In the Guyanese community here, diabetes is an epidemic.
The cause lies partly in the heritage they've brought with them, partly in habits they've acquired.
Almost a third of the city's 8,000 Guyanese residents have the chronic condition marked by high blood sugar, recent studies show. They are nearly twice as likely to have diabetes as their white neighbors. And that's the case even if a Guyanese person is relatively thin â usually a sign that someone is an unlikely candidate for diabetes.
Several Schenectady doctors began noticing an unusually high incidence of the disease among their Guyanese patients a decade ago, said Dr. Ephraim E. Back, medical director of the Ellis Medicine Family Health Center. Now he and other health researchers have documented the phenomenon.
In Schenectady, their research has spawned education efforts in the Guyanese community, which makes up about 12 percent of the city's population.
Beyond the city, it is contributing to an evolving understanding of how race and ethnicity play a role in one's chances of developing diabetes and in defining a healthy weight, said Dr. Utpal Pajvani of Columbia University's Naomi Berrie Diabetes Center in New York City.
The studies focus on Type 2 diabetes, which is often linked to excess weight. One, using data collected in 2011, was published in March by the Centers for Disease Control and Prevention in "Preventing Chronic Disease." The other, using 2004-2006 data, was published in the fall edition of the professional journal "Ethnicity and Disease."
Both studies show about 30 percent of Guyanese immigrants have diabetes, compared with 16 percent or 17 percent of white people. The earlier study also shows the rate of diabetes among Guyanese people to be greater than Hispanics (21.5 percent) and African Americans (17 percent).
Not only are Guyanese people more likely to have the illness, but compared to other diabetics, they are more likely to suffer from complications, such as vision problems and poor overall health, the studies show. Lack of consistent medical care, which can delay detection of a condition like diabetes, may have contributed to the rate of complications, researchers stated. Almost half the Guyanese people surveyed in 2011 had annual incomes under $20,000, and about a quarter lacked health insurance.
As for the high rate of contracting diabetes, researchers said both lifestyle and heredity are to blame.
Diabetes is often higher in immigrant groups who may eat more sugar and bigger portions while also reducing their physical activity in the United States, said Akiko Hosler, lead author of the more recent study and a researcher at the University at Albany School of Public Health.
Kathy Zieziulewicz, a nurse at CapitalCare Endocrinology in Schenectady, said diabetic Guyanese patients often mention a decline in activity since immigrating. Veronica Baijnauth Gomes, a 37-year-old who moved here 25 years ago, confirmed that is her experience.
"In Guyana, you don't jump in your car and get to the grocery. You walk," said Gomes, who had gestational diabetes when pregnant for her 3-month-old baby. Her aunts and uncles from Guyana cope with the chronic form of the condition.
But Gomes was skeptical that an American diet was causing Guyanese diabetics trouble. She blamed traditional meals, laden with carbohydrates like rice and roti, an unleavened bread, and finished off with sugary desserts. Carbohydrates and sweets raise blood sugar levels.
"A lot of Guyanese people do not like American food of greens and fish and meat," Gomes said.
Most Guyanese-Americans in Schenectady are of Indian descent. In addition to retaining India's traditions, they also carry genes similar to other South Asians.
Turns out that inheritance is another risk factor for diabetes.
Doctors measure obesity by body mass index (BMI), a figure calculated from height and weight. A BMI that shows someone is "overweight" or "obese" is more than a judgment about size; medically, it's an alert that a patient is at increased risk for illness.
A BMI in the upper 20s would typically raise a doctor's concerns, Pajvani said. That measure, however, is more accurate for white people than other racial or ethnic groups, Pajvani said. African Americans typically don't show signs of weight-related illness until their BMIs are higher.
And for people of South Asian descent, the chances of getting ill increase when BMIs are lower, hovering around 23, Pajvani said.
"We are using too generic a scale, because the same scale isn't applicable to everyone," Pajvani said.
Back, lead author of the earlier study, said he and colleague Dr. Avinash S. Bachwani have lectured to Schenectady doctors about screening Guyanese-Americans for diabetes at lower BMIs. Schenectady County health officials have also worked to educate doctors and the Guyanese community, using advertisements, community events and postings on its website, said county spokesman Joe McQueen. They also launched the West Indian Diabetes Action Coalition, a community group that includes Guyanese and other immigrants.
The community efforts and the study published in March were funded with a two-year, $400,000 grant from the CDC's Racial and Ethnic Approaches to Community Health program. The grant period ended in December.
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