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Complication rates caused by diabetes have improved overall for all races. However, there continue to be racial disparities.

A 2021 study published in the journal Current Diabetes Reports sought to examine the epidemiologic trends in diabetes complications as they relate to racial and ethnic minorities and underscore differences in microvascular and macrovascular complications of diabetes, health care utilization, and diabetes prevention efforts. The study also reviewed interventions to decrease racial/ethnic disparities and their limitations.

Microvascular Complications From Diabetes Affect Blacks and Hispanics More

Blacks and Hispanics with diabetes disproportionately experience microvascular complications compared to White adults. Microvascular complications include retinopathy, nephropathy, and nontraumatic lower extremity amputations. The INSIGHT study described the rates of diabetic retinopathy in patients with type 1 or type 2 diabetes in four urban clinics in the USA with a majority of Black American (62.4%) or Hispanic (14.8%) patients. The study found that 1 in 5 participants screened positive for diabetic retinopathy. In US population-based studies, Black people with diabetes had end-stage renal disease at twice the rate of Whites. Black and Hispanic patients were still more likely to undergo a major amputation than White patients.

Macrovascular Complications Are Higher in Some Minorities

Macrovascular conditions such as cardiovascular and cerebrovascular disease are major causes of morbidity and mortality for people with diabetes. Multiple studies have demonstrated a higher prevalence of poor glycemic control, hyperlipidemia, and hypertension in non-Hispanic Black individuals than in other ethnic groups. In the Diabetes & Aging Study, insured patients older than 60 years with diabetes had prevalence rates of heart failure were equal between White and Black patients (15%). However, these patients had an overall higher rate than Latino (10%), Filipino (9%), and Asian (8%) patients.

Changes Are Needed To Reduce The Racial Disparity

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The prognosis is improving for all patients, but with continued disparity for Blacks and Hispanics compared to non-Hispanic Whites. Culturally tailored education programs, as well as health system and population health management changes, were found to be effective strategies for mitigating racial disparities.


Haw, J. S., Shah, M., Turbow, S., Egeolu, M., & Umpierrez, G. (2021). Diabetes Complications in Racial and Ethnic Minority Populations in the USA. Current Diabetes Reports, 21(1), 2. https://doi.org/10.1007/s11892-020-01369-x