This year, the American Diabetes Association is celebrating its 75th anniversary. As part of this celebration, we honor progress in diabetes treatment, management and quality of life, and the Association’s role in these advancements. While tremendous progress has been made, much needs to be done to close the disparity gaps for minority populations such as the African-American community.
To learn more about the successes and challenges for Black History Month, we talked to Sam Dagogo-Jack, MD, President, Medicine & Science.
Samuel Dagogo-Jack, MD, President, Medicine & Science, American Diabetes Association
What advancements have benefited African Americans with diabetes the most in the areas of diabetes management, prevention, education and advocacy?
A child with diabetes in 1920 was not expected to survive one year. Thanks to the discovery of insulin and advances in medical research, people with diabetes today live longer, fuller lives. Much progress has been made since the founding of the American Diabetes Association in 1940, and the increased knowledge has improved the lives of ALL persons with diabetes, regardless of race or ethnicity.
The Association has been at the forefront of this knowledge revolution. Our expert panels have helped streamline the definition and diagnostic criteria for diabetes and created the Standards of Medical Care in Diabetes that the rest of the world follows. Our support and funding for research has been integral to the discovery of basic mechanisms and innovative approaches to diabetes management and prevention. Our advocacy and outreach programs fight discrimination and empower people with diabetes and their loved ones to lead fulfilling lives.
Although there has been progress, the rate of diagnosed diabetes among the African-American community is still high (13.2%) compared to whites (7.6%) and Hispanics (12.8%). Why is this?
We don’t know exactly why diagnosed rates of diabetes differ so markedly across racial/ethnic groups; it is a matter of ongoing research and inquiry. For example, we have identified more than 50 genetic markers that affect diabetes risk, but none of these explain the racial differences.
What has emerged as the most uplifting discovery from the National Institutes of Health’s Diabetes Prevention Program is that interventions are equally effective in warding off type 2 diabetes among high-risk persons from all backgrounds. So that’s good news.
What about African-American researcher/clinicians?
As professionals, African Americans are among the under-represented groups in biomedical research. To address this problem, the National Institutes of Health and the Association have special mentorship programs to help expand the pool of health professionals and researchers in the field. Over time, these foundational efforts will lead to a multicultural, diverse research workforce and create new mentors for future protégés in a kind of virtuous cycle.
Over the past 15 or so years, the Association has funded 55 Mentor-Based Minority Fellowships that trained 69 new fellows in diabetes research. There is much to be said for diversity among the guardians of our science, tasked with the creation and dissemination of new knowledge.
Have there been advancements in other areas of the African-American diabetes community, aside from public health awareness?
The progress that has been made in diabetes is real and palpable. Research released in 2014 by the Centers for Disease Control and Prevention (CDC) indicate major declines in the rates of diabetes complications between 1990 and 2010, a trend that continues. For example, heart attack rates declined by nearly 70 percent, the rates of stroke and amputations decreased by more than 50 percent each and end-stage kidney disease fell by nearly 30 percent.
As pointed out by the authors, the magnitude of these improvements did not differ appreciably according to sex or race. For instance, the decrease in amputation rate was 51.9 percent in whites and 58.7 percent in African Americans.
You are currently studying diabetes prevention and prediction in multiethnic populations. What interested you in this topic?
My research group is interested in uncovering biological causes of racial/ethnic disparities in the development of blood glucose abnormalities. In our ongoing Pathobiology of Prediabetes study, we have recruited African Americans and Caucasians, all of whom have one or both parents with type 2 diabetes. The study participants join with normal blood glucose levels and are tested repeatedly until some of them develop prediabetes, the precursor to type 2. The repeated tests include measurement of weight, diet and exercise habits, insulin secretion, insulin sensitivity, body fat, energy expenditure and so on. As part of the program, those who develop prediabetes are offered lifestyle intervention to help prevent their progression to type 2 diabetes.
The results we’re collecting should help us determine what factors trigger the development of prediabetes. Importantly, our data would help determine if, and to what extent, race leads to an additional risk among people with a similar family history of diabetes.
One of the Association’s priorities is to aggressively focus on reducing health disparities as it relates to diabetes. As our new President of Medicine & Science, what do you think the Association needs to do to help close the gap?
The Association has an unflagging commitment to reducing and ultimately eliminating health disparities in diabetes. Given the historically multifaceted origins of disparities, the organization recognizes the need for broader coalition and partnerships with kindred organizations (government agencies, policy makers, professional associations, managed care, industry, etc.). To reach that goal, the Association has held Health Disparity Summits that have brought numerous important stakeholders to the table, and we have always sent representation to summits and conferences convened by various organizations. There we share our mission of improving the lives of ALL persons affected by diabetes and our vision of “life free of diabetes and its burdens.”
The Association’s flagship programs, under the direction of the Health Disparities Committee, provide expert guidance in the areas of community education, outreach and training, and program evaluation focused on type 2 diabetes in high-risk populations. The latter programs have a comprehensive demographic footprint that encompasses African-American, Latino, Native American and Asian American/Native Hawaiian/Pacific Islander communities; we also have initiatives targeted at people with disabilities and young and older Americans. Our community education outreach programs reached more than 4.5 million people in high-risk populations in 2014!
In clinics and hospitals around the country, our Standards of Medical Care in Diabetes also provide a blueprint for standardized management of diabetes. If everyone with or at risk for diabetes receives the same quality care, that would help close the health disparity chasm.