetes and increased visceral adiposity in American minority groups. This review focuses on the 2 largest minority groups in the United States, African Americans and Hispanics. The risk of diabetes is 20% to 50% greater in African American men and twice as great in African American women as well as twice as high in Hispanic adults than in whites. Furthermore, the prevalence of diabetes-associated complications, such as retinopathy and amputations, is 50% to 100% higher in African Americans and Hispanics. The unfavorable consequences of diabetes in African American and Hispanic individuals do not seem to be due to inherent biological differences. Rather, it appears that differences in medical care and self-management of diabetes may be the major factor. The key to improving outcomes in these minority groups lies in enhancement of communication to overcome barriers to self-care. It is important to better understand the cultural milieu in minority communities to enhance patient involvement in their own management. Where this has been done, marked improvements in diabetes healthcare have occurred.