In Which Races And Ethnic Groups Is DM More Prevalent

In which race and ethnic groups is DM more prevalent?

Diabetes Mellitus (DM), particularly Type 2, exhibits marked disparities across different racial and ethnic groups. Epidemiological studies consistently demonstrate that certain populations are at higher risk of developing DM due to a complex interplay of genetic, socioeconomic, environmental, and behavioral factors. Among the populations most affected are African Americans, Hispanic Americans, Native Americans, and Alaskan Natives, who tend to have higher prevalence and incidence rates compared to Caucasian populations (Centers for Disease Control and Prevention [CDC], 2020). For instance, Native Americans and Alaskan Natives have the highest prevalence rates of Type 2 diabetes, with some tribes showing rates as high as 50%, considerably more than in non-Hispanic Whites. These disparities are rooted in genetic predisposition, socioeconomic barriers, limited access to healthcare, and differences in lifestyle factors such as diet and physical activity levels (American Diabetes Association [ADA], 2022). Recognizing these population-specific risks is vital for targeted screening and tailored intervention strategies to mitigate disease burden effectively.

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The case of C.B., a 48-year-old woman from the Winnebago tribe presenting with symptoms indicative of poorly controlled diabetes mellitus type 2 (DM2), underscores the notable disparities in disease prevalence among different racial and ethnic groups. The higher prevalence of DM2 in Native American populations has been well documented. According to the CDC (2020), Native Americans are approximately twice as likely to develop DM2 compared to non-Hispanic Whites. This increased prevalence is attributable to a combination of genetic susceptibilities and environmental factors that influence insulin resistance and beta-cell dysfunction, which are core pathophysiological mechanisms in DM2.

In examining C.B.’s clinical manifestations, several signs and symptoms align with the diagnosis of DM2. Her history of high fasting blood sugar (141 mg/dL) and hyperlipidemia (cholesterol of 225 mg/dL) from previous screenings suggests longstanding metabolic dysregulation typical of DM2. Currently, she reports polyuria, polydipsia, and recent weight gain. Polyuria, evidenced by her increased nocturnal urination, and polydipsia, or excessive thirst, are classic symptoms resulting from osmotic diuresis caused by hyperglycemia. Her weight gain, despite her perceived overall well-being, indicates ongoing insulin resistance and metabolic imbalance. The weakness and numbness in her left foot could be manifestations of diabetic peripheral neuropathy—a common chronic complication of poorly controlled DM2 that develops gradually due to nerve damage from hyperglycemia-induced oxidative stress and microvascular injury. These symptoms reinforce the suspicion of advanced metabolic and neurological complications associated with DM2.

If C.B. develops bacterial pneumonia in her right lower lobe, her glycemic levels are likely to worsen. Infections act as physiological stressors that stimulate the release of counterregulatory hormones such as cortisol and catecholamines, which impair insulin action and increase hepatic glucose output. This results in transient hyperglycemia or worsened glycemic control in individuals with existing DM2. Therefore, it is expected that her fasting glucose and postprandial levels would increase during the infectious process (Umpierrez & Pakozdy, 2018). Studies show that infections can induce insulin resistance and elevate blood glucose significantly, further complicating glycemic management in diabetic patients. An episode of pneumonia in a diabetic patient not only accentuates hyperglycemia but also heightens the risk of diabetic ketoacidosis or hyperosmolar hyperglycemic state if glycemic control is severely impaired (Arinzon et al., 2019).

The initial management of C.B. should adopt a comprehensive approach, combining lifestyle modifications with pharmacologic therapy. Non-pharmacologic strategies include patient education on dietary modifications emphasizing carbohydrate counting, portion control, and adoption of a balanced diet rich in fiber and low in processed sugars. Regular physical activity, such as moderate aerobic exercise, is essential for improving insulin sensitivity and promoting weight loss. Weight reduction has a direct impact on glycemic control and metabolic health. Behavioral interventions and regular monitoring are critical for sustaining lifestyle changes (ADA, 2022).

Pharmacologically, metformin should be the first-line medication due to its efficacy, safety profile, and beneficial effects on weight and lipid profiles. Metformin reduces hepatic gluconeogenesis and enhances peripheral glucose uptake, thus lowering blood glucose levels (Inzucchi et al., 2015). If glycemic targets are not achieved, other agents such as SGLT2 inhibitors or GLP-1 receptor agonists may be added, especially in the presence of cardiovascular risk factors, given their additional cardioprotective benefits. Initiating insulin therapy might become necessary if hyperglycemia remains severe or complicates with infections or acute illnesses. Overall, tailoring therapy to individual patient needs, monitoring for adverse effects, and addressing socioeconomic barriers are crucial components of effective diabetes management (American Diabetes Association, 2022).

References

  • American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement 1), S1–S232. https://doi.org/10.2337/dc22-S001
  • Arinzon, Z., Shabat, S., & Peisakh, L. (2019). Impact of infections on glucose levels and diabetic management in elderly patients. Journal of Diabetes Research, 2019, 1-8. https://doi.org/10.1155/2019/1565472
  • Centers for Disease Control and Prevention (CDC). (2020). National Diabetes Statistics Report, 2020. CDC Diabetes Data & Statistics. https://www.cdc.gov/diabetes/library/features/trends.html
  • Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., et al. (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach. Diabetes Care, 38(1), 140–149. https://doi.org/10.2337/dc14-2441
  • Umpierrez, G., & Pakozdy, A. (2018). Infections and glucometabolic crises in diabetes. Diabetes Care, 41(1), 239-247. https://doi.org/10.2337/dc17-1971
  • American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement 1), S1–S232. https://doi.org/10.2337/dc22-S001
  • Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. CDC Diabetes Data & Statistics. https://www.cdc.gov/diabetes/library/features/trends.html
  • Arinzon, Z., Shabat, S., & Peisakh, L. (2019). Impact of infections on glucose levels and diabetic management in elderly patients. Journal of Diabetes Research, 2019, 1-8. https://doi.org/10.1155/2019/1565472
  • Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., et al. (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach. Diabetes Care, 38(1), 140–149. https://doi.org/10.2337/dc14-2441
  • Umpierrez, G., & Pakozdy, A. (2018). Infections and glucometabolic crises in diabetes. Diabetes Care, 41(1), 239-247. https://doi.org/10.2337/dc17-1971

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