How Type 2 Diabetes Affects Black Americans

Several socioeconomic and environmental factors may contribute to why type 2 diabetes disproportionately affects Black Americans.

If you’re Black or African American, type 2 diabetes may affect you differently compared to white people and other races.

A staggering 37 million U.S. people are living with diabetes. Of those, about 90%–95% are living with type 2 diabetes.

Type 2 diabetes affects people of all races, but African American adults are 60% more likely to be diagnosed than non-Hispanic white people.

We took a deep dive and asked the experts how type 2 diabetes affects Black people, why it’s more common, and how you can work effectively with a diabetes care team.

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Why are Black people more likely to develop type 2 diabetes?

According to Jayne Morgan, MD, several factors contribute to the increased likelihood of Black people developing type 2 diabetes.

She notes that some factors include ones you might not consider, “such as access to housing, education, and career advancement.”

“Housing is the main factor in determining what types of foods are eaten, whether someone lives in a food desert (no fruits or vegetables nearby), whether there is a pharmacy within 5 miles of [their] house, and if fast and processed food is cheaper and more accessible than a supermarket, therefore helping to make budget decisions that ultimately can impact long-term health,” she says.

This can all increase the likelihood of developing obesity, especially fat around the abdomen, and insulin resistance, which are both risk factors for type 2 diabetes.

It isn’t just housing and access to food and pharmacies that can lead to the development of type 2 diabetes. Cultural and generational factors can also contribute.

Dr. Eugene E. Wright, Jr. says that a combination of some potential genetic predispositions, lived experiences, environmental exposures, and social determinants — including access to healthy foods, safe exercise spots, lacking medical care, and mistrust of healthcare facilities or doctors — all contribute to the increased occurrence of type 2 diabetes.

Serena Valentine, a diabetes peer educator, zeroed in on family culture as a contributing factor. She notes that both good and bad habits get passed down from generation to generation.

“I believe that this is the reason why we may find people who are a part of the same family with the same types of illnesses. Lifestyle habits are learned from birth and will continue unless a change of course happens,” Valentine says.

She adds that some people in Black communities often just accept type 2 diabetes as something you “get,” instead of as a preventable disease.

In summary, some of the reasons for an increased rate of type 2 diabetes among Black people include:

• limited access to nutritious foods (often referred to as “food deserts“) where processed foods and restaurant items are easier to access
• mistrust of doctors and care professionals
• lack of educational materials concerning risk factors and care for type 2 diabetes
• difficulties in changing habits, which can include a lack of access to safe places to exercise and cultural pressures to accept type 2 diabetes as a part of aging

Patient-doctor relationships

Each of the experts noted another trend: Many African Americans share a general mistrust of the medical community, mainly due to systemic racism.

“There is a disconnect where education about diabetes is concerned,” Valentine says. “This may be due to a lack of trust in healthcare providers.

“When there is mistrust, there will definitely be lack of communication and hesitancy to ask questions during doctor visits. Therefore, this causes the members of Black communities to share information amongst themselves that may be true or may not be true,” she says.

As a result, people in Black communities may not learn about and potentially address the different modifiable risk factors that could help them prevent type 2 diabetes from developing.

Improving relationships with Black communities can take time but it is possible.

“Providers can begin by taking an inventory of the communities that surround their doctors’ offices/clinics. It would help to be able to direct patients to untapped resources that are within these communities. Providers are in the best position to distribute this type of information to their patients,” Valentine says.

Increased complications

Black people are also more likely to develop diabetes complications compared with other groups.

In fact, non-Hispanic Black people were 2.5 times more likely to be hospitalized with diabetes and related complications than non-Hispanic white people in 2019.

Many of the same factors that increase their risk of developing diabetes also contribute to their chances of having a complication associated with type 2 diabetes.

Morgan says some reasons for increased rates of complications include “less access to healthcare, more suspicion of medical facilities, and fewer doctors that reflect their culture.”

She adds that “all of these add up to often delayed medical care with more complications.”

The bottom line

Type 2 diabetes disproportionately affects Black people in the United States. Some of the reasons for this include lack of access to healthcare, medical mistrust, and limited access to nutritious foods.

If you’re living with type 2 diabetes, it’s important to keep in contact with a healthcare professional about every 3 to 6 months. If you’re facing challenges getting the care you need, you can always seek out a second opinion.

You can also check out Healthline’s Black Health hub or reach out to organizations for more resources and support, such as:

• Office of Minority Health’s OMH Resource Center
• BlackDoctor.org
• American Diabetes Association