Diabetes Mellitus in American Low-Income Communities

Topic: Endocrinology
Words: 2301 Pages: 8


Diabetes affects everyone, which makes it all the more dangerous. Considering that Diabetes Mellitus often leads to heart conditions, heart attacks, strokes, hyperglycemia, nephropathy, mental health issues, and other serious health conditions, the statistic that 1 in 11 adults has Diabetes Mellitus is rather alarming (Sapra & Bhandari, 2021). The onset of Type 1 Diabetes Mellitus peaks at the ages of 4 till 6, which results in almost half of children being diagnosed before the age of 10 (Sapra & Bhandari, 2021). In 2019, the disease was the seventh leading cause of death in the United States (Centers for Disease Control and Prevention, 2021). Thus, it is apparent that this illness is a serious issue, which requires a multi-faceted and well-structured preventative approach to reduce the number of people affected (Conway et al., 2018; Shirinzadeh et al., 2019). The purpose of the paper is to propose a community-based non-pharmacological program, which would educate vulnerable populations on the disease and its risk factors in an effort to reduce the incidence of Diabetes Mellitus in low-income communities.

Health Problem

In order to understand the actual significance of the proposed project, it is crucial to acknowledge the scope of diabetes as an epidemic in low-income communities all around the United States. Diabetes Mellitus is a condition, which prevents a person’s body from using the energy it gets from food properly. Diabetes occurs either due to the disrupted functionality of the pancreas, which produces insulin or because of insulin resistance. Insulin is a hormone responsible for helping the body break down sugar and use it for energy. Diabetes Mellitus has “many sub-classifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes” (Sapra & Bhandari, 2021, para. 1). As mentioned earlier, diabetes can be characterized by the inability of the pancreas to produce insulin due to damaged beta cells, which is referred to as Type 1 Diabetes Mellitus. If the primary cause of the condition is insulin resistance, it is categorized as Type 2 Diabetes Mellitus.

There are many risk factors, which may contribute to the development of the disease. They include a family history of diabetes, injured pancreas, physical stress, older age, and autoimmune illness (Centers for Disease Control and Prevention, 2020). However, some risk factors such as high blood pressure, obesity, smoking, excessive drinking, or the use of steroids one is more in control of. It is important for people to get educated and recognize that sugar itself does not cause diabetes. Consuming excessive amounts of sugary foods will not result in Diabetes Mellitus, but rather lead to tooth decay.

Although diabetes is a global problem that affects hundreds of millions of people no matter their age, socio-economic status, or ethnicity, this paper focuses on the low-income communities in the United States. They face an actual crisis based on the rates of newly diagnosed individuals who are residents of poor neighborhoods. Studies demonstrate that a person is more likely to develop both Type 1 and Type 2 Diabetes Mellitus if they are poor in comparison to individuals having a middle income (Conway et al., 2018). People from low-income communities outnumber other socioeconomic groups in the rates and seriousness of the disease. This is most probably due to the delays in recognition of the illness as well as the lack of access to high-quality care. Delayed diagnosis, non-identified worsening prognosis, inadequate medical care, and other factors contribute to the increased vulnerability of poor people in the United States.

It is evident that economically disadvantaged individuals are less likely to get diagnosed early on and receive quality care once the disease has developed. However, it is also crucial to acknowledge the position African-Americans, Hispanic, and other minorities are subjected to. Despite universal health coverage, they are at an even greater disadvantage, according to multiple studies (Conedo et al., 2018; Lipman et al., 2020). They usually do not have the access to high-quality care or regular health checkups. In addition, in comparison to white Americans, they are more likely to reside in poor neighborhoods. Thus, there is an overall lack of community-based programs, initiatives, and policies to address the rising health concerns. Moreover, parks, recreation facilities, and public transport options are often unavailable to these individuals. Poor Latino and African-American neighborhoods often force the residents to grow up surrounded by environmental toxins, which contributes to obesity, one of the primary risk factors for developing Diabetes Mellitus (Banzhaf et al., 2019).

Poor individuals have trouble dealing with all the expenses associated with costly diabetes treatment. Medical care plans for the management of Diabetes Mellitus usually include insulin pumps or syringes, various medications to increase insulin sensitivity, as well as the adoption of a medically-prescribed diet plan. People coming from low-income backgrounds are often unable to bear the financial burden of the aforementioned diabetes management options either for themselves or their children.

