Diabetes: The Silent Killer Report Presented By: Johanna Henriquez Diana Lesmes Matt Mayo Paul Michelletti April 16, 2001

Introduction The rate of diabetes in the African American community has tripled in the past thirty years. In fact, African Americans are nearly twice as likely to develop diabetes as non-Hispanic whites. It's serious business. In fact, the Centers for Disease Control recently reported that diabetes was up another 6% in the United States in 1999. For African Americans, the increase was 8.9% to 9.9%. Some 16 million Americans have diabetes. Dr. Jeffrey Koplan, Director of the Centers for Disease Control, described diabetes as an epidemic in the U.S. Information, education, and lifestyle changes -- starting with a free diabetes screening -- can lower the odds of diabetes.

Problem Approximately 2.3 million – or 10.8% -- of all African Americans have diabetes, but one-third of them do not know it. Diabetes has serious complications – blindness, kidney disease, amputations, heart attack and stroke. Due to these complications, diabetes has become the fourth leading cause of death by disease in the African American community. There is no cure for diabetes.

Question If 13% of the American population is African American, then why do African Americans constitute for the majority of the diabetic population? Furthermore, why are they unaware?

Diabetes is a disease that affects the body’s ability to produce or respond to insulin, a hormone that is needed to convert sugar, starches, and other food into energy needed for life. Diabetes is a chronic disease that has no cure. If you have "sugar," you have diabetes – and that’s serious. If you don’t treat it, it can cause you to go blind, suffer a heart attack, lose a foot or leg, even kill you. Diabetes falls into two main categories: type 1, which usually begins in childhood or adolescence, and type 2, the most common form of the disease, usually occurring after age 45.

Type 1  An auto-immune disease in which the body does not produce any insulin. This most often occurs in children and young adults. People with type 1 diabetes must take daily insulin injections to stay alive. Type 1 diabetes accounts for 5 – 10 percent of diabetes.

Type 2  A metabolic disorder resulting from the body’s inability to make enough, or properly use insulin. It is the most common form of the disease. Type 2 diabetes accounts for 90-95 percent of diabetes. Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans, and a greater prevalence of obesity and sedentary lifestyles.

Warning Signs  Frequent urination  Unusual thirst  Extreme hunger  Unusual weight loss  Extreme fatigue  Irritability These are all warning signs of type 1 diabetes.

Warning Signs Warning signs for type 2 diabetes, the most common kind, include all the above plus:  Frequent infections  Blurred vision  Cuts/bruises that are slow to heal  Tingling/numbness in the hands or feet  Recurring skin,  gum or bladder infection

Risk Factor You are at greater risk for diabetes if:  You are age 45 or older  You are overweight  You have high blood pressure  You have a family history of diabetes  You are African American  You don’t exercise regularly

Consequences Many people first become aware they have diabetes when the develop one of its life-threatening complications.  Blindness- Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. Each year thousands of people lose their sight because of diabetes. Retinopathy may not cause any symptoms. You should get an eye exam every year if you’re over 30. You should also see your eye doctor if: Your vision is blurry You see double floaters You see spots or One or both eyes hurt You feel pressure in your eye You lose the ability to see things at the side You have trouble reading

Consequences Kidney Disease. Diabetes is the leading cause of end-stage renal disease (kidney failure), accounting for about 40% of new cases. Kidney disease causes no symptoms until the kidneys are badly damaged. Kidney damage cannot be reversed.

Consequences  Nerve Disease and Amputations. About 60 – 70 percent of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 14 – 40 times greater for a person with diabetes. The damage diabetes causes to nerves is called diabetic neuropathy.

Consequences Heart Disease, Stroke and Blood Vessel Damage. People with diabetes are 2 to 4 times more likely to have heart disease, which is present in 75 percent of diabetes-related deaths. They are 2 to 4 times more likely to suffer a stroke. Diabetes makes them more likely to get hardening of the arteries or peripheral vascular disease in which not enough blood reaches the areas farthest from the heart.

Statistics Figure 1 shows the prevalence of diabetes for African American men and women based on the most recent national study.

Statistics The proportion of the African American population that has diabetes rises from less than 1 percent for those aged younger than 20 years to as high as 32 percent for women age 65-74 years. In every age group, prevalence is higher for women than men: overall, among those age 20 years or older, the rate is 11.8 percent for women and 8.5 percent for men.

Statistics National health surveys during the past 35 years show that the percentage of the African American population that has been diagnosed with diabetes is increasing dramatically. In 1976-80, total diabetes prevalence in African Americans age 40-74 years was 8.9 percent; in 1988-94, total prevalence had increased to 18.2 percent--a doubling of the rate in just 12 years.

Statistics Prevalence in African Americans is much higher than in white Americans. Among those age 40-74 years in the 1988-94 survey, the rate was 11.2 percent for whites, but was 18.2 percent for blacks--diabetes prevalence in blacks is 1.6 times the prevalence in whites.

