This article reviews the current literature with regard to non-insulin-dependent diabetes mellitus and primary and secondary prevention activities among ethnic minorities in the United States. Articles were identified through a MEDLINE search for the period from 1976 to 1994 using specific selection criteria.

In general, the prevalence of diabetes is higher in ethnic minorities than in whites in the United States. It is uncertain whether this is due to higher incidence or prolonged duration, as very few incidence studies have been conducted. Complications due to diabetes are also more prevalent in minority populations, including diabetic end-stage renal disease (ESRD), blindness secondary to diabetes (blacks, Native Americans and Pima Indians only), peripheral vascular disease (blacks only), lower extremity amputations (blacks and Pima Indians only), and coronary artery disease (unclear patterns).

With regard to the prevalence of ESRD, the pattern is consistent across studies; however, survival among minority patients with diabetic ESRD who are treated with hemodialysis is better than for white persons. Some ethnic minorities (Hispanic, blacks, and Native Americans) have been shown to have higher rates of proteinuria than do white persons.

Diabetes-specific mortality rates for blacks, Hispanics, and Native Americans are higher than those for whites. However, it is difficult to determine whether the higher mortality rate is secondary only to the higher prevalence rate of non-insulin-dependent diabetes mellitus or to other factors.

Data on risk factors were assessed, but in general, little is known that can explain the epidemiologic prevalence findings. However, it is important to consider that comparisons of data from other parts of the world with data on US minorities show that all minorities in the US for which data exist have a higher prevalence of diabetes than do residents of their countries of origin. Further, as Native Americans have changed their diet and exercise patterns over time, diabetes prevalence has also increased.

Risk factors such as poor diet, low exercise, and obesity are more prevalent in minority groups, but there are few data that can be considered to directly link these factors with racial differences in diabetes. The authors suggest that the “thrifty genotype” (minorities may have a genotype selected for survival in less plentiful environments) may put minority groups at risk for diabetes when food supplies are constant and abundant. Finally, data are risk factors for complications are more sparse. Glycemic control, hypertension, and access to health care might be considered, but, again, do not completely explain the epidemiologic patterns.

With regard to primary prevention interventions, only two trials were reported, both focusing on children. Others are now underway. Secondary prevention trial are more common, and all that have been reported emphasize culture-specific reports. The authors make suggestion for further prevention efforts, including screening education programs and developing low cost models of diabetic care.