The history (and future) of diversity in diabetes

There have long been glaring disparities when it comes to diversity in diabetes care. Racism, implicit bias, and discrimination are as entrenched in healthcare as they are in every other societal institution.

For Black, Indigenous, and people of color (BIPOC), the mistrust is longstanding. This skepticism is valid when you consider the role the U.S. Public Health Service played in the heinous Tuskegee syphilis study, which led to the mistreatment of 600 African American men and the untimely death of more than 120 between 1932 and 1972.

While there has been some advancement in the 50 years since the Tuskegee experiment, justice has been slow to come. Today, as a Black woman living with a chronic health condition, I often think about what Black people dealt with then, and I'm now hyper-vigilant about my interactions with health professionals.

The fight for health equity

During Barack Obama's historic presidency, the administration faced significant opposition in its fight to sign the Affordable Care Act, also known as Obamacare, into law. Though not perfect, Obamacare leveled the playing field by making it illegal for insurance companies to deny coverage to those with preexisting health conditions, and it enabled children to remain on their parents' health insurance until age 26.

These were small victories, but when you consider that health insurance premiums and policies still remain higher for minority patients — and often exclude coverage for new technologies that could help those living with diabetes achieve optimal health — it's still a pressing issue.

A report published by the American Diabetes Association (ADA) found that 34.2 million Americans, or 10.5% of the population, have diabetes. More specifically, nearly 1.6 million Americans have type 1 diabetes (t1d), including 187,000 children and adolescents. Of those with the condition, 12.5% are Hispanic, 11.7% are African American, 14.7% are American Indian/Alaskan Natives, and 9.2% are Asian American, compared to 7.5% who are white. Yet, health insurance for these minority communities remains drastically underfunded.

The pandemic highlighted health disparities

Underfunding became even clearer at the height of the COVID-19 pandemic. COVID-19 killed Indigenous, Black, and Pacific Islander Americans at alarmingly higher rates than other races due to underlying health conditions like heart disease, cancer, and diabetes.

As a Black woman who has lived with t1d for more than two decades, I've dealt with negligent physicians and insurance companies, and I've had to advocate for my health. While I know my rights, I worry about those who aren't as informed. Their lives matter, and they should also have access to affordable insulin and life-saving technologies (such as continuous glucose monitors, or CGMs, and insulin pumps) to make their lives healthier. Diabetes is a condition that touches all cultures, yet minority communities remain grossly underserved and underfunded.

The CDC's efforts to assist those with diabetes

The COVID-19 pandemic and civil unrest following George Floyd's death finally shifted longstanding tides of racism in healthcare. The Centers for Disease Control and Prevention (CDC) partnered with public and private organizations to launch the National Diabetes Prevention Program, an affordable, evidence-based lifestyle change program to assist people with prediabetes prevention.

Additionally, the CDC website lists a national registry of recognized organizations (organized by state) that have been funded to provide in-person programs in underserved areas. Along with in-person delivery, the programs can also be accessed online, by distance learning, and through a combination of these formats. Participants work with a trained lifestyle coach to learn how to make better food choices, be more physically active, and find ways to cope with problems and stress.

The Appalachian Diabetes Control and Translation Project helps reduce the impact of type 2 diabetes among people who live in high-risk, economically distressed Appalachian communities. And the Native Diabetes Wellness Program aims to help prevent diabetes among at-risk Native Americans.

Other initiatives to help underserved communities

The Health Equity Bill of Rights established by the ADA lays out 10 basic rights for the 122 million Americans living with diabetes and prediabetes. It's meant to promote the human right to health, including access to affordable insulin and other medications, healthy food, insurance that covers diabetes management, and the latest medical advances.

In partnership with Medtronic, one of the world's largest medical technology, services, and solutions companies, the ADA launched the Technology Access Project (TAP). TAP offers access to diabetes technology regardless of gender, race, income, or location. Medtronic also committed $16 million in Health and Education Partnerships to address racial disparities and advance social justice in Black communities through its Medtronic Foundation.

Four insulin manufacturers (Lilly, Sanofi, Novo Nordisk NovoCare, and Mannkind Support Programs) have also stepped up. Lilly Insulin Value Program limits insulin prescription costs to $35 a month for the uninsured.

Meanwhile, Abbott Labs was the first Anchor Sponsor of Health Equity Now, committing $5 million over three years to bring improved diabetes care to underserved communities. Abbott is the maker of the Freestyle Libre Sensor, a CGM system that replaces the need for fingersticks and the costly test strips required to monitor blood sugar levels.

While the initiatives implemented within the last year are good first steps to creating an equitable healthcare system in this country, I think there's still much work to be done. It's been a long journey toward fair treatment — not just for diversity in diabetes care but in all areas of healthcare for BIPOC communities that need it most.

Curious to learn more about the history of diabetes? Explore the Health Insights blog for more information around the condition's discovery and the evolution of modern management efforts.