During the symposium Race, Racism, and Diabetes Research, a diverse interprofessional panel of experts—including an epidemiologist, a health services researcher, a historian, and a medical anthropologist—shared their work and insights on the role of race and racism in diabetes research and diabetes care.
The session was livestreamed on Friday, June 3, and can be viewed on-demand by registered meeting attendees at ADA2022.org. If you haven’t registered for the 82nd Scientific Sessions, register today to access the valuable meeting content.
Marshall Chin, MD, MPH, the Richard Parrillo Family Professor of Healthcare Ethics and Research Director, Chicago Center for Diabetes Translation Research at the University of Chicago, began the session with a discussion about how racism affects diabetes care.
A key challenge for clinicians and a systemic barrier that must be overcome, he said, is a lack of trust in the health care system among underserved populations and communities. Additionally, training programs for clinicians need to include more focus on overcoming racism and implicit bias in health care delivery, he said.
“People of color have significant distrust and mistrust of the health care system and have lower ratings of patient experience measures,” Dr. Chin said. “Health professional trainees are generally not well trained in how to address racism and implicit bias, as much of the communication training and clinician-patient relationship training tends to be structured rather than focused on meeting patients where they are at.”
Bias training is important, he said, but must be accompanied by structural reform.
“Implicit bias training alone does not work in terms of being sustainable. It has to be accompanied by systemic structural interventions—they go hand in hand,” Dr. Chin said.
Elizabeth Selvin, PhD, MPH, Professor of Epidemiology and Medicine at the Johns Hopkins Bloomberg School of Public Health, discussed the evidence of “racial differences” in A1C.
“There are differences in A1C across racial and ethnic groups that have been misinterpreted to suggest that A1C may be a less valid test in certain race or ethnic groups,” she said. “Most differences by race or ethnicity, however, are related to social determinants of health.”
Current evidence supports a similar interpretation of A1C test results in Black and White people, Dr. Selvin said.
“Discouraging the use of A1C in certain racial or ethnic groups could worsen disparities,” she added. “Race is not a precise construct and is a poor surrogate for differences in underlying causes of disease risk. Race-based medicine is disquieting. We need to move beyond race-based analyses to better understand nonglycemic factors that may be relevant and reduce real disparities in diabetes.”
Arleen M. Tuchman, PhD, the Nelson O. Tyrone Jr. Chair in History at Vanderbilt University and author of the book Diabetes: A History of Race and Disease, said the U.S. has a long history of using race and class to explain health disparities in diabetes.
“In the early 20th century, for example, the group believed to be most at risk of developing diabetes consisted of White people in general, and Jews in particular,” Dr. Tuchman said. “At the same time, it was widely believed that diabetes rates were lowest among Black people and Native Americans. This is what physicians and public health officials saw when they looked at the data.”
This led to the racial misconception that diabetes was a disease that disproportionately affected “civilized” people, she said.
“The focus on race meant that the dominant approach to explaining disparities was to blame biology and behaviors for the high rates,” Dr. Tuchman said. “The dominant paradigm for explaining health disparities in diabetes rates has long been race, both genetic and behavioral, but history shows that data can be interpreted through different lenses. Instead of race, the focus should have been on racism.”
Clarence Gravlee, PhD, Associate Professor of Anthropology at the University of Florida, concluded the session with an examination of the biological concept of race and its utility in social science and health discourse. It is time, he said, to move beyond the popular idea that race is a social construct and is not about biology, and shift the focus to the biological consequences of systemic racism.
“When we assert that race is a social construct, it seems to suggest that that’s the answer, when in fact it’s just the question—it should be the starting point, not the end point,” Dr. Gravlee said. “And crucially, it cedes biology to the reductionists, because when we say that race is a social construct, not biology, we are inadvertently substituting the word biology when what we are really talking about are genetic differences. It could be true that race is a social construct and also be true that race is biologically useful.”