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Non-Insulin-Dependent Diabetes Mellitus in Minorities in the United States

Janette S. Carter, MD; Jacqueline A. Pugh, MD; and Ana Monterrosa, MD
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From the University of New Mexico School of Medicine and the Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico, and the University of Texas Health Science Center at San Antonio, Audie L. Murphy Memorial Veterans Hospital, the Mexican American Medical Treatment Effectiveness Center, and the Texas Diabetes Institute, San Antonio, Texas. Grant Support: In part by grant DK38392 from the National Institute of Diabetes and Digestive and Kidney Diseases (Dr. Pugh) and grant U01HS07397 from the Agency for Health Care Policy and Research (Drs. Pugh and Monterrosa). Requests for Reprints: Jacqueline A. Pugh, MD, Audie L. Murphy Memorial Veterans Hospital, University of Texas Health Science Center at San Antonio, Ambulatory Care 11C6, 7400 Merton Minter Boulevard, San Antonio, TX 78284. Current Author Addresses: Dr. Carter: Primary Care, 11PC, Veterans Affairs Medical Center, 2100 Ridgecrest, SE, Albuquerque, NM 87108.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(3):221-232. doi:10.7326/0003-4819-125-3-199608010-00011
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Purpose: To review the available information on prevalence, complications, and mortality of non–insulin-dependent diabetes mellitus and primary and secondary prevention activities in black persons, Hispanic persons, Native Americans, and Asians and Pacific Islanders in the United States.

Data Source: MEDLINE search from 1976 to 1994 through the PlusNet search system.

Study Selection: Use of the key words non–insulin-dependent diabetes mellitus, the names of each specific minority group, socioeconomic status, acculturation, genetics, diet, complications, mortality, treatment, and intervention (lifestyle or medication) produced 290 unduplicated articles. Additional articles cited in the original articles were also included.

Data Extraction: Risk factors, incidence, prevalence, complications, and mortality of non–insulin-dependent diabetes mellitus.

Data Synthesis: All minorities, except natives of Alaska, have a prevalence of non–insulin-dependent diabetes mellitus that is two to six times greater than that of white persons. Most studies show an increased prevalence of nephropathy that can be as much as six times higher than that of white persons. Retinopathy has variably higher rates in black persons, Hispanic persons, and Native Americans. Amputations are done more frequently among black persons than among white persons (9.0 per 1000 compared with 6.3 per 1000), and Pima Indians have 3.7 times more amputations than do white persons. Diabetes-related mortality is higher for minorities than for white persons, and the rate is increasing. The relative importance of genetic heritage, diet, exercise, socioeconomic status, culture, language, and access to health care in the prevalence, incidence, and mortality of diabetes is not clear. Studies of interventions in minority populations are in progress.

Conclusion: Diabetes should be treated as a public health problem for minority populations.


Grahic Jump Location
Figure 1. Rate in country of origin compared with rate in the United States. Compiled from references 2, 11, and 121 to 130.
Prevalence of diabetes mellitus in minority populations.
Grahic Jump Location




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