Group 1

Sara B., Erica A., Kiera B., Rushi, and Katelyn Algas
11/20/12
Professor W.
Health 201-701
Type 2 Diabetes: A Health Disparity Amongst Young Black Women
The high prevalence of type 2 diabetes in young African American women in
urban cities is linked to low socioeconomic status, low health literacy, and a lack of
resources, compared to other groups, which calls for the collaboration of a team of
multidisciplinary health care representatives to help solve the disparity.
Young African American women in urban cities are prone to type 2 diabetes as a
result of their low socioeconomic status. Low socioeconomic status places a handicap on
African American women, ultimately affecting their health. For instance, in an article
titled, African American Women and Diabetes: A Sociocultural Context, the author
gives statistics of African Americans socioeconomic status compared to whites. The
author writes, In general, blacks have fewer years of education and higher rates of
poverty than whites. In 1993 the poverty rate was 33.1 percent for blacks and 12 percent
for whites (Rajaram, 3). African Americans in general have higher rates of poverty and
do not typically reach as high of an education as whites in America. These numbers give
fuel to the fire in dealing with the prevalence of type 2 diabetes in African American
women as a health disparity. The author of this article also goes on to say that; Lower
socioeconomic status results in restricted access to quality health care. Recent data
indicates an inverse relationship between socioeconomic status and the prevalence of
diabetes amongst both black and white Americans(Rajaram, 3). Low socioeconomic
status inhibits the quality of health care a person may receive whether they are black or

white. In an article titled, Diabetes in African American Women, found in the

postgraduate medical journal the author mentions that low socioeconomic status in many
African Americans can contribute to the fact that many do not control the disease well.
For instance, the author states, African American diabetic patients are less likely to have
their treatment intensified to improve glycemic control. One possible explanation for this
phenomenon is that African Americans, as a group, have a lower socioeconomic status
than white Americans. Indigent patients have less access to health care and often present
with diseases that are already far advanced (Marshal, 1). According to the author, many
African Americans do not intensify their treatment to improve their glycemic control as a
result of their low socioeconomic status. The author also implies that because whites have
a higher socioeconomic status they are able to control their diabetes better than African
Americans.
As a result of the low socioeconomic factors that contribute to the high prevalence
of type 2 diabetes in African American women, lack of knowledge in regards to the
disease also constitutes as a health disparity amongst this population. In a study titled,
Diabetes in Urban African Americans: Functional Health Literacy of Municipal Hospital
Outpatients With Diabetes, researchers examined the actual and self-reported health
literacy of urban, primarily female, African American patients with diabetes. In the
results section of the study, in assessing the data, the author wrote, According to these
scores, diabetes patients in this urban public hospital have marginal functional health
literacy at best, with half of the patients having inadequate functional health literacy
(Nurss, 4). The participants in the study reported to have a less than basic health literacy
at best, with the majority having a below average health literacy. According to a cross

sectional study on health literacy titled, Association of Health Literacy with

Complementary and Alternative Medicine Use, the results of the study stated that
adequate health literacy was higher among whites, Hispanics, and other races compared
to blacks (Bains, 1). African Americans health literacy is poor compared to other races.
As a result of their low health literacy, they are not likely to take care of their disease as
well as they should or look into complimentary or alternative medicines as seen in the
cross sectional study. For example, the author stated that, Studies indicate that patient
health literacy skills are associated with disease knowledge and self-management,
medication adherence, quality of life, and clinical outcomes (Bains, 1). As the author
stated, health literacy is associated with a better control of the particular disease one has.
Due to the fact that African Americans as a whole have poor health literacy compared to
other racial groups, it explains why there is such a high prevalence of type 2 diabetes in
young African American women. Low health literacy, in addition to low socioeconomic
factors, play a huge role in the treatment and the development of type 2 diabetes in
African American women.
In addition to low socioeconomic factors and poor health literacy amongst African
American women, a lack of resources also plays a role in constituting type 2 diabetes as a
health disparity amongst the population. In urban communities especially, there are not
enough resources in place to promote a healthier lifestyle for many young African
American women. For instance, in an article titled The Unhealthy Truth: Obesity in the
Black Population of Chicago, author Anthony Clark states that, In Chicago, the
communities most likely to be in poverty and with the least access to health-improving
resources are the black and Hispanic communities of the inner city (Clark, 1). African

