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AACE: Ethnocultural-specific approaches needed for diabetes treatment
To better care for people with diabetes of different ethnic and cultural backgrounds, health care providers must more effectively incorporate biological and sociological considerations into their treatment plans, according to a position statement from the American Association of Clinical Endocrinologists.
“If you look at the typical American diabetes practice nowadays, what you’re seeing is a multicultural waiting room or multiethnic waiting room,” Jeffrey I. Mechanick, MD, FACN, FACP, MACE, ECNU, professor of medicine, medical director of the Marie-Josee and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart and director of metabolic support in the division of endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mount Sinai in New York, told Endocrine Today. “You see patients from all over the world and all different ethnicities and cultures, and yet one of the shortcomings is doctors are really ill-prepared. It’s not really part of formal medical education to deal with the different cultural approaches to medical care and diabetes care specifically.”
In the statement white paper, Mechanick and colleagues identified several important differences between ethnic groups in terms of diabetes development and care, including genetics, socioeconomic disparities, demographics, language, religious and cultural beliefs and long-term historical effects of discrimination, population displacement and enslavement.
The statement and its accompanying recommendations are the outcome of discussions held at the 2015 AACE Pan-American Workshop and at three 2017 conferences on the subject in addition to a detailed review of research pertaining to diabetes prevalence, development and treatment among people of African American, Native American, Latino/Hispanic and Asian American ethnicities.
“We’re talking about a lot of nonphysical attributes of culture as opposed to the physical attributes, which are conferred by genetics, epigenetics, physiology and appearance,” Mechanick said. “There are also nonphysical attributes — approaches to food, approaches to physical activity, approaches to eating patterns, approaches to taking medicine, approaches to injections.”
In the statement, the authors push for several changes to create a more culturally inclusive approach to diabetes care, in particular, a better understanding of differences between ethnicities. For example, labeling all black patients as “African American” ignores the different cultural influences for those who are of Caribbean or another non-African descent, according to the authors, who also note that it is important to gather details about a patient’s ethnicity and culture from the patients themselves.
In addition, the authors advise health care providers to better equip their practices and break down potential obstacles to providing optimal care to patients of all ethnicities and cultures. This may require improving technologic offerings, adjusting office hours and addressing language barriers to improve communication and trust between patient and physician.
“The nutrition and the foods and the eating patterns need to be culturally adapted,” Mechanick said. “Doctors need to understand the various customs when recommending physical activity and nutrition.”
Outside of the practice itself, the authors recommend that health care providers work with resource providers within a patient’s community to better encourage ideal self-care habits. They also note that government officials at all levels have an important role to play, particularly in promoting better nutrition practices and health education. In addition, to better understand how diabetes care should be personalized to people of different ethnicities and cultures, it is important that these populations receive more representation in research populations, which tend to be predominantly composed of non-Hispanic white participants. A more precise understanding of how the development of diabetes and the effects of the disease differ between ethnicities and cultures can also be achieved by making their study a larger part of how medicine is taught and by including more researchers of different cultures and ethnicities in the investigations themselves.
“A more specific answer would be that it just simply is not part of formal medical school curriculum or residency training. There isn’t much literature on it, and there isn’t much scientific foundation for it. You don’t see many studies looking at head-to-head comparisons of approaches,” Mechanick said. “The science is emerging. I think the next step is the education.” – by Phil Neuffer
Disclosure: Mechanick reports he has received honoraria from Abbott Nutrition for lectures.