June 2003 � When a person is diagnosed with diabetes, race and ethnicity can mean the difference between life and death says Ranjita Misra, a Texas A&M University professor who specializes in health and kinesiology in minority health disparities.
Her research, published in the �Journal of the National Black Nurses Association� on Type-II or adult-onset diabetes, has shown the disease is the fourth-leading cause of death in America. For African-Americans, the incidence of the disease is 50 to 100 percent higher than for Caucasians.
The American Diabetes Association says diabetes mellitus is sometimes described as �high blood sugar.� In reality, �sugar� is only one component of the disease. It may be broadly described as a chronic, systemic disease characterized by abnormalities in the metabolism of carbohydrates, proteins, fats and insulin and abnormalities in the structure and function of blood vessels and nerves.
Because it is a systemic disease � affecting the entire body � Misra says factors such as mental and physical health, social support, acceptance of the disease, health promoting behaviors and glycemic control are keys to living longer after its onset.
Acceptance � the opposite of being in denial when diagnosed with diabetes � is believed to promote good health behaviors and a longer life. However, Misra�s research has shown this may not always be true for minorities.
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�African Americans, for example, already have a much higher incidence of micro and macro vascular problems that result in loss of vision, kidney disease, high blood pressure, heart disease, stroke and circulation problems,� she said, adding that all of these also are problems that typically result from diabetes.
In working with the new Center for the Study of Health Disparities at Texas A&M to examine some of these problems, Misra advises physicians and health professionals to carefully monitor high-risk patients for the disease.
�The longer one has diabetes, the greater chance of it affecting the body. Individuals with poor control, as determined by a high hemoglobin A1C level (a test measuring blood glucose levels over a 2-3 month period) and high fasting blood sugar levels, should be educated about health-promoting behaviors,� she said. These include good nutrition, including following the exchange diet; physical activity; knowledge of the disease and its complications; social support; and disease management by regular blood tests and medications.
Normal blood glucose levels range from 70 to 110 mg/dl. Misra points out there are many individuals whose fasting blood sugar is over the normal level but below the level defined as diabetes (i.e., between 110 to 125 mg/dl). She says these people are called �pre-diabetics� or have impaired glucose levels. Prevention programs should focus on them in an effort to prevent or delay the onset of the disease.
�I want people to understand that this is a very serious disease. If you have it, you will develop serious complications,� Misra states. �Because African-Americans, Latinos, Native Americans and Pacific Islanders are more prone to the resulting complications of the disease, it is most important they maintain good blood sugar and blood pressure control.�
Control comes through regular exercise and a diet low in carbohydrates and fats and a good attitude about maintaining health, she adds. Good social and family support helps encourage and sustain this attitude. Diabetics who practice some form of spirituality also find their stress levels to be lower. Misra says reducing stress has a direct connection to reducing glucose levels.
Misra is currently studying a population of Indian Americans (those whose ancestors immigrated to the United States from India) as part of a national study with sites in Houston, Phoenix, Washington, D.C and Edison, N.J. Indian Americans have a high rate of heart disease as well as a high genetic predisposition for both heart disease and diabetes. Her preliminary results in Houston indicate they have high rates of diabetes and metabolic syndrome (the clustering of certain lipid and glucose abnormalities).
The rate of diabetes in Caucasian Americans � described as �epidemic� at six percent � is approximately 18 percent in Indian Americans, her preliminary analysis shows.
Misra hopes her studies will lead to a better understanding of the disease and better outreach and health education in minority populations and eventually result in reducing the number of early deaths from diabetes.
Source: Texas A&M University
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