American communities in Chicago have a lack of health-improving resources, which

directly affects the rate of African American women with diabetes. In the poverty stricken
African American communities, healthy foods are not easily accessible or bought. For
instance, in Clarkes article he discusses this issue. He states:
Previous research from the Chicago Urban League found that most grocery stores
offering a range of items including fresh produce and low fat meal options were
located outside of the predominantly black inner city neighborhoods. The
convenience or corner stores that the residents of these areas are forced to shop
at feature high priced low nutrition foods that are easily consumed from the
package or with minimal preparation (Clarke, 12).
The author provides evidence that African Americans have a lack of resources to promote
better health. Grocery stores providing a wide range of fresh produce do not go to lowincome African American communities, which is why they are left with only convenience
stores. This lack of resources is linked with the high prevalence of type 2 diabetes in
young African American women in urban communities because they are not being
provided with a chance to eat enough healthy foods.
Along with diabetes being a health disparity, the medical and social implications
of the disease are vast. Diabetes mellitus - often referred to simply as diabetes - is a
condition in which the body either does not produce enough, or does not properly
respond to, insulin, a hormone produced in the pancreas. Diabetes is a defect in the
bodys ability to convert glucose (sugar) to energy. Glucose is the main source of fuel for
the body. Type 1 diabetes is when the body makes little to no insulin. Type 2 diabetes is
when the body is not producing sufficient quantities of insulin or when the body is
resistant to the insulin that is produced.
Diabetes is both a medical and social problem. It is a medical problem because
diabetes is when there is a defect in the bodys ability to convert glucose (sugar) to

energy. Insulin is either not produced in sufficient quantities or the insulin produced is
defective and cannot move the glucose into the cells. Diabetes also requires medication,
such as insulin shots or oral medication. Because diabetes has a medication it also has
side effects. Diabetes is a social problem because minorities are disproportionally
affected. Also, because of the role of finance of the disease, most people with diabetes
cannot afford the medication. Some distinct cultures and family issues complicate
diabetes management and health. People with diabetes have to be on a certain diet to
make sure there health is in order. Being overweight (obese) places extra stress on your
body in a variety of ways, including your bodys ability to maintain proper blood glucose
levels. In fact, being overweight can cause your body to become resistant to insulin.
Blood tests are used to diagnosis diabetes .All diabetes blood tests involve
drawing blood and sending the sample to a lab for analysis. Lab analysis of blood is
needed to ensure test results are accurate. Any one of the following tests can be used for
diagnosis: an A1C test is the blood test that reflects the average of a persons blood
glucose levels over the past 3 months and does not show daily fluctuations. When
diabetes is uncontrolled, there is too much glucose in the bloodstream. This extra glucose
enters your red blood cells and links up (or glycates) with molecules of hemoglobin. The
more excess glucose in your blood, the more hemoglobin gets glycated. By measuring the
percentage of A1C in the blood, you get an overview of your average blood glucose
control for the past few months. People with an A1C above 6.0 percent are considered at
very high risk of developing diabetes. A level of 6.5 percent or above means a person has
diabetes. The fasting plasma glucose (FPG) is a test that screens for diabetes by
measuring the level of glucose in a persons blood plasma after an eight-hour period of

