Overcoming the Odds
Digging a little deeper into the link between Latinos and type 2 diabetes
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July 2008 — There is regular talk about type 2 diabetes and its prevalence in the Latino population. With Miami as one of the cities with the largest proportion of Latinos in the US, it is no surprise that diabetes professionals there have interesting insights to share about the connection between Latinos and diabetes.
For this edition of "Hola Diabetes," I spoke with Luigi Meneghini, an Associate Professor of Clinical Medicine and Director of the Kosow Diabetes Treatment Center of the Diabetes Research Institute at the University of Miami Miller School of Medicine in Miami. At least 50 percent of the patients he sees are Latino.
Manny Hernandez: There is a higher incidence of type 2 diabetes among Latinos than any other ethnic groups. In your experience, what contributes to this trend?
Luigi Meneghini, MD, MBA: It depends on the specific ethnic group the person is from. For example, Cubans have genetic roots with more elements in common with Europeans. Puerto Ricans and Mexican Americans, in turn, have more of an African and [American] Indian background, respectively. As a result, Cubans have a lower genetic pre-disposition to develop type 2 diabetes than Puerto Ricans or Mexican-Americans, given that their predominance of Caucasian genes results in a lower genetic pre-disposition.
However, genes only tell part of the story. The environment also pre-disposes individuals to a diabetes diagnosis. Some of the genes that are meant for survival - to conserve energy and fat during periods of limited food availability, such as famines – ultimately lead to a diagnosis.
If you take these populations and put them in an environment of abundance (the US today) and a more sedentary lifestyle, individuals become more prone to gaining weight and, as a consequence developing type 2. We have seen this among Cuban immigrants: when they get to the US, they tend not to be overweight, but once they are here for a generation or two or even for a few years, their put on weight.
MH: Family and culture are two powerful pillars among Latinos. However, they can get in the way when it comes to diabetes management, because family "medical" advice sometimes counters the doctor's orders. What has your experience been with this?
LM: We see this all the time. Among Latinos and Caribbean people, both taboos such as the perception about insulin therapy can be equally influential. Patients remember the start of insulin therapy by someone in the family and tie it with the person's eventual diabetes complications (blindness, amputations, kidney failure) or even death. They don't think that their relative may have been at a stage where the damage due to the complications associated with diabetes may have been a result of the chronically elevated blood sugars and poor diabetes control.
In addition to these incorrect perceptions, the use of injections to administer insulin prompts connotations of drug addiction and anxiety about using needles that help perpetuate taboos such as this one.
MH: How do you get the message across to Latino patients with diabetes?
LM: The way to address them is through patient education. Certified Diabetes Educators sit down with patients to explain to them the implications and the complications associated with diabetes. It takes a number of conversations and developing a solid, trusting relationship with patients.
To develop a good relationship with Latino patient, it makes a great difference to speak to them in their own language. So we always ask them what language they prefer to talk in: it makes it easier for the patient to communicate the subtleties of their condition. Fortunately in Miami there are a lot of professionals who can speak Spanish, but there does exist a nationwide lack of health professionals who can address Latinos in their own language.
MH: How can other people help the work you and your colleagues do at Diabetes Research Institute (DRI)?
LM: There are a number of ways that people can help the DRI. They can make efforts to be aware of what research is being conducted. DRI is always looking for people that are willing to participate. They can also support the institute through philanthropy in order to help cover the costs of the research being conducted. Advocates can also attempt to influence the government in terms of stem cell research policies, one of the areas of research at DRI. Above all, people can be educated about diabetes: an educated public will always be DRI's best partner.
MH: Would you like to add anything else?
LM: Diabetes is a tough disease. It's with you all the time, every day, all year. I know this: I work on diabetes and I have a sister that has diabetes - that is why I went into this field.
Unfortunately, we still don't have any good solutions or cures for diabetes. Yet, we have a lot of ways to make life more manageable for people with diabetes, so that they can live long, productive, and healthy lives. I hope a cure will come soon and I think a lot will be happening in the course of the next decade. So there's lots to be hopeful about.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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