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Blacks more likely to die from complications of diabetes

| Saturday, June 22, 2002

In the white frame annex of St. James AME Church in East Liberty, 10 residents gather for a program that's part Oprah Winfrey, part confessional and part religious revival.

They meet because of a common bond. They are black. They are diabetic or the relatives of diabetics. And they need each other's support to change their lifestyle so that they can avoid the deadly complications of their disease.

A study released by the Pittsburgh Regional Healthcare Initiative shows that local blacks are nearly twice as likely as whites to have a leg amputated because of a failure to manage their diabetes. And they are more than twice as likely as whites to be hospitalized for kidney failure, a complication of diabetes that often leads to dialysis.

The disease can be fatal, especially for blacks. A study released Monday by University of Pittsburgh researchers Dr. Trevor Orchard and Zsolt Bosnyak tracked the outcomes of black patients diagnosed with Type 1 diabetes between 1965 and 1979. The 20-year follow-up showed that black patients with this diabetes, a condition normally linked to youths, were 2.5 times more likely to die than whites.

Lack of information about diabetes contributes to blacks' high rates, said Priscilla Thorpe, 61, of South Oakland. That's why she attends the education program at St. James. It is run by the diabetes project of the Centers for Healthy Hearts and Souls, a nonprofit group that encourages East End residents to live a healthy life.

Audrey James, 72, of Homewood, blames blacks' high diabetes rate on their diet.

"We're raised on more oil, grease, fried foods, sugar," she said. "We were raised on less vegetables and fruits because we couldn't afford that when I was growing up."

James learns tips on nutrition at the meetings. She and fellow diabetics sip diet soda and snack on nectarines, taco chips and salsa. They exercise. They pray. And they swap tales of their efforts to manage their disease.

"I got my asthma together. I got the diabetes together," James said at Tuesday's meeting. "Now I got leg problems.

"They told me sleep with my legs up. The heart doctor said to sleep with my head up. Now I'm like an accordion."

The room echoed with laughter.

Although many diabetics smile in the face of their disease, medical experts search for explanations as to why black diabetics are more likely than whites to suffer the deadly complications of the disease.

"A lot of African-Americans don't trust the medical system," said Dr. Velma Scantlebury, a transplant surgeon at UPMC.

Some blacks lack insurance coverage because they are unemployed or work in jobs that don't provide coverage.

"If you get care from an emergency department, you don't get the type of quality care for your chronic disease that other people get," said Dr. Jeannette South-Paul, chairwoman of the Department of Family Medicine at the University of Pittsburgh.

Many blacks cannot afford to buy medicine or the strips to test their blood-sugar level, said Julia Hart, diabetes project director for Healthy Hearts and Souls. Strapped for funds, some black patients take their insulin every other day rather than daily, she said.

The tendency of blacks and other ethnic groups to get diabetes may also be genetic.

Blacks and Native Americans lived off the land for centuries, said Susanne Shearer, a certified diabetic educator at Fayette Home Care in Uniontown. As a result, their metabolism was slow, and their bodies tended to store food for times when food was lacking.

"Now that everybody has access to foods and lots of it," she said, "their metabolism is still on a hoarding mechanism."

South-Paul explained the cycle of some diabetic blacks this way:

"If you have to wait in a bus or take two buses, then you have to go to a clinic where you have to wait again to have something done that's unpleasant, then they refer you for an additional thing, which will cost you money you don't have, then you don't" seek treatment.

Discrimination is another factor.

"We know doctors make different choices based on (patients') ability to pay," South-Paul said.

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