Introduction

Diabetes is one of the leading causes of death and disability in the United States, contributing to $245 billion annually in medical costs. According to the American Diabetes Association 25.8 million Americans have diabetes, approximately 95% of which have type II diabetes. Type II diabetes is largely caused by obesity, with 85% of people with type II diabetes also diagnosed as obese. The prevalence of diagnosed diabetes in the United States has increased by 128% from 1988 to 2008. Of those diagnosed, the risk of diabetes is 1.8 times higher among the black American population. Compared to 10.2% of non-Hispanic whites with diabetes, Blacks average 18.7% of the population with diabetes.

What is Diabetes?

There are three types of diabetes, all of which are associated with high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Type 1 diabetes is a result of the body’s immune system attacking and destroying its own insulin-producing beta cells in the pancreas. Type 2 diabetes is the most prevalent, accounting for 95% of all diagnosed cases of diabetes. It generally occurs in adults over the age of 40; however, is becoming more frequent in younger adults. Type 2 diabetes occurs when the body does not make enough insulin or cannot use the insulin it makes effectively. Lastly, gestational diabetes develops during pregnancy and can lead to type 2 diabetes. There are many contributing factors to the development of type 2 diabetes, most of which can be prevented. Some risk factors include having a family history of diabetes, diagnosis with pre-diabetes, aged 45 years or older, abnormal cholesterol (lipid) levels, polycystic ovary syndrome or blood vessel problems affecting the heart, brain or legs. Some preventable factors are lack of exercise and poor diet leading to obesity or overweightness. As discussed above the black population is also at an increased risk for type 2 diabetes.
Diabetes Among Blacks Vast amounts of clinical research have been conducted in order to determine the root cause of the increased disposition among the black population to type 2 diabetes. There is no doubt that many lifestyle variables, such as high obesity rates and socioeconomic status can account for part of the higher prevalence of diabetes among the black population. Obesity is a severe problem among Blacks, particularly Black women. Both the degree and the distribution of fat is thought to contribute to the occurrence of diabetes in the Black population. This risk factor is further increased in poorer economic groups. One interesting theory relating to the higher rate of diabetes in the Black community is that Blacks might possess a gene known as the “thrifty gene” inherited from their ancestors. This gene is thought to have enabled its holders the ability to use energy more efficiently when food was scarce by promoting efficient fat deposition. The theory supposes that without the “fast and famine” cycles associated with the necessity of this gene, the gene now contributes to increased fat storage and type 2 diabetes susceptibility. This remains a theory; however, and is questioned by many to be a contributing factor to increased obesity among minority populations. One criticism is the role of physical activity on the development of the thrifty genotype. Because this gene was handed down by hunter-gatherers we have to take into account that only the ancestors that were physically strong enough to obtain food survived to hand down their genetics. Also, during both feast and recovery from exercise, insulin levels increase while conversely insulin levels decrease during famine and performance of exercise. This lends credit to believing the gene is not only designed to affect feast and famine but also one’s ability to survive the physical means to procure food. This all flows into the current environment of low activity levels and high calorie diets, tying the thrifty gene theory back in to the link of type 2 diabetes onset and modern American lifestyles. Another theory of the predisposition of Black Americans to type 2 diabetes is interestingly enough related to the skin pigmentation of Black people. Melanin, the naturally produced chemical which is responsible for the pigmentation in human skin, hair and eyes is responsible for providing protection against the absorption of harmful UVA and UVB rays. The academic journal “Pharmacol Pharmacother,” article “Vitamin D: The ‘Sunshine’ Vitamin,” by Rathish Nair and Arun Maseeh, claims that melanin while blocking the rays damaging effects also prevents the absorption of sunlight, from which the skin produces Vitamin D which is largely responsible for the production of insulin. This leads to an increased issue in the production and absorption of insulin, further attributing to the onset of type 2 diabetes in Black Americans.