DRWF Podcast: Increased risk of type 2 diabetes in people from different backgrounds
In the latest DRWF podcast, we present a series of interviews on the subject of how people from different backgrounds can be more at risk of type 2 diabetes. In part one we talk to Dr Joan St John.
This article was produced as part of the DRWF Living with Diabetes podcast series.
DRWF podcast presenter Claire Levy said: “In this episode we are looking at living with type 2 diabetes in ethnicity. We know that Black, Asian and ethnic minority groups are three times more likely to have a diagnosis of type 2 diabetes than white people. We are very interested to hear from people who can share their experiences on this matter.”
Dr Joan St John
“We need to amplify the voices of diabetes ambassadors who can speak to people from their community about how they are looking after their diabetes to spread their message” – Dr Joan St John
Dr Joan St John is a doctor with special interest in diabetes and is currently working as part of the multi-disciplinary award-winning Brent Integrated Diabetes Service.
Dr St John has always felt that education is the key to improving the quality of diabetes care. She is enthusiastic and passionate about informing and empowering people with diabetes to enable them to live healthier lives and improve their self-care.
A commitment to education has seen Dr St John giving talks and working in partnership with community and religious groups as well as teaching doctors, nurses, pharmacists and other healthcare professionals.
Dr St John is a voluntary Clinical Advisor to Diabetes Africa and is a co-author of the Diabetes footcare in dark skin tones handbook. Dr St John is also co-author of the Carbs & Cals World Foods book.
Throughout her career Dr St John has always strived to provide excellent healthcare to all and has provided advice, practical assistance, support and health information to organisations dealing with conditions that disproportionately affect Black people and Black, Asian and minority ethnic communities.
Living with Diabetes: What does the population of Black and South Asian people living with diabetes in England look like at the moment?
Dr Joan St John: “Our best guide is the National Diabetes Audit and the figures that we obtain from that. The percentages for people of Asian or Black ethnicity living with type 2 diabetes is much greater than it is for those living with type 1 diabetes.”
Living with Diabetes: Are there regional differences for these communities?
Dr St John: “From a historical perspective, given that people who came to help rebuild this country after the Second World War, sometimes called the ‘Windrush generation’, would be concentrated in urban areas. The likelihood is, and this is demonstrated again in the audit, that for certain areas, urban areas are more likely to have a higher preponderance of people from these ethnic groups living with diabetes.”
Living with Diabetes: I believe the profile of Black, Asian and minority ethnic communities is significantly younger than the white population. Does this impact on type 2 diabetes diagnosis overall?
Dr St John: “It certainly does. What we found is that people from Black, Asian or other minority ethnic communities are likely to develop type 2 diabetes at a younger age. That is why there is a higher percentage of them represented in the population of people living with type 2 diabetes within England and Wales. It impacts their life that the diagnosis is going to be made at an earlier age, and the person from those communities is going to be living with the condition for a longer time.”
Living with Diabetes: What do we know about that increased risk of type 2 diabetes in these populations?
Dr St John: “People from African, African Caribbean, Asian, South Asian populations tend to develop type 2 diabetes at an earlier age. They are therefore likely to live longer with this condition, and that can put them at increased risk of complications developing, because of the effect that longer exposure to hyperglycaemia (high blood glucose levels) is going to have on their bodies.”
Living with Diabetes: People often find making the recommended changes to diet and lifestyle very difficult.
Dr St John: “I think this is universal. This is a long-term condition. It is something that you have got to deal with on a day-to-day basis. One of the bits of advice to tackling these challenges that I would give are small steps. It is very difficult to make major changes, but small steps are more attainable. I would suggest that people look for trusted sources, and trusted voices to advise and assist them.
“Something that came out of the pandemic, as painful as that period was, one of the things we learned was that particularly for people from a Black or a minority ethnic community, it was really important for them to hear from voices that they trusted, to be directed to credible information sources that they felt they could trust. I think the same applies in the field of type 2 diabetes. If you are trying to make changes to your diet, which is totally ingrained in your culture and your lifestyle, it is going to affect you socially, it is going to affect you at work, it is going to affect all aspects of your life.”
