We know obesity is a basic risk factor for diabetes. If we can control our weight by making moderate modifications in what we eat and what we do, then we can significantly reduce our risk for diabetes even if we have a family history. It’s a fact that can be confirmed by Dr. Monica Peek, assistant professor in the Division of General Internal Medicine at the University of Chicago where she provides clinical care, teaches and does health services research in the area of health disparities.
Here are the facts:
- In 2013, 29.1 million Americans, or 9.3 percent of the population, had diabetes.
- African Americans (13.2 percent) are almost twice as likely to be diagnosed with diabetes as non-Hispanic whites (7.6 percent).
- On average, Hispanics are 1.7 times as likely to have diabetes as Whites. In 2008, the death rate from diabetes in Hispanics was 50 percent higher than the death rate of non-Hispanic Whites. (HHS Office of Minority Health)
Here, Dr. Peek speaks with rolling out to call attention to the disparate impact of diabetes in the African American and Hispanic communities as well as their innovative programs across the country that are improving patient engagement and health outcomes.
Why are people who appear perfectly healthy and are not overweight, diabetic?
Type 1 diabetes is an autoimmune disease. The body’s immune system is attacking the pancreas. The pancreas helps you make insulin and regulates all your food. It is not weight related.
Type 2 diabetes is a mismatch between the pancreas’ functional capacity and our weight. Basically, we’re putting too much weight on our frame and our pancreas can’t keep up with what our body increasingly needs because of the excess weight.
Is the treatment the same for both types?
Most likely when you see adults who look completely healthy and have diabetes, it’s probably type 1. Their pancreas is all shocked and they have to have insulin [shots] because their body doesn’t make insulin at all.
Whereas people who have type 2 diabetes may be on insulin; their bodies may not make enough. They can be on medication to help their bodies make insulin, to be more receptive or sensitive to the insulin their body does make or they can supplement their insulin needs. There are a variety of ways to treat type 2 diabetes as opposed to type 1 — all bets are off, you have to have insulin.
Is diabetes hereditary?
There are some forms that are strongly genetic and we can point to the gene. Most cases are [due to] a familial history that predisposes you. Just like we tend to look like our family members in pictures, well so do our insides. There’s an increased risk but not like sickle cell genes. The genetics aren’t as [definitive] for most kinds of diabetes. There are a few cases where there are gene mutations that you will have diabetes.
Most people who have diabetes have type 2. In the African American community, what’s really driving diabetes is obesity. There’s an inability for people to modify their environment sufficiently — what they eat and what they do. If they live in a food desert and don’t have access to the best, healthy foods at a reasonable cost or they may not have safe neighborhoods where they can exercise, have the facilities or the resources. They may not have access to the physicians to provide medications and counseling. Or there are barriers to preventing or controlling diabetes. Most poor communities are disproportionately of color. What we’re doing is assessing these factors and looking at the epidemic from multiple standpoints — what’s keeping people in our communities from doing well with diabetes.
What services do your organization provide?
We want to make sure they have all the information, skills and tools to manage diabetes at home and within their family context as well as when they go to the doctor and to help negotiate their treatment decision.
Providers need to have a [customized] paradigm for how to treat people with diabetes. The health personnel need to be more conducive and the environment needs to be better.
We have a large community footprint. We collaborate with a myriad of community organizations, businesses, advocacy groups and faith-based organizations to help people in community settings.
How is your body mass index indicative of your risk for diabetes?
Obesity is a major risk factor for diabetes. Your BMI measures your height and your weight proportion and tells if you are overweight or obese.