Goals and Objectives

The goal of the intervention is to create a community-based non-pharmacological program for residents of poor neighborhoods in rural Texas. These initiatives would focus on behavioral modification through education centered around dietary advice, weight loss recommendations, and other preventative measures for diabetes. The first objective of the proposed intervention reduces the prevalence of diabetes by 10 % in the low-income communities of Hidalgo County, Texas over the course of 7 months. The second objective is to increase the overall level of health-related education in regard to diabetes risk factors among the residents of the low-income communities in Texas. Both of these objectives are specific and measurable through collecting relevant statistics using state records and assessment surveys designed and distributed specifically for this intervention.

The proposed community-based educational program is aimed at reducing the incidence of Diabetes Mellitus and associated risk factors, including high blood pressure, large weight, as well as low activity levels. It would target a specific population based on location and socioeconomic status and reach individuals outside clinical settings by organizing lectures at schools, churches, or workplaces (Shirinzadeh et al., 2019). The primary goal of community-based programs is to apply a variety of evidence-based approaches to establish local initiatives for diabetes prevention and early intervention (Shirinzadeh et al., 2019). These approaches, however, require behavioral changes, raising the education and awareness levels of the target population in regards to diabetes risk factors, as well as convincing the policy-makers to invest resources into such initiatives.


The significance of the proposed intervention is hard to overestimate. First, it is important to take another look at the alarming statistics the United States has in regard to diabetes. According to the data collected by the American Diabetes Association (2017), 1.5 million people are diagnosed with Diabetes Mellitus each year, which makes the condition all the more serious. In 2017, a total amount of 270,702 death certificates mentioned the disease as the underlying cause of death (American Diabetes Association, 2017). However, there are many instances, which lead to diabetes being underreported as the cause of death. Studies demonstrate that only close to a third of people with diabetes had it listed on their death certificate, and only 10% had it referred to as the primary cause of death (American Diabetes Association, 2017). Thus, it is evident that this condition affects millions of people in the United States both directly and through a variety of health implications as the body struggles to produce more insulin or lower the resistance.

Despite the fact that everyone can develop the condition no matter their socio-economic status, it is crucial to acknowledge that individuals from low-income communities are less able to diagnose the condition early in or receive high-quality treatment. Karachaliou et al. (2020) argue that financially disadvantaged individuals “face unique challenges related to lack of awareness, difficulty in accessing health care systems and medications, and consequently failure in achieving optimal diabetes management and preventing complications” (p. 1). After adjusting for the differences in age and sex, it was estimated that the average healthcare expenditures of people with diabetes were 2.3 times higher than those who did not have the condition (American Diabetes Association, 2017). Therefore, a community-based program targeted specifically toward people from poor neighborhoods would help them significantly.

The risk for these people to develop diabetes is much higher in comparison to individuals with high incomes because they are more vulnerable and less educated. Moreover, they rarely have access to high-quality care due to financial issues. Since they cannot possibly allocate time to regular health checkups because they are unable to leave work, diabetes often remains undiagnosed in this population, which creates a vicious cycle where money is vital. Nevertheless, community-based programs can be the most appropriate and practical solution for diabetes prevention and early intervention.

The proposed community-based intervention can also benefit the economy of the state and the country as a whole. Americans with diabetes spend close to $237 billion to manage their condition (American Diabetes Association, 2017). While it is impossible to cure every person suffering from the disease, early interventions can help to prevent diabetes from developing at such a high rate. Thus, billions of dollars will be saved and spent on the services of other industries. Moreover, the amount of money the United States loses in reduced productivity as a result of diabetes is going to be reduced. In American low-income communities, the burden of diabetes often overpasses the burden of certain communicable diseases. Policymakers at the local and national levels can coordinate their efforts and help develop a number of community-based educational initiatives, taking the proposed program in Hildago County, Texas, as an example. The more initiatives there are, the more issues can be identified and resolved efficiently to ensure that all the future endeavors lead to even more positive outcomes.

