Poverty’s Link to Diabetes

[C]onventional wisdom about Type 2 diabetes would suggest that once obesity, lack of physical activity and other lifestyle risk factors were taken into account, diabetes incidence rates would even out between lower- and higher-income groups….

[A recent study found that] for men, being in the lowest-income category (earning less than $15,000 per year), doubles the risk of developing Type 2 diabetes compared to being in one of the highest-income brackets (earning more than $80,000 per year). The risk remains the same when other risk factors are taken into account, such as education, body mass index and physical activity levels.

The findings are even more striking for women in the lowest-income category. For them, the risk of developing type 2 diabetes is more than triple the risk of women in the highest-income category. When education, body mass index and physical activity levels are taken into account, the risk is still well more than double. — CTV

Like other discussion of diabetes risk factors, this is looking at correlation. In looking at other risk factors, a family history of the disease doubles the risk as well.  Other diabetes risk factors that dovetail in with “not enough money” include: stress/cortisol; depression; inadequate sleep; lack of exercise (and while some living in poverty have very physical jobs, they may not get the relaxation and stress-relief benefits that tend to go with leisure-time exercise) and while it’s probably not an official risk factor I doubt that food insecurity would help prevent diabetes.

11 thoughts on “Poverty’s Link to Diabetes

  1. My husband was diagnosed with type 2 diabetes 6 months before he retired from the navy (at the rank of E6, his yearly income was approximately $18K, and that supported him, his wife, and 2 of her 5 kids). That was 16 years ago, so I’m assuming his income was poverty level for the number of people he was supporting (sad commentary on how our military is compensated, isn’t it). Add to that the fact that military meals aren’t necessarily the healthiest ones (especially when you’re spending 6 months at sea and rations can run short). Then add in that both his parents had type 2 diabetes, as do 4 of his 6 brothers, and he was almost certainly doomed to end up with the disease.
    Not to mention that the military life isn’t the least stressful occupation out there, whether our nation is at war or not (and at the time he enlisted, it was at the end of the Viet Nam War, he stayed in for both of the Gulf Wars, and got out after 20 years in 1994). No stress in his life, nope not a bit (/sarcasm).
    It makes me wonder how many veterans end up with type 2 diabetes. Just from what I’ve seen when my husband goes to see his doctors at the VA, I’d venture to say that compared to the general population, veterans have a higher incidence of type 2 diabetes. Whether that’s from the meals, the stress, genetics, or the chemicals they’re exposed to during warfare, or a combination of any or all of those – well, that’s probably something we’ll never know for sure.

  2. I really sometimes wonder if, if we had a time machine, if we could go back in time and screen everyone for type 2 diabetes at various points in history, if we wouldn’t discover that the proportion of diabetics to non-diabetics is the same.

    Think about it… poverty would have the same effect, just possibly the number of people who are living in poverty and exactly what level of income indicated poverty would change.

    Then you have the fact that prior to the last about 50 years, the idea of going in to the doctor once a year when nothing was wrong with you was something that only the very wealthiest did. Even the middle class usually wouldn’t do any such thing. So right there, you could have a significant population of undiagnosed diabetics simply because a doctor has never even looked at them.

    Add to that the fact that, except for the most severe cases, you can be “diabetic” and not really experience any major symptoms for years, even without any sort of intervention. It’s not like things like blindness etc develop within days or weeks of being officially diagnosed. There are years of just things that could be overlooked or blamed on something else entirely. Combine that with the fact that the average lifespan has increased by some 40-odd years over the last 100 years, and it would not surprise me AT ALL to discover that by the time the worst symptoms of diabetes would present themselves, the person was already dead or nearly dead of “old age”. A symptom of which could very well be diabetes.

    There really hasn’t been any actual studying of diabetes — it’s all been performed on the basis of finding societal or behavioral causes. What if the actual cause is something much simpler than that… the parts just WEAR OUT. And being under constant stress, as from poverty, discrimination, being the target of hate speech or some combination thereof simply accelerates the process.

    I mean, probably everyone has had the experience of buying some mechanical object and discovering that it breaks down well before the same object owned by a friend does, simply because you use that object more. Like when I was a kid, my parents had to replace the VHS tape of “The Last Unicorn” probably a dozen times, but they never had to replace any of the other movies. It had nothing to do with the tapes being better or worse than the other tapes, it was just that the other movies were not being subjected to a unicorn obsessed child who liked to fall asleep listing to her favorite movie and can still recite every line from memory 20-odd years later.

    The more you use something, the sooner it wears out. Maybe emotional stress has the same effect on the working parts as physical stress does over time.

