Inequalities in diabetes care

America is doing a “god-awful job managing diabetes,” a specialist said at a recent forum hosted by The Hill digital news company.

Skyrocketing rates of diabetes in the United States are being met with “systemic inertia.”

African Americans and Native Americans have higher rates of diabetes than Caucasians. Speakers at the forum said disparities in access to diabetes technologies like insulin pumps and continuous glucose monitors have multiple causes but devastating effects.

We’re doing “a god-awful job managing diabetes,” said Dr. Gary Puckrein, president of the National Minority Quality Forum. “The numbers are insane. We’re not doing what we can.”

Dr. Sanjoy Dutta, vice president of research at JDRF, said “Blindness due to diabetes is completely preventable. It’s almost criminal not to address it, but we need a systemic push” to make care widely available.

Dr. Jasmine Gonzalvo, Purdue University, said working in a clinical setting “feels like putting fires out” and we need to get on the front end of prevention and treatments.

Puckrein said by 2030 the health care system will not be able to manage the increasing numbers of people with diabetes. In 2000, 3.5% of the U.S. population had diabetes and that has increased to 9.5%

Diabetes is the most expensive chronic condition in the United States, according to the Centers for Disease Control and Prevention with costs mostly incurred by people over 65 covered by Medicare. So this is truly a financial burden falling upon the government and taxpayers.

Increasing numbers of physicians are turning to a different approach.

Physicians Committee for Responsible Medicine, a non-profit with more than 17,000 doctors, recently sent a statement to the U.S. Senate Agriculture Committee calling on Congress to consider the growing evidence that meat and dairy are linked to chronic diseases including diabetes.

“Foremost in Congress’s minds should be rising rates of obesity in the United States, especially among people of color, and that nutrition policy in this country still does not warn against the risks of consuming processed meat or dairy, or the benefits of a plant-based diet,” stated Dr. Neal Barnard, adjunct professor of medicine at the George Washington School of Medicine and president of the Physicians Committee.

Obesity is linked to increased risk of diabetes.

Red meat also increases the risk of heart disease and certain cancers, according to the statement.

The American Diabetes Association reports annual costs for diagnosed cases are currently $327 billion and that’s projected to increase. More than 34 million Americans have diabetes and an additional seven million more Americans have diabetes but are undiagnosed.

Dr. Ananta Addala, pediatric endocrinologist at Stanford Medicine, said at the forum that disparities in care exist because the system is not “primed” to support minorities and people with low socio-economic status.

However, it is minorities and those in low socio-economic levels who are at high risk.

“The onus is on the system, not the individual,” Addala said.

Another approach to diabetes without medication and without devices like continuous glucose monitors and insulin pumps is promoted by Eric Adams who will become New York City’s second Black mayor on Jan. 1.

In his book, “Healthy at Last: A Plant Based Approach to Preventing and Reversing Diabetes and Other Chronic Illnesses,” Adams recounts his deteriorating health, eventual diabetes diagnosis and consultations with physicians who all advised medication. Then he saw Dr. Caldwell Esselstyn who advocates a whole food, plant based diet with no added oils.

Adams, who had been losing his vision and dealing with nerve damage, writes that within months he started to experience improvements in his health. He now follows a vegan diet and writes his ulcer healed, he lost weight, lowered his cholesterol, lowered his blood pressure and his vision improved.

In a New York Times podcast with Ezra Klein, Adams said he had wanted to deal with the cause of his diabetes, not treat the symptoms, and he wants other people, especially in the Black community, to connect chronic disease with diet.

Adams said, “The food we call soul food is slave food. We were forced to eat it. We were forced to put [in] sugar, oil, fatbacks, pig knuckles, pig ears. Our ancestors were extremely creative. They should be commended because working the fields and getting the scraps from the slave owners’ table and then finding a way to make it palatable, it just shows the creativity of the human spirit. But we’re no longer on the plantation physically, but we’re still there mentally, because each time that recipe is handed down, we are handed down the tradition of slavery.”

He uses a metaphor in describing his governing style as vegan, meaning don’t treat the symptoms, find the underlying causes and correct them. He said that applies to educational performance, incarceration rates, crime, policing and public policy issues.



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