DIABETES & DISCRIMINATION

BY DR. STEPHEN LAWRENCE

Is diabetes the most prejudiced disease of all?

Let’s pull up a chair and dish out some hard truths, served with a side of irony. While society condemns all forms of bigotry, nobody seems to be calling out diabetes for some of the most ingrained bias you’ll see in medicine. Stick around, because by the end, you might be convinced that diabetes is the ultimate misogynist, racist, and ageist, at least when it comes to who gets hit hardest with cardiovascular disease.

The Sexist Sit-Down

If you thought biology was fair, think again. Diabetes is that gate crasher who wipes out women’s heart health advantage the moment they walk into the club. Here’s what the evidence says:

          •         Women with diabetes have a 30–58% higher risk of dying from heart disease compared to men with diabetes, never mind that, without diabetes, their risk is generally lower [1][2].

          •         Before menopause, women are somewhat “protected” from heart disease.

If a woman develops type 2 diabetes, that shield evaporates. The risk of heart disease levels with men equalises or even tip in favour of the men [3][1][2].

Put it another way, diabetes doesn’t just level the playing field, it tips it on top of the women.

The Racist Reality (with a MasterChef Garnish)

While we frown on “profiling”, diabetes itself does not. Some ethnic groups get off relatively lightly in terms of one complication, only to pay the price elsewhere:

Evidence shows that Black people (African Americans) with diabetes have paradoxically lower rates of classic heart attacks than White Americans, but, plot twist, they experience ”worse clinical outcomes, including higher mortality” when heart disease does strike [4][5].

South Asians develop diabetes and heart problems several years earlier and at lower weights than their White friends. Elevated diabetes prevalence and, for some, higher cardiovascular risk too [4][6].

So maybe profiling is a dirty word, unless you’re a risk calculator for diabetes. Unlike a certain TV chef recently accused of crossing the line with offensive language (no worries, we’re not naming names, there’s enough heat in MasterChef’s kitchen as is) [7][8][9], when medicine ignores race, important risks get missed. Sometimes, calling out race and ethnicity is not only okay, it’s essential to avoid misdiagnosis or ignorance.

Ageist and Proud?

Show me a disease that discriminates against the young, and I’ll show you diabetes:

The younger you are when diagnosed with type 2 diabetes, the higher your relative risk of everything bad, including cardiovascular death. In fact, a 30-year-old with diabetes may have a five-fold or higher risk of heart attack compared to someone the same age without diabetes. The risk drops off the older you are at diagnosis, finally, something positive for the seniors [10][11].

It’s like diabetes has an “OK Boomer” attitude, except it’s far more ruthless to Gen Z.

Why “Profiling” Can Save Your Life

We lambaste racial profiling in law enforcement and media. But justice, unlike diabetes, should be blind. Unfortunately, diabetes brings its baggage everywhere: gender, race, age. Ignoring these “profiles” doesn’t make risk disappear, it just means someone goes undiagnosed, untreated, or dies unnecessarily.

Medical risk calculators use these demographic details not to perpetuate bias, but to counteract the hidden discrimination that the disease itself doles out. Check yours out via Diabetes UK at https://riskscore.diabetes.org.uk/start

In Conclusion: Let’s Cook Up Some Awareness

If a TV judge can be thrown off the show for offensive words (well, allegedly), maybe it’s time for diabetes to be held accountable for the silent, statistical discrimination it dishes out every day. Sometimes, the most important thing is not ignoring the differences, but acknowledging and acting on them, so that no matter your age, gender, or ethnicity, your health gets a fair chance at the table.

Remember, with diabetes, everyone’s risk is not created equal. Just ask your heart.