What factors increase Type 2 Diabetes in African Americans? The frequency of diabetes in African American adults is influenced by the same risk factors that are associated with type 2 diabetes in other populations. Two categories of risk factors increase the chance of developing type 2 diabetes. The first is genetics. The second is medical and lifestyle risk factors, including impaired glucose tolerance, gestational diabetes, hyperinsulinemia and insulin resistance, obesity, and physical inactivity.

What factors increase Type 2 Diabetes in African Americans? Some researchers believe that African Americans inherited a "thrifty gene" from their African ancestors. Years ago, this gene enabled Africans, during "feast and famine" cycles, to use food energy more efficiently when food was scarce.

Overweight African Americans Figure 2 shows the amount of overweight African Americans compared to Whites over the past 3 years.

How Does Diabetes Affect African Americans? Gestational diabetes, in which blood glucose values are elevated above normal during pregnancy, occurs in about 2 percent to 5 percent of all pregnant women. Several studies have shown that the occurrence of gestational diabetes in African American women may be 50 percent to 80 percent more frequent than in white women.

How Does Diabetes Affect African Americans? African Americans are twice as likely to suffer from diabetes-related blindness. The frequency of diabetic retinopathy is 40 percent to 50 percent higher in African Americans than in white Americans. African Americans with diabetes experience kidney failure, also called end-stage renal disease (ESRD), about four times more often than diabetic white Americans. In 1995, there were 27,258 new cases of ESRD attributed to diabetes in black Americans.

How Does Diabetes Affect African Americans? Diabetes is the leading cause of kidney failure and accounted for 43 percent of the new cases of ESRD among black Americans during 1992-1996. Hypertension, the second leading cause of ESRD, accounted for 42 percent of cases. African Americans with diabetes are much more likely to undergo a lower-extremity amputation than white or Hispanic Americans with diabetes. Based on the U.S. hospital discharge survey, there were about 13,000 amputations among black diabetic individuals in 1994.

How Does Diabetes Affect African Americans? The hospitalization rate of amputations for blacks was 9.3 per 1,000 patients in 1994, compared with 5.8 per 1,000 white diabetic patients.

How Does Diabetes Affect African Americans? Figure 3 shows how many African Americans die due to diabetes compared to Whites.

Points to Remember In 1993, 1.3 million African Americans were known to have diabetes. This is almost three times the number of African Americans who were diagnosed with diabetes in 1963. For every white American who gets diabetes, 1.6 African Americans get diabetes. The highest incidence of diabetes in blacks occurs between 65 and 74 years of age. Twenty-five percent of these individuals have diabetes.

Points to Remember Obesity is a major medical risk factor for diabetes in African Americans, especially for women. Some diabetes may be prevented with weight control through healthy eating and regular exercise. African Americans have higher incidence of and greater disability from diabetes complications such as kidney failure, visual impairment, and amputations.

Essex County vs. Canada  In Essex county the population is 765,348. Diagnosed with diabetes:28,621 at a rate of 37.4. Undiagnosed: 14,744.  In Essex county the black population is of: 84,549. The people diagnosed with Diabetes: 1,585. ( this is the highest diagnosed total for any county in N.J.)

Essex County vs. Canada  The prevalence in diabetes for blacks in N.J. in 1994 is: Blacks-the NJ population is 1,134,271. Diagnosed-50,727 Undiagnosed-26,132 Total Prevalence-76,860 at a rate of 67.8

Essex County vs. Canada  In 1996 the diabetes prevalence for Blacks in the Canadian population was 3.8% where as the whites was it was 3.2%  Compared to that of the United States population, 10.8% of all African Americans have it.

Pen 3 Model Educational Diagnosis of Health Behavior Perceptions-Diabetes is not a serious disease, and it is curable. Enablers-Variety of ways to maintain healthy lifestyle, exercise, dietary food, and health groups. Nurturers-Advice of family members to watch diet

Pen 3 Model Cultural Appropriateness of Health Behavior Positive-Increased exercise amongst today’s society Exotic-Can still eat sugary, “good-tasting” food when exercising after eating. Negative-Variety and accessibility to fast food and other unhealthy types of dieting.

Pen 3 Model Health Education Person-Exercise daily and eat healthy. Advice from schools, churches, etc…. Extended Family-Diabetic help for pregnant women. Neighborhood-American Diabetes Association, providing healthy lifestyle information as well as informing community about diabetes and treatment.

Programs: American Diabetes Association  Their message is “Diabetes is Serious.”  Raise awareness to African American Community through National Organizations, local churches, and volunteers. GOALS-  To raise awareness in the African American community about the seriousness of diabetes and its complication.  To raise awareness in the African American community about risk factors associated with diabetes.  To raise awareness about the importance of healthful eating and regular exercise.  To raise awareness of those with the disease, that you can control your diabetes.

Programs: American Diabetes Association Involvement-  Offers informational workshops through local community organizations to raise awareness about diabetes control and prevention.

What is Needed?  Patient education is critical. People with diabetes can reduce their risk of complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels and get regular checkups from their health care teams.  People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels, as close to the normal range as is possible for them. Find out if you have diabetes. Take the risk test. Get a free screening.