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Special diabetic populations require adjusted treatment
Familial roles and dietary accommodations need to be considered when approaching diagnosis and treatment strategies of Hispanics.
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Type 2 diabetes has emerged in the past decade as a leading cause of morbidity and mortality. The social, economic and health policy costs of this phenomenon are tremendous, with an estimated total economic cost for 2002 of about $132 billion.
It is understood that due to many reasons, American Indians, Hispanics and blacks make up most of the newly-diagnosed diabetes cases. Even more concerning is that within these groups, the incidence of type 2 diabetes in children and adolescents, though rare, is increasing.
These individuals are not only special because of the different degree of penetrance of chronic diabetic complications – for example, the risk of nephropathy in blacks or circulatory disease in Hispanics – but also in the approaches to prevention, early diagnosis and treatment strategies that they will require.
It is also worth mentioning that the current definition of metabolic syndrome needs to be revised for both Asian-American and, more recently, (though still debatable), Hispanic individuals.
Hispanic population
Hispanic people generally have a family-centered organization regarding health issues. In these groups the female head of the family predominantly acts as the health care facilitator and is directly involved in the nutrition of her family.
Frequently we encounter that when dealing with a Hispanic patient, health care providers forget this central role of the mother. The mother needs to be taught both the nutritional and therapeutic aspects of this disorder, because without her help, it is unlikely that changes will occur.
It is clear that general nutritional guidelines for the recommended intake of calories from carbohydrates, proteins, dairy products and meat will have to be adapted for the unique composition of the Hispanic diet. To complicate matters, the Hispanic diet in the United States hardly resembles that of first-generation Hispanics before coming to this country.
In many Hispanics’ countries of origin, it is common for diets to contain a large contribution of grains (corn, rice, beans), some roots (potatoes, yucca) and fruits/vegetables with relatively scarce consumption of meats – specifically for economic reasons.
However, Hispanic families who come to the United States rapidly try to modify their diet to include what were before viewed as luxury items. They are overcompensating with large quantities of red meats, eggs and dairy products but also keeping the large quantities of carbohydrates in the form of corn, rice and beans.
The typical Hispanic diet in the United States will now include other items, such as pork, but very little fish. Many Hispanics prefer frying food over other methods of meal preparation.
Treating special populations
Treatment of diabetes within the Hispanic population will require a comprehensive approach to the disease with specific nutritional recommendations that accommodate specific Hispanic preferences.
It is also important to acknowledge that certain therapies will be faced with unusual resistance.
One of several issues is that of introducing insulin into Hispanic patients’ regimens. It has been extensively described that these individuals, for no clear reason, associate insulin administration with the appearance of end-stage renal disease (hemodialysis), blindness, cataracts and sexual dysfunction.
Programs oriented to the evaluation and treatment of a special population also face a difficult challenge. Their task is to change the next generation of younger individuals who will face many years of chronic diseases that, in the end, could catastrophically raise the cost of our health care system.
More studies and resources should be directed to elucidate the psychological grounds of the patterns of adaptation that these populations bring to our “melting pot.”
Our diabetes strategies will not be able to match their needs if we do not provide population-specific recommendations on how to prevent, diagnose and treat diabetes in the next century.
For more information:
- Pablo Mora, MD, is an Associate Professor in the Department of Internal Medicine in the Division of Endocrinology, Diabetes and Metabolism at The University of Texas Southwestern Medical Center in Dallas. He is also Codirector of the Saint Paul Diabetes Program at Saint Paul Hospital in Dallas. He can reached at (214) 648-3494 or pablo.mora@utsouthwestern.edu.
- ADA National Diabetes Fact Sheet. www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf. Accessed April 11, 2005.
- ADA Diabetes Statistics. www.diabetes.org/utils/printthispage.jsp?PageID=STATISTICS_233181. December 29, 2005.