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Friday, April 29, 2016

What Doctors Don't Understand About Hispanics Who Have Diabetes

In the United States, no ethnic group has higher rates of diabetes than Hispanics, and no ethnic group has higher rates of complications from diabetes than Hispanics. Part of the problem is that doctors just don't understand Hispanic cultures.

I grew up in Central and South Texas. Among Mexican-Americans in Texas, it's generally better to get health advice from a respected person in the community, your abuela (grandmother), your priest, or maybe the curandero (folk healer). Doctors aren't necessarily the first people you seek our when you have a health issue. This is true in other Hispanic cultures. Doctors need to work with the community, not to talk down to it.

Another common theme in Mexican, Central American, Cuban, and South American communities is diabetes is bad, but maybe I have the good kind, type 2. Insulin is seen as a kind of punishment, almost, even though type 2's can also benefit from insulin treatment early on to help them reverse the disease. One survey found that 50 percent of Hispanics associated insulin use with personal failure, and 40 percent believed it would be too complicated to use on their own.

Many people in Hispanic communities see diabetes as a kind of temporary condition. You try to get over it by eating right and taking your medicine, and if that doesn't work, then it's just something you live with--let's eat! I know a surgeon in San Antonio who a couple years ago had a patient try to bring a cheeseburger into the operating room where he was having his foot amputated. This 500-pound, 34-year-old man survived the operation, but died of sleep apnea a few months later.

In Texas, it's not unusual for Hispanics to accept the complications of diabetes as a normal consequence of aging. You get old, your toes fall off, you get dry skin, you have trouble with urination, and you die. It's OK to feel bad all the time, because you're old. An administrator of a diabetes outreach program in Texas told me he found dozens of men over 50 who had HbA1C's over 20, who didn't go to the doctor because they thought it was normal to feel bad.

But perhaps the most critical factor in reaching Hispanics who have diabetes is the culture of independence. Hispanic people don't rely on hand outs. They work out things for themselves. Women who have diabetes don't change their diets because they are cooking for the family, not for themselves. They put their personal needs before the needs of their families--and many leave their families by dying at an early age.

Add to this mix, 91 percent of Hispanics use natural medicines. That's a good thing, but no natural medicine, unfortunately, takes the place of insulin.

What can doctors do to help Hispanics control diabetes?

  • Respect their independence. Hispanics by and large want to take charge of their own treatment.
  • Respect their dedication to their families. Help the mother who is cooking good food for the family find a way to provide flavor for the family and a healthy diet for herself.
  • Enlist the help of respected people in communities, pastors, priests, nuns, teachers, business leaders. Don't try to do outreach on your own.
I admit I still don't know what to do when my diabetic friend Octavio sits down next to me at a party with his plate of cookies. I want to say, "Do you want to die at 58 like your father?" I don't say that. It would not be felt as a friendly gesture. But I know that any way forward requires respect and integrity by me.

Further information: 

Dr. Joyce Frieden. 

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