  3. Pingback: Poverty's Link to Diabetes | Living ~400lbs | Diabetes Advisory

  4. Oh, I’d guess food insecurity has a lot to do with age of onset. It’s still primarily a disease of heredity and aging (like Erin said, parts of you just wear out). But a lot of people who have food security issues feed their children first, and when there’s no money, they subsist on very little food until a check comes in, at which point they’ll eat a lot since they’re really frickin’ hungry. And people who have food security problems probably aren’t going to binge on Kobe beef and free-range chicken and organic veggies, either. That shit’s expensive.

    But closing the staggering gap between the haves and have-nots in this country doesn’t seem to be very high on the official U.S. priority list, diabetes or no diabetes.

  5. I’m glad you mentioned cortisol. I remember reading a while back about studies that stated high cortisol (= high stress) could lead to abdominal weight gain, metabolic syndrome and higher diabetes risk. Not only does this probably account for at least part of the poverty-diabetes link, but it could be the rarely-mentioned factor connecting obesity and diabetes: stress from the stigma associated with being a fat person in our culture. (I’d guess diabetes rates might also be higher among other stigmatized groups, but I don’t know whether extensive research has been done into this. I suspect not; it’s always easier to blame the individual rather than look into social factors.)

    Erin S., I’m pretty sure this is behind the apparent rise in childhood type II – up till a few years ago, they simply wouldn’t have thought to screen younger people’s blood glucose unless they had obvious symptoms. As for ageing, my late mother, during her last few years, was diagnosed as type II, then found not to have it a few months later, then re-diagnosed a few months after that…I’m guessing that before the current obsession with diabetes, this might have been seen as normal fluctuation for someone in their 70s. (She was dreadfully shocked, being under 100lb and having bought into the idea that only fat people ever get diabetes!)

  6. One of my friends was diagnosed with Type II diabetes six years ago, he was young and have enough money but he doesn’t exercize and eat very unhealthy. The doctors said to him that he has to exercize and cut refined sugar, he was scared, he begun to exercize, he begun to love exercising he run his first iron man three years ago and now he is cured. Now he watch his diet and keeps running triathlons and his sugar levels are good. He is much more thinner now. But it is only a particular case.
    I guess that not exercize +unhealthy eating is more risky that being fat. And that being fat is sometimes (sometimes not), due to unhealthy eating and not exercising, my friend was fat because doesn’t move and eat huge amounts of sweets. There are a lot of people that doesn’t move, eat unhealthy, and they are thin. They can develope diabetes but they feel safer because they are thin.

  7. It could be that fat people are discriminated against in getting employed, staying employed and getting promoted so they are more likely to be poor. Most people with Type II Diabetes are fat even though most fat people never get Diabetes. If there are more fat poor people in a group because of discrimination then there is going to be a larger percentage of people with Type II Diabetes in that cohort. Always remember that correlation does not always equal causation.

    Hel, your friend is not cured of Diabetes but controlling it with diet and exercise. Some people can do this and some cannot. The key in this case is not getting rid of sugar in one’s diet but controlling all carbohydrates. Carbohydrates include sugars and starches. For some people control of carbohydrate would have to be so extreme that quality of life would suffer. Most of us with Type II Diabetes do what it takes to control this disease. Everybody is different and so each person does it differently.

    I have Type II Diabetes and have chosen to use insulin and medications. This is working for me right now. I do find that I feel better if I’m not completely sedentary so I try to put movement into my everyday activities.

    One last thought, please try not to blame the person for their disease. Most people who “eat poorly” and are sedentary will never develop Diabetes. Many people who “eat the right things” and exercise regularly will still develop Type II Diabetes.

  8. “One last thought, please try not to blame the person for their disease. Most people who “eat poorly” and are sedentary will never develop Diabetes. Many people who “eat the right things” and exercise regularly will still develop Type II Diabetes.”

    My bad, I was trying to say that my friend had Type II diabetes, or uncontrolled type II diabetes, because he ate badly and did not exercise (plus genetics), but that it was his particular case and not an universal case.

  9. Hel, I think you got it closer to right when you said uncontrolled diabetes. Your friend was able to control his diabetes when he changed his eating and exercise patterns. This is working for him now. In the future this could change and he might decide to try something else. Cutting carbohydrates can lead to serious feelings of deprivation because you not only limit sweets but things like pasta, bread, potatoes and rice.

    I really wish we knew more about the causes of Type II Diabetes because then we would be able to treat the illness and not just the symptoms.

  10. Pingback: Correlation Humor « Living ~400lbs

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