Diabetes in native populations and underserved communities in the USA

Joshua J. Joseph, Sherita Hill Golden

Research output: Chapter in Book/Report/Conference proceedingChapter


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.

Original languageEnglish (US)
Title of host publicationDiabetes Mellitus in Developing Countries and Underserved Communities
PublisherSpringer International Publishing
Number of pages34
ISBN (Electronic)9783319415598
ISBN (Print)9783319415574
StatePublished - Jan 1 2016


  • Asian American
  • Bariatric surgery
  • Diabetes management
  • Diabetes prevention
  • Genetics
  • Hispanic American
  • Lifestyle intervention
  • Native American
  • Non-Hispanic black
  • Racial/ethnic minority
  • Type 2 diabetes

ASJC Scopus subject areas

  • Medicine(all)

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