Living with Diabetes: There will be proactive people within the Black and South Asian communities who may have been doing as much as they possibly can to avoid developing the condition. What is their response to a diagnosis?
Dr St John: “Some people are aware of their risk and very careful about their lifestyle in terms of what they are eating, in terms of their activity. And yet, perhaps because of genetic factors that we are not absolutely certain of as yet, they can still go on to develop type 2 diabetes. They may have a very strong family history, and those people may be disappointed by the diagnosis, but their proactivity can remain and can continue so that they are still going to be careful, so that management of their diabetes condition, if I can call it that, is optimised and they are still going to look after themselves in the best possible way.
“If somebody is proactive in what they are doing, that will continue even after they have been given the diagnosis of type 2 diabetes. They can be almost like ambassadors for other people. In every community there are people who are like this, who have embraced the diagnosis and enabled themselves to live healthier lives.
“They can be the people whose voices we need to amplify so that they can speak to people from their community about how they are looking after their diabetes and give them the platform to spread their message so they can assist others living with the condition.”
Living with Diabetes: How can we then persuade people to make better diabetes choices, or learn some more through education, and make changes to diet and lifestyle?
Dr St John: “We as healthcare professionals have got to recognise things like mental health issues and that sometimes life itself is overwhelming to somebody, that diabetes has to take a backseat. When we are aware of that, and we are alongside the person living with the condition, we can say that at the moment, the diabetes is not the main priority.
“Be supportive to that person. Strategies like cognitive behavioural therapy can help with things like diabetes distress or other forms of mental health distress. Sometimes we just have to pause and just let somebody get to grips with life or diabetes distress, and then revisit what we can do about optimising the health of them living with type 2 diabetes.”
Living with Diabetes: How do we deal with communities where there is no discussion around type 2 diabetes and people keep the diagnosis secret from family and friends?
Dr St John: “That can be very tricky to deal with because if, for whatever reason, they are unwell, the people around them may not realise what the problem is or what the problem may be due to. I have had discussions with people who will point-blank refuse to tell anybody about their diabetes. It is sad that there is this stigma around their health whilst living with type 2 diabetes.”
Living with Diabetes: How important is an understanding of the differences in dark skin tones in diabetes care?
Dr St John: “I think it’s vitally important, if we look at it from a historical perspective. When I was at medical school, I don’t think I was ever taught the different presentations or the different signs that you would get in different coloured skins. I don’t think I was ever taught that because the textbooks had been written quite a long time ago by people who were looking at a particular population and demonstrated and illustrated the signs only in that population.
“These things can potentially lead to serious, life-threatening or life-affecting complications if they are not recognised. It was really important for us to do something to address this health inequity and inequality. This is trying to address a disparity, an inequality, because as history goes on, as our knowledge continues, we want to do better when we know better.”
Living with Diabetes: A World Health Organization report recently talked about the rise in type 2 diabetes across the world and especially in Africa and Asia.
Dr St John: “I think our experience in England and Wales is reflecting what is going on globally – that there has been an increase in the rate of people living with type 2 diabetes, particularly at a younger age. We have found from studies looking at this younger population that people from Black or minority ethnic communities tend to be overrepresented in that youthful population of people living with type 2 diabetes.”
Living with Diabetes
This latest edition of our podcast Living with Diabetes was supported by Abbott.
Living with Diabetes is a Blue Aurora media production for DRWF. Copyright 2025 Diabetes Research & Wellness Foundation. All rights reserved.
Listen to the interviews in full as part of the DRWF Living with Diabetes podcast series
This article was produced as part of the DRWF Living with Diabetes podcast series and appeared in the Spring 2025 edition of Diabetes Wellness News. To subscribe visit here
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