Cultural Considerations of Diabetes Treatment

Nurses play an important role in helping patients with pre-diabetes and diabetes stay on top of their condition. Certain patients face added cultural and socio-economic challenges in disease management. Intrepid healthcare practitioners have found ways to connect with their patients to get them the care they need.

“It’s an uphill climb,” Angela Vera-Jackson, RN, FNP said of her efforts to get their diabetic patients to change their eating habits. Vera-Jackson works at a private clinic in rural Porterville, Calif., where about 65% of the population is Hispanic. She explained, “The culture that I speak with is Mexican and their main food intake is carbs. There are patients that have to have a tortilla at every meal.” There is also heavy soda consumption among the population.

Obstacles to Care
Beyond the cultural dietary mores, there are other obstacles to Vera-Jackson’s patients getting appropriate care for their diabetes. “Some patients don’t have a high level of literacy,” she noted. That can make them afraid to ask questions of their healthcare provider, as they don’t want to appear not to know something.

Financial issues can lead to difficulties traveling to appointments and also paying for services. Practitioners will investigate if there are supplemental programs from pharmaceutical companies that can offset the cost of medication and supplies. Is there quality, lower-priced generic medication options that the patient can more easily afford?

“Our biggest challenge is in our community we don’t have endocrinologist,” Vera-Jackson said. She will refer patients to the endocrinologist in rare cases, but that comes with the added burden of travel time and appointments are often not scheduled for three months.

Speaking the Same Language
“Understanding all these variables you can encounter makes it easier to treat the patients and help them.” One way nurses at the clinic meet the patients where they are is through speaking Spanish. It is a requirement the staff is bilingual. “I want them to understand the patients,” said Vera-Jackson.glucose monitor

Engaging family members is a key part of diabetes management strategy. “The more support patients have, the more likely they are to engage in the process. The clinic’s certified diabetes educator sits with patients and family members and discusses their current challenges. “Once we develop the rapport, we can see where we want to go from there.”

Patients need to be mentally ready to make a change before they can be proactive in their disease management. Vera-Jackson asks her patients if they want to go to dialysis in a few years. The answer is of course, no, and that fear can encourage them to modify behaviors to keep their diabetes in check. “We can see outcomes when they do change their behavior,” said Vera-Jackson.

On the other side of the country, at Fair Haven Community Health Center in New Haven, Conn., Elizabeth Magenheimer, APRN is fighting diabetes before it begins. The patient population at her clinic is similar to Vera-Jackson’s, at about 75% Hispanic.

Risk Factors
“Over my 40 years of practice, I realized the evolving obesity and diabetes epidemic was almost palpable in clinical medicine. You could feel the evolution.” A National Institutes of Health Diabetes Prevention Study showed that intense programs advocating behavioral change has better outcomes than medication in stopping diabetes. “It became clear you could delay the onset of Type 2 diabetes,” explained Magenheimer.

Using that knowledge, her clinic applied for a grant to screen patients with 1 known risk factor. In the first round, they screened Hispanic women between the ages of 18 and 65 with liver studies, an oral glucose tolerance test, and a test of their A1C level. Each patient had a one-on-one meeting with a nurse to discuss their results and risk factors.

Of the women with diagnosed pre-diabetes, Magenheimer noted, “When the family had access to supportive diabetes risk management, we had positive results.”

Family Affair
Family involvement was a key part of stopping the disease in its tracks. Clinicians will treat diabetic grandparents and parents. Identifying genetic and environmental factors that contribute to diabetes help clinicians treat those older generations and acknowledge that the grandchildren may also be at risk of future health problems. Using a family-centered approach creates better behaviors. Magenheimer said, “The age of folks getting Type 2 Diabetes is younger and younger. This is a family problem.”

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The practitioners are invested in reaching their Spanish-speaking patients. “Everything is bilingual. The nurses are bilingual and all our information is bilingual,” Magenheimer explained. One diabetes screening class per month is conducted in Spanish and all educational material is available in English and Spanish.

The lifestyle-based 16-week Diabetes Prevention Program follows a family-model. “It’s not about one person changing his or her behavior.” The clinic incorporated a pediatric diabetes prevention program that parents must also attend. An exercise program for children and adults meets three times per week, targeting children above the 80th percentile of risk for diabetes and their parents, as well as adult women with pre-diabetes.

Changing Attitudes
Since ahealthy diet also plays a significant role in diabetes prevention, the clinic started its own farm program, which has spun-off into an independent non-profit with 8 gardens. About 50 families are involved in an agricultural shares program that gives them access to healthy, yet sometimes unfamiliar, foods. Participants learn gardening skills to keep the contents thriving and give them a sense of ownership over their health. Taking charge of where their food comes from helps combat food poverty and overcomes otherwise limited access to fruits and vegetables. The Diabetes Prevention Program’s emphasis on nutrition extends to classes to learn how to cook those healthy foods.

“It’s a family-oriented relationship and the entire clinic works in that mindset,” noted Magenheimer.

By increasing access to information and prompting and supporting behavioral modifications, all while respecting patients’ cultures, nursing professionals can make positive inroads into curbing the diabetes epidemic.

Danielle Bullen Love is on staff. Contact: