Fast Facts Hispanics with Diabetes Cost Diabetes-related Complications Diabetic Retinopathy Diabetes-related Kidney Disease Amputations due to Diabetes Risk Factors for Developing Diabetes References Diabetes is the sixth leading cause of death in the United States.  As of 1999, approximately 16 million Americans, 5.9 % of the total population, had been diagnosed with the disease. Diabetes occurs more often among racial and ethnic minorities than among non-minorities, with a larger proportion of African Americans and Hispanics carrying the burden of the disease. Fast facts   Diabetes is the sixth leading cause of death in the United States. (1) All minorities, except Alaska Natives, have a prevalence of type II diabetes that is two to six times greater than that of the white population.(2)  Diabetes is the leading cause of kidney failure and accounted for 43 % of the new cases of ESRD among African Americans during 1992-1996.(3)  Frequency of diabetic retinopathy is 40 % to 50 % higher in African Americans than in white Americans, according to NHANES III data.(4)  African Americans with diabetes are much more likely to undergo a lower-extremity amputation than white or Hispanic Americans with diabetes. (3)  Diabetes occurs more often among minority than non-minority elders.(5) Hispanics with Diabetes Diabetes is particularly common among middle-aged and older Hispanic Americans. For those age 50 or older, about 25 to 30 % have either diagnosed or undiagnosed diabetes. Diabetes is twice as common in Mexican American and Puerto Rican adults as in non-Hispanic whites.  The prevalence of diabetes in Cuban Americans is lower, but still higher than that of non-Hispanic whites.(6) Cost Estimates of the economic costs of diabetes mellitus in the United States suggest that they are quite substantial and growing. Total cost estimates range from $2.6 billion in 1969 to $98.2 billion in 1997, with the highest estimate being $137.7 billion in 1995. Although several of the reports consider only direct costs, most include both direct and indirect costs. (7) Back to Top Complications Certain minorities also have much higher rates of diabetes-related complications and death, in some instances by as much as 50 % more than the total population.(8) Compared with white Americans, African Americans experience higher rates of diabetes complications such as eye disease, kidney failure, and amputations. They also experience greater disability from these complications. Some factors that influence the frequency of these complications, such as high blood glucose levels, abnormal blood lipids, high blood pressure, and cigarette smoking, can be influenced by proper diabetes management.(3 ) Diabetic Retinopathy Frequency of diabetic retinopathy is 40 % to 50 % higher in African Americans than in non-Hispanic white Americans, according to NHANES III data.(4) Pima Indians in Arizona and Native Americans in Oklahoma have both been shown to have higher rates of retinopathy than non-Hispanic whites.(8)  Retinopathy may also occur more frequently in African Americans than in non-Hispanic whites because of their higher rate of hypertension. In the San Antonio Heart Study, the rate of diabetic retinopathy among Mexican Americans was more than twice that of non-Hispanic white Americans. NHANES III also found that Mexican Americans had a twofold higher rate of diabetic retinopathy.(4) Diabetes-related Kidney Disease Diabetes-related kidney failure affects a much higher percentage of African Americans than non-Hispanic whites.(9) African Americans with diabetes experience end stage renal disease (ERSD)about four times more often than diabetic white Americans.(10)  Rates of early stage kidney disease (proteinuria) are higher among Hispanic Americans, African Americans, and American Indians than among the non-Hispanic white population. Diabetes is the leading cause of kidney failure and accounted for 43 % of the new cases of ESRD among African Americans during 1992-1996. Hypertension, the second leading cause of ESRD, accounted for 42 % of kidney failure cases. (3) Back to Top Amputations African Americans with diabetes are much more likely to undergo a lower-extremity amputation than non-Hispanic white or Hispanic Americans with diabetes.(3) The hospitalization rate of amputations for African Americans was 9.3 per 1,000 patients in 1994, compared with 5.8 per 1,000 non-Hispanic white diabetic patients. However, the average length of hospital stay was lower for African Americans (12.1 days) than for non-Hispanic white Americans (16.5 days).(3) Risk Factors for Developing Diabetes A family history of diabetes increases the chance that people will develop diabetes.      The San Antonio Heart Study showed that the prevalence of diabetes among Mexican Americans who have first-degree relatives (e.g., parents) with diabetes was twice as great as for those with no family history of diabetes. There are also medical and lifestyle risk factors, including impaired glucose tolerance, gestational diabetes, hyperinsulinemia and insulin resistance, obesity, and physical inactivity.(6) Being overweight is a major risk factor for type II diabetes.       The NHANES surveys found that being overweight is increasingly common in the United States, among both adolescents and adults.(11,12) Hispanics are more likely than non-Hispanic whites to be overweight.  Mexican American adults, particularly women, have substantially higher rates of obesity than non-Hispanic white Americans, but rates that are similar to those of African Americans.(11,12)   Mexican American women, especially when they are overweight, have higher rates of gestational diabetes than non-Hispanic white women.(13) In addition to the overall level of obesity, the location of the excess weight is also a risk factor for Type II D iabetes.      Excess weight carried above the waist is a stronger risk factor for diabetes than excess weight carried below the waist. African Americans have a greater tendency than members of other racial groups to develop upper-body obesity, which increases their risk of diabetes.(14) Regular physical activity is a protective factor against type II diabetes and, conversely, lack of physical activity is a risk factor for developing diabetes.      Researchers suspect that a lack of exercise is one factor contributing to the high rates of diabetes in African Americans. In the NHANES III survey, 50 % of African American men and 67 % of African American women reported that they participated in little or no leisure time physical activity.(14) For more information on the effect of diet and physical activity on health, go to Nutrition. Back to Top References 1. Diabetes Disparities Among Racial and Ethnic Minorities. November 2001. AHRQ Publication No. 02-P007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/diabdisp.htm 2. Diabetes in American Indians and Alaska Natives Fact Sheet, National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, NIH Publication No. 99-4551, April 1999. 3. Diabetes in African Americans Fact Sheet, National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, NIH Publication No. 98-3266, June 1998. 4. Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 1998;21(8):1230-5. 5. Buchowski MS, Sun M. Nutrition in minority elders: current problems and future directions. J Health Care Poor Underserved 1996;7(3):184-209. 6. Diabetes in Hispanics Fact Sheet, National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, NIH Publication No. 98-3266, June 1998. 7. Songer TJ, Ettaro L, and the Economics of Diabetes Project Panel. Stidies on the Cost of Diabetes. National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Atlanta, GA: CDC, June 1998. 8. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996;125(3):221-32. 9. Perneger TV, Brancati FL, Whelton PK, Klag MJ. End-stage renal disease attributable to diabetes mellitus. Ann Intern Med 1994;121(12):912-8. 10. Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawthorne VM. Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes. N Engl J Med 1989;321(16):1074-9 11. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149(10):1085-91. 12. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. Jama 1994;272(3):205-11. 13. Hamman RF, Marshall JA, Baxter J, et al. Methods and prevalence of non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. Am J Epidemiol 1989;129(2):295-311 14. Crespo CJ, Keteyian SJ, Heath GW, Sempos CT. Leisure-time physical activity among US adults. Results from the Third National Health and Nutrition Examination Survey. Arch Intern Med 1996;156(1):93-8. This research was supported by a National Library of Medicine (NLM) Publication Grant #5G08 LM07653-02 in support of the creation of a web site titled Factline: Tracking Health in Underserved Communities, www.factline.org. Saqi S. Maleque, MSPH, Researcher, Principal Investigator: Virginia Brennan, PhD.