Black History Month is a time for African Americans (AA) to reflect on positive events in our history and resolve to honor our ancestors. Most importantly, it is a time to reflect on our responsibilities to reduce health disparities in chronic diseases affecting our community, especially diabetes.
Type 2 diabetes is the biggest health challenge facing AAs, especially women. For example, one in four AA women older than 55 has diabetes, and 4.9 million AAs aged 20 and older have diagnosed or undiagnosed diabetes—that’s 12.6% of the adult AA population.
As AAs, we have the most, and many times the largest, differences in health risks when compared to other minority groups. As a group, we have more disability and early death from complications. Some argue that generations of racism, poverty, lack of trust in the medical system, cultural differences, regional beliefs, problems accessing care, availability of care, lack of knowledge about the importance of screening and shame in disclosing the disease all have a role in racial health disparity. Some research indicates that genetics also play a role and or contribute to diabetes.
Some researchers cite that diabetes is on the rise in the AA community because “diabetes runs in families.” Although some research has identified genes responsible for the expression of diabetes, few genetic research studies have been conducted in AA communities. The need to understand the high rate of type 2 diabetes in minorities began a long time ago. In 1962 geneticist James Neel proposed the “thrifty gene theory” to partially explain the rise in type 2 diabetes in the world. His theory stated that through natural selection we evolved to be good at food storage and how we use fuel. Neel proposed that ancient humans went through a cycle of feast and famine (food and no food). The people who had bodies that were better at fuel storage were more likely to survive during a famine, or a cycle without food. Nonetheless, many generations later, the overabundance of food and limited physical activity created a challenging situation: The previously advantageous thrifty genes now make one susceptible to type 2 diabetes and obesity.
Similarly, some AAs may have inherited the thrifty gene from their African ancestors as a protective mechanism. Africans hunter/gatherer groups and child-bearing women with this gene would have an advantage, because the gene would allow them to fatten more quickly during times of abundance. Thus fatter individuals carrying the thrifty genes would have a better chance of surviving during food scarcity or shortage. This helped the hunter/gatherers and childbearing women adapt more effectively to “feast and famine” food cycles on the African continent. However, over many generations and in a new environment such as United States, these genes were no longer protective, and even placed the person at risk for developing type 2 diabetes and other diseases. Although conclusive findings regarding diabetes and genetics are not yet available, genetic research such as Project SuGar among the Gullahs of South Carolina is promising and may offer further insight into better medication for and treatment of diabetes in AAs.
Regardless of the “thrifty gene theory,” we cannot rule out the impact of environment and lifestyles passed from generations to generations. We share more than genes; we share cultural habits, beliefs and fears, cooking styles and our own perception of physical activities and exercise.
In order to address racial and health disparities in diabetes, we must become empowered and take charge of our personal health, our family and our community. As we honor our ancestors during Black History Month, we must become empowered with knowledge about the disease process, our risk status, self-management, lifestyle changes, diabetes signs and symptoms, and the connection between diabetes, high blood pressure and kidney disease.
We must resolve to take advantage of family gatherings and family reunions as opportunities to talk about “who has diabetes” (commonly known as “sugar” in the AA community) and what they are doing about it. We need to ask questions of our birth parents and biological sisters and brothers so we can complete the family health history questionnaire. We need to make a commitment to take the completed form to our primary doctor/provider. This is important because family history of diabetes is closely associated with developing type 2 diabetes.
By becoming empowered, you will learn information about which behaviors to avoid, as well as lifestyle changes you can make to improve your health and lower your risk for diabetes. So let’s give thanks to our ancestors, embrace our family, embrace our community and take the pledge to Stop Diabetes® in our African-American community!
Ida Johnson-Spruill, PhD, RN, LISW, FAAN
Assistant Professor, Medical University of South Carolina, College of Nursing
Member, African-American Subcommittee, American Diabetes Association