Sweet and Gay
The unrecognized diabetes minority.
When you think about minorities or subgroups affected with higher rates of diabetes, has the lesbian, gay, bisexual, transgender (LGBT) community crossed your mind?
Chances are slim because the data is circumspect. Just because it isn't directly measured, doesn't mean it doesn't exist. Take into consideration:
- Some studies suggest the LGBT population in the U.S. to be at 10% of the total population. Others segregate it out and look at male homosexuality (6%) and lesbians (3.6%). These surveys define homosexuality in different ways and the census does not gather this information thereby adding to potential underreporting. The point being, even if 5% of the population is LGBT, it suggests at least 1.25 million LGBT people have diabetes.
- Cigarette smoking rates are very high in the LGBT community: 47% of gay youth, 27% of gay men (50% higher than men in general community) and 32% of lesbians (triple that of women in general community). Cigarette smoking is a known factor for increasing insulin resistance, a known precursor for type 2 diabetes.
- Lesbians have the highest rate of polycystic ovarian syndrome (PCOS) of any subgroup of women. PCOS is a leading risk factor for type 2 diabetes in adolescent and young adult women.
It's not like people are lining up to study diabetes within this subgroup. Is it because there is evidence of widespread homophobia and heterosexism amongst healthcare professionals (according to Scott et al. Sexual Exclusion – homophobia and health inequities: a review)? If the diabetes professional community is not aware of the LGBT community being at high risk, or lack support for or don't know how to be inclusive of this often silent minority, where does that leave the LGBT person with diabetes? The medical community is a vital part of the diabetes care team and yet, for the LGBT person with diabetes this critical professional may be missing. If the health practitioner's environment makes no effort to address this subgroup, or if medical forms outright exclude sexual orientation, the LGBT person with diabetes may not feel comfortable disclosing their orientation, discussing other health issues out of fear of facing homophobia, or not return for further care.
To help address the health disparities that face LGBT people with diabetes, Ion (John) Coman, a type 1 living in San Francisco along with his partner, Jim Castaneda, started the DANG (Diabetes ANd Gays) Foundation in 2009. He and his partner experienced homophobia first hand ironically in the gay bubble of the world in the Castro district of San Francisco while going to a local Emergency Department. Ion had a severe low blood glucose reaction followed by a seizure. His partner, Jim, was ushered to the waiting area while staff worked on raising Ion's glucose. No one bothered to tell Jim that his partner was admitted to ICU. They used this experience to form DANG so that others would not have to suffer in silence and disregard. Plus, according to Ion, "Diabetes is a stress in any relationship and when you combine that with the stresses of life as a lesbian or gay man—whether you are open about it or not—there is a great need for LGBT people with diabetes and the partners who support them to receive services and information geared to their unique needs."
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...