fasting. A sample of blood is taken from a vein in the arm. If the blood glucose level is
greater than or equal to 126 mg/dl, the person is retested and, if the results are consistent,
diagnosed with diabetes. The oral glucose tolerance test measures blood glucose after a
person fasts for at least eight hours, and 2 hours after, the person drinks a liquid
containing 75 grams of glucose dissolved in water. If a persons glucose level is 200
mg/dL or above after they drink the beverage they are considered diabetic.
As of today, there is no cure for either type of diabetes, although there are many
ways of keeping diabetes under control. Diabetes treatments are designed to help the
body to control the sugar levels in the blood. Type 1 diabetes requires insulin. Injected
insulin replaces the insulin missing in the body. Diabetics will need to learn how to
balance their insulin with their food intake and their physical activity. It is important that
diabetics work with a diabetes educator and are under the care of a diabetes team, who
can assist you in managing your diabetes. Type 2 diabetes treatment will vary dependent
on your blood sugar levels. Many patients are counseled to change their lifestyle and lose
weight. It is important to work with a diabetes educator and dietitian. Treatment begins
with changing certain food choices and beginning an exercise program. Diabetes is a
progressive disease, and the treatment may change over time, requiring oral medication.
In many cases, doctors may need to increase the dose, give multiple medications, or start
on insulin.

As many working in the health care field can attest to, more than one medical
profession is needed in the minimization and resolution of any disease. In most cases,
long-term diseases take a psychological toll on patients, and family and friends may not

always provide the best support for those suffering. In these cases, the work of a social
worker can become vital in patient care. Evidence based research confirms that close
links between positive psychological adjustment and the well being and good
management of diabetes (Power). It is easy to conclude that when diagnosed with any
disease a poor sense of adjustment will arise. Specifically, when discussing diabetes,
patients tend to undergo a loss of self-esteem with the realization that their day-to-day life
will now be changing. This is where social work intervention becomes crucial in
maximizing the potential of a patients everyday life.
With that being said, social workers play the role of providing young African
American women with diabetes with coping methods in order to minimize, or eliminate,
the stress and psychosocial problems that occur upon diagnoses. When diagnosed at a
young age, it may be hard for an adolescent to understand what exactly will become of
their futures. It is important to note that; depression is about three times more common
among persons with diabetes than those without (Cox). With the support of a social
worker and their ability to include the family in everyday therapeutic exercises, an
adolescent will have access to everyday reminders on how to cope and move forward
with this disease. A social workers main goal is to help minimize the amount of negative
thoughts one with diabetes puts toward their life. Many strategies can be used to help an
adolescent in their everyday life, one method being the use of cognitive behavioral
therapy. This type of therapy is thought to raise self-esteem by modifying negative
thoughts into more constructive thoughts on how a patient can now approach their life
(Power). The advice and coping mechanisms that social workers may provide allow for a
minimization in the stress that can eventually take a physical toll on a diabetes patient. By

including an adolescent patients family, there is an everyday reminder to remove the

stress inducing negative thoughts.
Social workers also play a large role in the elimination of an African American
adolescent females diabetes condition worsening. By educating them on the importance
of a healthy lifestyle and the idea that just because the diagnoses is complete there are
still ways of making sure it does not become worse than it needs to be (Cox). Social
workers, through time, may develop a mutual understanding with the patient and be able
to provide information in a language that allows the patient to understand its importance.
Another important way a social worker can impact, maybe prevent, a child developing
diabetes is policing them, warning them, on the importance of an active and healthy
lifestyle and making points using adults that have developed diabetes through an
sedentary and unhealthy lifestyle (Cox).
Educating patients of the needs and care that will become crucial to keeping their
disease progression at a minimum is only one of the many interdisciplinary fields that
will be involved in the care of diabetes. The work of a social worker is one that will be
influential during the patients entire lives. Whether or not a patient is meeting with this
social worker consistently may not always matter. What matters are the tools and
strategies a patient is given in order to live their everyday life to its full potential. A social
worker, along with other disciplinary fields, can prolong a patients life, and if not
prolong, then they can improve that patients quality of life no matter how long it may
last.
Another person who can minimize, resolve, or eliminate type 2 diabetes in
adolescent African American women is a primary care physician. One way a primary care

