Diabetes affects African Americans more than whites — Dr. Thaddeus Bell aims to change that.
While studying at the Medical University of South Carolina from 1972 to 1976, Thaddeus Bell, MD, noticed that the complication rate of diabetes was disproportionately higher for Blacks than for whites. A recent article published by The State Media Company concurred with Dr. Bell’s discovery, citing that African Americans who suffer from the disease are three or four times more likely to require amputation than any other demographic in the rural South. As a student, Dr. Bell thought the reason for this imbalance was poor communication between doctors and patients or that perhaps Blacks didn’t understand how serious the ramifications, such as blindness, heart attack, stroke or loss of limbs, would be if they weren’t compliant with medical guidance. Over time, however, he learned the issue was much more complex than he had first believed.
The Roots of Health Disparities
Early on in his residency, Dr. Bell found that the culprits responsible for the disparity were poverty and socioeconomic status, twin dynamics that negate health literacy. Factors such as misdiagnosis due to missed red flags and failure to run tests, along with lack of access to quality health insurance, further revealed that the root cause was a direct result of racism. “Unfortunately, the premise of the Hippocratic Oath, which requires doctors to treat everybody with the same dignity and respect, couldn’t be farther from the truth,” he said. “And not much has changed over the 50 years since I’ve been practicing medicine.”
Education and Prevention
Throughout his career, Dr. Bell’s mission has been to flip that narrative by educating underserved African American communities about the burden of the disease and how to prevent or effectively treat it. “Diabetes often runs in families that are closely associated with obesity as a result of eating improper food and a lack of exercise,” he explained. “My message for those at risk is about the importance of controlling weight by implementing a well-balanced diet, eliminating a sedentary lifestyle and taking medication when necessary.”
Cultural Barriers and Historic Mistrust
Yet Dr. Bell’s work is often undermined by extenuating, deep-rooted cultural complications. “For decades, the Black community has had a mistrust about medicine and don’t believe that it works,” he said. “This ideology stems back to the 1840s when Dr. Marion Sims, the so-called father of gynecology, experimented on enslaved women without giving them anesthesia, which was readily available during that time. Horrific practices such as these have been largely responsible for the distrust that is prevalent today.”
The other issue, he said, is that “Many African Americans subscribe to the myth that insulin is a medication for patients whose complications are so far gone they can’t be reversed and that taking it leads to loss of limbs, blindness and heart attack. However, this is the opposite of the truth as insulin is critical for diabetics at every stage.”
Complications and Communication Gaps
Despite the difficulty Dr. Bell faces when it comes to overcoming these challenges, he is determined to continue advocating for an informed population. “People need to understand the major complications of diabetes,” he said. “For example, if you let an A1C level stay above a 7 for months on end, the blood sugar is going to spiral out of control, and, after a period of time, that can’t be reversed. Inflamed blood vessels, which are caused by the disease, can spread all over the body beyond a toe or foot to the heart, eyes, brain and organs. Further, uncontrolled diabetes can lead to erectile dysfunction in men as a result of a lack of blood flow to an inflamed penis.” More often than not, he said, this information hasn’t been fully explained or efficiently emphasized to patients.
Role of Dietitians and Lifestyle Guidance
In addition to communication between the doctor and patient, proper treatment for diabetics should always include a referral to a registered dietitian who teaches new eating habits, as mandated by the American Diabetic Association’s standard of care. However, that is not always the case in Black communities. “A lot of doctors don’t take the time to make sure the patient is lined up for an appointment to take a five-to-seven-hour class with a registered dietitian, even though it’s covered by insurance,” said Dr. Bell. “Without that professional guidance, uninitiated diabetics sometimes think, If I just eat once a day, I can control this. Or, instead, they take their medication but they don’t make lifestyle changes, so nothing alters.”
Food Deserts and Environmental Barriers
In rural situations where food deserts limit access to healthy foods rather than junk, making better choices would seem difficult, if not impossible, when stores such as Family Dollar display a selection of potato chips, Little Debbie cakes and cookies and sugary drinks in prime locations. The only other options in proximity often are fast-food restaurants. As Dr. Bell pointed out, there is a direct correlation between how drive-thru joints are positioned in Black communities and the number of heart attacks and strokes that occur as a result. By contrast, in wealthier, predominately white neighborhoods, there are few fast-food restaurants and thus a much lower rate of diabetes-related complications.
Screening and Proactive Care
For pre-diabetics and patients who are overweight or who have diabetes in their family, Dr. Bell recommends regular screening for AIC levels. “I screen all patients 30 years old, or younger, if diabetes is hereditary or if they’re overweight. Family history doesn’t mean a patient will necessarily get it, but they likely will if they assume a sedentary lifestyle.” In addition to regular screening, Dr. Bell suggests that at-risk patients “take charge, see a doctor and follow their recommendations. By making better choices like these, it’s possible to hold diabetes off.”
Modern Tools and Cost Barriers
Additionally, Dr. Bell finds that modern technology such as the lifestyle monitor by Dexcom, a real-time device that tracks blood sugar and shows if spikes are too high or too low, is a more straightforward option than traditional finger sticks. He also advised that the drug Ozempic is another tool for helping diabetics who need to lose weight. There is a drawback to both, however. “Many insurance companies require prior authorization from a doctor. Then after that whole process, they usually don’t want to pay for the high costs of it.”
Living Healthy Without Insurance
As the price of insurance continues to skyrocket, many of Dr. Bell’s patients are unable to afford coverage. In this case, he advised living as healthy a lifestyle as possible: “Don’t smoke, keep your weight under control and never forget that exercise is medicine.”
To learn more about how the good work of Thaddeus John Bell Family Medicine, LLC is closing the gap in health care while making health make sense, visit closingthegapinhealthcare.org and follow Dr. Bell on Instagram at thaddeus.bell and on Facebook at Thaddeus John Bell.
By Sarah Rose
