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Diabetes in Native Populations and Underserved Communities in the USA

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Diabetes Mellitus in Developing Countries and Underserved Communities

Abstract

In the USA type 2 diabetes mellitus affects roughly 9 % of the population with a disproportionate burden in racial/ethnic minorities. The prevalence of diabetes is highest in American Indians/Native Alaskans followed by non-Hispanic blacks, Hispanic Americans, Asian Americans, and non-Hispanic whites. Many causes exist for the disparity in rates of prevalent diabetes spanning from biology and genetics to healthcare delivery and prevention programs for diabetes. Racial/ethnic minorities also have higher rates of microvascular complications suggesting a need for examination of delivery of care, non-pharmacological treatment, and selection of antidiabetes medications. In this article we review the epidemiology, classification, and unique pathophysiological aspects of type 2 diabetes in minority populations in the USA including race/ethnic differences in biological factors (obesity, fat distribution, glucose metabolism, and insulin resistance) and nonbiological factors (acculturation and health behaviors). We evaluate the genomic and epigenetic landscape including novel diabetes-associated single nucleotide polymorphisms (SNPs) and epigenetic factors specific to native populations and underserved communities. We assess the limitations of current diagnostic criteria including racial/ethnic differences in hemoglobin A1c. We examine issues related to management of diabetes in native and underserved populations from a multilevel perspective, beginning with the coordination and delivery of diabetes care services progressing to pharmacologic and non-pharmacological management of diabetes, including lifestyle and surgical interventions. Last, we evaluate the current models of translation of primary prevention of diabetes in native and underserved populations and finish with a discussion of unmet research needs. In this manner we aim to provide a comprehensive review of important aspects of diabetes and its management in native populations and underserved communities.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite# 333, Baltimore, MD, 21287, USA

    Joshua J. Joseph MD & Sherita Hill Golden MD, MHS

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  1. Joshua J. Joseph MD
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  2. Sherita Hill Golden MD, MHS
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Correspondence to Sherita Hill Golden MD, MHS .

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  1. University of Tennessee Health Science Center, Memphis, Tennessee, USA

    Sam Dagogo-Jack

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Joseph, J.J., Golden, S.H. (2017). Diabetes in Native Populations and Underserved Communities in the USA. In: Dagogo-Jack, S. (eds) Diabetes Mellitus in Developing Countries and Underserved Communities. Springer, Cham. https://doi.org/10.1007/978-3-319-41559-8_14

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