physician can minimize diabetes is to screen patients for pre-diabetes. Sam Dagago-Jack,
MD, FRCP from the Division of Endocrinology, Diabetes and Metabolism, University of
Tennessee College of Medicine, stated that pre-diabetes has five times the prevalence of
diabetes mellitus (DM) (Clarke 1). The Diabetes Prevention Program Research Group
affirmed how a trial of the US Diabetes Prevention Program affected people with prediabetes:
The US Diabetes Prevention Program (DPP) trial showed that most people with
pre-diabetes will likely develop type 2 diabetes within 10 years unless they make
modest changes in their diet and level of physical activity, which can help them
reduce their risks and avoid the debilitating disease (Diabetes Prevention Program
Research Group qtd. in Clarke 1).
The US Diabetes Prevention Program trial included the largest number of minorities to
date in this type of study, and demonstrated that preventive measures can be efficient in
this population. This trial compared the differences between lifestyle modification and
treatment, as stated here:
The trial looked at the efficacy of lifestyle modification versus the use of
metformin in preventing the progression of patients with IGT [impaired glucose
tolerance] to DM [diabetes mellitus]. Metformin helps to control diabetes by
enhancing peripheral insulin action and inhibiting hepatic gluconeogenesis
(Clarke 1).
Lifestyle modification included cutting dietary fat and calories and by exercising at a
minimum of thirty minutes daily, five days a week. Most participants chose walking.
Three thousand participants were used, and 17% were African American and 45% were
minorities. Results revealed that these lifestyle changes resulted in a 5% to 7% weight
loss, reducing the incidence of type 2 diabetes by 58%. Every group evaluated had a
greater benefit from lifestyle changes than from metformin at an approximate 2:1 ratio.
Each minority group had greater benefits from lifestyle modification (Native Americans,

75%; Hispanics, 65%; African Americans, 60%) than whites at 40% (Clarke 2).
Minorities are disproportionately affected by type 2 diabetes, but by changing their
lifestyle choices, it effectively reversed the disease in these groups. Although this study
included African Americans, it did not mention the ages of the participants. Adolescent
patients are different to work with compared to adults, especially when they have the
disease. It is important for the primary care physician to find ways for his or her
adolescent patients to work with their diabetes.
A primary care physician can help resolve diabetes for adolescent African American
women by helping them find ways to fit diabetes into their lives. In a study done from
September 2003 to June 2005, adolescents aged thirteen to nineteen years were asked
questions by trained group facilitators about their self-management of their diabetes.
Their answers were audiotaped and written down. They were then coded, resulting in four
common domains: adolescent psychosocial development, role of others with diabetes,
environmental influences, and adolescents problem solving/coping skills. The majority
of the participants were African American, and 62% of the participants were female.
Primary care physicians were mentioned under adolescent psychosocial development and
environmental influences. A common theme for adolescents was rebellion. Adolescents
were reluctant to accept what adults were telling them or rejecting the diabetes goals set
up by parents. Adolescents gave examples of rebellious (or mock rebellious)
behaviors, such as pretending to complete an action, making it appear as if sugars were
checked, or pretending to not listen to adults when speaking (Mulvaney 677). They also
deceived parents or healthcare providers by taking the batteries out of their meter to erase
data or using another persons blood for a reading. Adolescents also had their views on