Apart from potentially helping thousands of people who could get affected by diabetes, community-based programs relieve some of the pressure placed on the local healthcare facilities. Medical centers often do not have adequate capacity, resources, or even time to offer behavioral interventions. Therefore, the proposed program design is perfect for addressing the prevention and early intervention issues with great expertise in an effort to provide the vulnerable populations with education related to health-related behavioral shifts.

Integration of the Health Issue and Target Population

The action plan for the integration of the proposed community-based intervention is rather complex and includes a number of steps, which require even more tasks to be completed. First, it is important to approach local authorities to secure funding and support. Second, comes the stage of developing educational resources and lecture plans. Then, it is crucial to attracting as many people as possible by engaging with local community learners, churches, and schools. After that, educational events, public discussions, speeches, presentations, and other creative projects will be held every month. As a result of these 7 months, project coordinators will collect statistical data and compare the results of the health-related assessment tests people have submitted at the beginning of the intervention to the ones submitted towards the end.

It is evident that the creation and implementation of the proposed community-based program require a lot of resources ranging from qualified medical personnel, educators, and consultants to policymakers and volunteers. In order to avoid any conflicts of interest, it would be wise to choose one route of financing the intervention: either receiving money from private foundations and a variety of non-governmental institutions or asking for assistance from local authorities. The second option is more beneficial long-term since the success of the proposed program can then be copied by neighboring communities and lead to the development of a state-wide initiative. In order to attract high-qualified healthcare professionals and other expert personnel, it is important to offer them something besides monetary gains. Thus, potentially, it is a great idea to publicize the project in major U.S. publications to offer exposure in exchange for their services and consultations. Apart from that, it is crucial to engage with community learners, including pastors, local celebrities, and a variety of other thought leaders.

During the stage of development of all the educational materials and lectures, it could be considered useful to get not only medical experts but editors as well, involved to ensure that the information presented is both accurate and entertaining. It is also important to invite diabetes patients to speak at such events in an effort to educate people on the health complications and lifestyle changes often associated with Diabetes Mellitus.

When it comes to infrastructure, it is crucial to recognize that it is best to find venues to hold lectures right in the middle of poor neighborhoods. Individuals coming from low-income communities often have no transportation options and rarely can afford to take time off work to travel around the city for an event. When it comes to schoolchildren and college students, the events can be held right on the campus or in the classroom. This way pupils and students can have easy access to these lectures. Thus, local authorities would have to issue requirements for schools in low-income neighborhoods to support such events.

Discussion and Conclusions

Diabetes remains one of the most alarming health issues that the United States faces nowadays. Researchers argue that the diabetes crisis disproportionately affects the nation’s population. Some of the most vulnerable populations include residents of low-income communities who are often racial minorities. Apart from being unable to access high-quality care, these individuals are usually not educated about healthy lifestyles and disease prevention. In order to reduce the prevalence of the disease, it is necessary to apply evidence-based approaches to prevention and early intervention. A community-based program funded by local authorities and targeted toward poor individuals can potentially achieve the goal of saving millions of lives. It would allow to reach people outside conventional medical settings and educate them on health-related behavior modification to reduce the risk of developing diabetes.


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Centers for Disease Control and Prevention. (2020). Diabetes risk factors. CDC. Web.

Centers for Disease Control and Prevention. (2021). Leading causes of death. CDC. Web.

Conway, B. N., Han, X., Munro, H. M., Gross, A. L., Shu, X.-O., Hargreaves, M. K., Zheng, W., Powers, A. C., & Blot, W. J. (2018). The obesity epidemic and rising diabetes incidence in a low-income racially diverse southern US cohort. PLOS ONE, 13(1), 1-18.

Karachaliou, F., Simatos, G., & Simatou, A. (2020). The challenges in the development of diabetes prevention and care Models in low-income settings. Frontiers in Endocrinology, 11(518), 1-9.

Sapra, A., & Bhandari, P. (2021, February 23). Diabetes mellitus. National Center for Biotechnology Information. Web.

Shirinzadeh, M., Afshin-Pour, B., Angeles, R., Gaber, J., & Agarwal, G. (2019). The effect of community-based programs on diabetes prevention in low- and middle-income countries: a systematic review and meta-analysis. Global Health, 15(10).

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