Despite significant advances in diabetes management over the last few decades, glycaemic control in the US remains relatively poor, and racial/ethnic disparities may be a contributing factor to this troubling trend. A recent study published in the Journal of the American Medical Association (JAMA) by Venkatraman and colleagues revealed that among adults currently diagnosed with diabetes and receiving insulin, individuals who self-identified as Mexican American or non-Hispanic Black had the highest prevalence of severe hyperglycaemia. The study, which used data from the National Health and Nutrition Examination Survey (NHANES) survey among 2,482 adults to conduct a serial, population-based, cross-sectional analysis, revealed that this disparity might even be increasing.
Hyperglycaemia in diabetic patients, also known as high blood glucose, can affect the eyes, kidneys, nerves and heart even in non-severe cases. In severe cases, life-threatening ketoacidosis may develop. Unfortunately, according to Venkatraman and colleagues, Mexican American and non-Hispanic Black individuals who had been prescribed insulin had 2.29 and 2.48 times the odds of having severe hyperglycaemia, respectively, when compared with non-Hispanic Whites. This trend suggests that racial disparities may play a role in current diabetes outcomes, as these gaps have not changed between 1988 and 2020, and have even regressed for Mexican Americans between the 1990s and early 2000s compared with 2020.
Diabetes is a pervasive and growing disease in the US. According to GlobalData, diagnosed type 1 diabetes cases are expected to increase from approximately 1.79 million cases in 2023 to 1.88 million cases by 2029. Likewise, diagnosed type 2 diabetes cases are anticipated to increase from roughly 22.94 million cases in 2023 to 24.58 million cases by 2028. These trends make improvements to diabetes management imperative in order to prevent substantial increases in diabetes-related morbidity resulting from severe hyperglycaemia.
However, doing so may require structural changes to diabetes management, such as reducing the price consumers pay for insulin. Results from the study by Venkatraman and colleagues also revealed that individuals living at 130% above the federal poverty line were significantly less likely to develop severe hypoglycaemia. The same was true for individuals covered by health insurance. Given that Mexican American and non-Hispanic Black individuals are less likely to be covered by health insurance and are more likely to live below the 130% federal poverty line when compared to non-Hispanic Whites, interventions aimed at reducing the cost of insulin to consumers may also help to reduce this disparity. Other lifestyle and educational interventions targeting glycaemic control among patients using insulin may also benefit patients. Doing so could help reduce diabetes morbidity moving forward, even as the number of diagnosed prevalent cases increases.