When I diagnose a patient with type 2 diabetes, I notice something consistent in the room. Fear. Sometimes tears. Occasionally: "Does this mean I'm going to lose my leg?"
The fear is understandable. Type 2 diabetes has a reputation. But I spend the next few minutes trying to convey something important: this condition, caught at the right time, managed correctly, is highly controllable. People with well-managed diabetes live long, full lives. The horror stories — amputations, blindness, kidney failure — are almost always stories of undiagnosed or poorly managed diabetes. Not of diabetes itself.
That said, African communities face specific risks that deserve frank discussion.
Why African and Black populations are at higher risk
People of African, Caribbean, and South Asian origin are 2–4 times more likely to develop type 2 diabetes than white Europeans of the same age. This disparity has multiple causes:
Genetic predisposition: There is evidence that certain genetic variants affecting insulin secretion and sensitivity are more common in people of African origin. This is not destiny — genes load the gun, lifestyle pulls the trigger — but it raises the baseline risk.
Body fat distribution: People of African origin tend to develop insulin resistance at lower BMI values than white Europeans. A BMI of 27 in a Black patient carries similar diabetes risk to a BMI of 30 in a white patient. This means standard BMI cut-offs underestimate risk in African patients.
Lower diagnostic threshold: NHS Diabetes Prevention Programme guidelines now recommend screening at a BMI of 27.5 for people of Black, Asian, and minority ethnic background, versus 30 for white adults.
Later diagnosis: Many Black patients are diagnosed later, when HbA1c (the blood sugar average) is already high and complications may be starting. Earlier, proactive screening matters.
Understanding HbA1c — the number that matters most
When I diagnose and manage diabetes, the most important single number is HbA1c. This is a blood test that measures your average blood sugar over the past 2–3 months. It is more useful than a single blood glucose reading because blood sugar fluctuates throughout the day.
| HbA1c level | What it means |
|---|---|
| Below 42 mmol/mol (6%) | Normal |
| 42–47 mmol/mol (6–6.4%) | Prediabetes — act now |
| 48 mmol/mol (6.5%) or above | Type 2 diabetes diagnosed |
If you have prediabetes, this is the most important intervention point. Studies consistently show that lifestyle changes — weight loss, exercise, dietary changes — can prevent or significantly delay progression to type 2 diabetes.
Case study: Emmanuel's diagnosis and reversal
Emmanuel, 52, originally from Nigeria, works as a security supervisor in London. He came to see me for a routine check and I ordered a blood test. His HbA1c came back at 51 — diabetic range.
He was not surprised. His father had diabetes. His brother had diabetes. He assumed he would too.
What surprised him was what happened next. I referred him to the NHS Diabetes Prevention Programme. Over 9 months, he lost 8kg through dietary changes and daily walking (he works nights, so the gym was impractical — he simply walked for 45 minutes on his lunch break). His HbA1c came down to 44 — prediabetic range.
Two years later, with sustained weight management, it is at 40 — normal range. He is not on medication. He monitors his HbA1c every 6 months.
"I thought it was a life sentence," he told me. "It turned out to be a wake-up call that I actually responded to."
Not everyone achieves remission. But Emmanuel's story is not unusual. For patients diagnosed early, with HbA1c in the 48–55 range, lifestyle intervention genuinely reverses the condition in a significant proportion of cases.
The dietary reality
I am going to be honest rather than diplomatic here. Traditional West African and Zimbabwean diets are not inherently unhealthy — they are rich in vegetables, legumes, and whole foods in their traditional forms. The problem is often what happens to those diets in the diaspora: more white rice, more refined carbohydrates, larger portions, less physical activity.
Fufu, jollof rice, sadza, pounded yam — these are not evil foods. They are high-glycaemic foods that, in large portions with limited vegetables, can significantly raise blood sugar. The solution is not to abandon your culture — it is to adjust portions, increase vegetables, reduce how much refined carbohydrate you eat in a single sitting, and eat more slowly.
Medications — what you might be offered
If lifestyle changes alone don't control your blood sugar, medication is added. The most common first-line medication is metformin — cheap, effective, well-tolerated by most people, and now linked to potential additional benefits beyond blood sugar control.
Beyond metformin, several newer classes of medication are now available that have additional cardiovascular and kidney protective effects — SGLT2 inhibitors (empagliflozin, dapagliflozin) and GLP-1 agonists (semaglutide, liraglutide). These are particularly worth discussing if you have cardiovascular disease or kidney disease alongside diabetes.
When to ask for a diabetes check
Ask your GP for an HbA1c check if you are:
- Over 40 and Black, with a BMI above 27.5
- Any age with a family history of diabetes (parent or sibling)
- Experiencing increased thirst, frequent urination, unexplained tiredness, slow-healing wounds
- Overweight and sedentary
You do not need symptoms to ask for this test. Prevention and early detection save complications.
Sources: NHS Diabetes Prevention Programme guidelines; Diabetes UK — Ethnicity and diabetes facts 2024; Khunti K et al, Diabetologia 2020; NICE NG28 — Type 2 Diabetes in Adults (updated 2022); Lean MEJ et al, The Lancet 2018 (DiRECT trial).