health care. Anxiety was noted related to clinic visits and the short- and long-term
consequences of diabetes (Mulvaney 680). There were also healthcare providers who
gave recommendations for self-management to most of the adolescent patients: eat
breakfast, count carbohydrates, what to eat, or get counseling. However, simply telling
adolescent patients what to do may not be enough. Perhaps things should be broken down
in parts.
In order for a primary care physician to be efficient in helping adolescent African
American women, he or she should start slowly by breaking things down in parts. In an
article by Ponder, Sullivan, and McBath, they explained how clinicians should start with
adolescent patients and how to help them change their habits:
Clinicians should start slowly, trying to focus on two or three behavior change
goals to work on for each visit. If clinicians advocate a comprehensive change in
an adolescents eating behaviors, it only serves to discourage the teen and the
family, thus limiting adherence in other areas of self-management (Ponder 13).
By starting slowly like this, the anxiety mentioned in the study by Mulvaney may
decrease, and diabetes may become more manageable. Another thing that a primary care
physician can help with is to incorporate exercise into the life of the adolescent patient to
help them with weight management. However, an overly ambitious exercise prescription
can result in poor adherence and frustrate teens and their families (Ponder 13). The
primary care physician can first suggest walking, which is a good start for most inactive
teens. If there is an activity a patient enjoys, such as dancing, skating, or a team sport,
encouraging the patient to continue with such activities can be done. The primary care
physician should work with each child, and come to a mutual agreement on the type and
amount of activity (Ponder 13). Then a healthy pattern of regular activity can be
established, but it should be started slowly and for short periods of time to build

tolerance. By having the primary care physician break down the management of diabetes
for adolescent African American women, type 2 diabetes will be more manageable, and
they will be more willing to do what the primary care physician tells them to.
The nutritionist is very essential to the health care team. In urban cities, a
nutritionist can help lower the prevalence of diabetes in young African American women
by being in local grocery stores, providing health literacy in communities, and by setting
up appointments with the young women.
First of all, the way a nutritionist can help prevent diabetes in young African
American women is by being available to local grocery stores. This is where families get
all their food and drinks from, so if they do not know what the healthiest item to buy is,
they are already making the problem worse. A nutritionist can conduct a tour of the store,
identify healthy food choices, and review food labels with customers. An example of this
is, Recently, Kristen Decker, the dietitian at the Utica Ridge Hy-Vee in Davenport, Iowa,
just across the Mississippi River from Moline, spent her morning preparing Fast Fit
Meals, a program that supplies three meals and two snacks a day totaling 1,200 to
1,500 calories to cover five days a week. The shoppers pay $75 a week, and pick up the
food and instructions to prepare it for each day of the week (Strom) The results of
someone trying this out after having a total cholesterol of 332 were that, He called that
day, two months later, because he had been to the doctor and his cholesterol had dropped
to 170 and he had lost 27 pounds (Strom). With these results occurring, local grocery
stores in urban cities should implement a nutritionist in their stores.
Furthermore, a major problem that leads to diabetes in young African American
women in urban cities is the lack of knowledge about the subject. They do not have high

health literacy about diabetes nor about their health in general. A nutritionist can go to
schools, do presentations, pass out pamphlets, or even do a small workshop on eating
healthy foods. Another way the nutritionist can improve the health literacy of the young
African American women is by maybe doing an after-school class, which is not only
exclusive to students, but opening up that class to the community as well. The School
Health Education Evaluation found that a minimum of 50 hours were needed to impact
behavior. However, students in this study only participated in a minimum of 6 hours of
nutrition education. Thus, changes in dietary behavior were minimal, yet significant.
Ideally, more instruction hours would yield a more positive impact on behavior. In the
present study, longer term education could not be provided due to educational costs and
time restrictions (Powers). This study shows that kids who participated in the afterschool program saw changes in their diets, and if they were given more time, there would
have been significant changes in their diets. If the young women are informed on the
topic, they will make better choices and eat healthier.
The nutritionist plays a pivotal role in preventing diabetes in young African
American women. They give advice on eating healthier, buying the right kind of food,
and overall having a positive mentality during this process. Without the nutritionist, these
young women will not know what the right thing to do is. In the long run, the nutritionist
will help them live longer.
Type 2 diabetes in young African American woman is a health disparity that can
be resolved with the help of a multidisciplinary health care team consisting of social
workers, primary physicians, and nutritionists. With these three disciplines working
together, they can help minimize the prevalence of type 2 diabetes amongst young black

women. These three disciplines work together to attack the mind and body of a patient to
promote their general well being.

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