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8/15/2000

Blacks' Risks for Diabetes Problems Could Be Reduced

Cheryl A. Thompson

Control of high blood pressure before the onset of diabetes should be added to clinicians’ efforts to decrease African-Americans’ excess risk for diabetic microvascular complications, researchers suggest.

By following for nine years a biracial group of adults who initially did not have diabetes, researchers found that the blacks who later had diabetes started with higher systolic and diastolic blood pressure than their white counterparts. The participants—more than 12,000 middle-aged adults in four U.S. communities—were classified as having diabetes if they had fasting serum glucose levels of at least 126 mg/dL, nonfasting glucose levels of at least 200 mg/dL, or a current prescription for a medication to treat diabetes or said a physician had told them they had diabetes.

Noting that blacks with diabetes have a much higher risk for end-stage renal disease, lower-extremity amputation, and blindness than do whites with diabetes, the researchers proposed that pre-existing high blood pressure in blacks contributes to this excess risk. Interventions aimed at reducing this population’s excess risk for microvascular complications could include controlling blood pressure before the onset of diabetes, the researchers suggested.

According to the researchers’ findings, reported in the May 3 issue of the Journal of the American Medical Association, black women had a 2.4-fold greater incidence of diabetes than white women during the nine years of observation, starting in the late 1980s. Black men had a 1.5-fold greater incidence of the disease than white men.

Through further analysis of the data, the researchers found that racial differences in potentially modifiable risk factors, especially obesity, accounted for almost 50 percent of the excess risk for diabetes among black women but not men. Efforts to reduce this excess risk among black women, the researchers proposed, might include strategies aimed at weight reduction, dietary modification, and increased physical activity.

To view the article, go to http://jama.ama-assn.org/issues/v283n17/pdf/joc91280.pdf.