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Medically reviewed and verified by Kate Burke, MD, MHA
Diabetes is a widespread health problem in the United States. In 2021, about 38.4 million Americans, which is 11.6% of the total population, had diabetes. Of these, 29.7 million were diagnosed, while an estimated 8.7 million were undiagnosed. Diabetes is especially common in seniors. Nearly 30% of Americans 65 and older have the condition. Every year, doctors diagnose around 1.2 million new cases, and an additional 97.6 million adults have prediabetes! This puts them at a high risk of developing the disease. So diabetes is everywhere, but it turns out it does not happen evenly across different racial and ethnic groups. Why is there an inequality in how diabetes and diabetic macular edema (DME) affects people? Here is an overview from PatientsLikeMe.
How Diabetes Affects Different Racial Groups
The rates of diagnosed diabetes in adults varies quite a bit. According to the American Diabetes Association, the rates by racial and ethnic background are:
- American Indian/Alaskan Native: 13.6%
- Non-Hispanic Black: 12.1%
- Hispanic: 11.7%
- Asian American: 9.1%
- Non-Hispanic White: 6.9%
But why is this? There are a few factors that contribute to the disparity in diabetes! To start, many racial minorities have to deal with barriers in their access to care. This can include a lack of insurance coverage and fewer local healthcare providers. Social determinants of health also play a big role. Factors like family income, education, employment, and neighborhood conditions impact health outcomes quite a bit. Lower-income communities often do not have transportation options and educational resources about diabetes management.
There has also been a demonstrated bias and systemic inequality in how healthcare is delivered. Studies show that racial minorities often get lower-quality care. This means fewer preventive screenings and less aggressive treatment options. Minority patients often delay or completely skip these exams because of cost, lack of awareness, or a distrust in the healthcare system. Furthermore, drugs are utilized for treating diabetic macular edema (DME) in patients of all races, but there are variations in treatment response among different racial groups. Consequently, increased diversity in clinical trial participation is critical to develop DME treatments that are effective for all patients.
Diabetes, Diabetic Retinopathy, and Diabetic Macular Edema
This disparity goes beyond just a diabetes diagnosis! It also impacts diabetic retinopathy and DME. Diabetes can lead to complications like diabetic retinopathy, a condition where high blood sugar damages blood vessels in the retina. Diabetic retinopathy affects about 1 in 4 people with diabetes. If left untreated, diabetic retinopathy can progress to DME, where fluid builds up in the macula, causing swelling and vision loss. About 1 in 15 people with diabetes get DME.
Racial minorities, especially Black and Hispanic Americans, are more likely to get diabetic retinopathy and DME than White Americans. Research shows that Black Americans are 40% more likely to develop DME, even when controlling for factors like income, diabetes management, and blood pressure.
Closing the Gap: What Can Be Done?
Addressing disparities in diabetes and DME requires a thoughtful and proactive approach.There are a few steps to take! The critical first step is expanding access to preventative care, as early detection is crucial for preserving vision. Eye screening is the best way to catch DME early, before it progresses and damages vision. Free or low-cost comprehensive annual eye exams can help tremendously. Insurance coverage related to diabetes can also be expanded for vision care services.
Another important factor is increasing the diversity among healthcare providers! In 2017, medical school graduates were 58.9% White, 24.6% Asian, 8.9% Hispanic, and 7.2% Black. While diversity has increased from earlier in the decade, those numbers do not mirror the population itself. The National Academy of Medicine has concluded ‘increasing racial and ethnic diversity among health professionals...is associated with improved access to care for racial and ethnic minority patients.”
What does the data show?
Evidence suggests that when patients and providers are the same race or ethnicity, there are improvements in:
- Time spent together
- Medication adherence
- Shared decision-making
- Wait times
- Cholesterol screening
- Patient understanding ov cancer risk
- Patient perceptions of treatment decisions
- A reduction in implicit bias
Patient education and awareness is an important part as well! Education around diabetes, diabetic retinopathy and DME can improve understanding around these conditions. With better awareness about warning signs and risk, people will be more likely to get care for themselves or loved ones.
We have a long way to go to reduce disparities in how diabetes and DME are treated. The reasons behind this are largely rooted in social, economic, and systemic inequities. But understanding why this is the case is half the battle. By being better informed, patients and providers can take steps to improve how we diagnose and treat conditions like DME.
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