Physician's Weekly Article - Improving the Care & Management of Hispanics With Diabetes

       Physicians managing Hispanic patients with diabetes need to be aggressive when monitoring and treating the disease. Special considerations are required to address adherence issues and cultural norms.

      Hispanics represent the largest minority population in the United States and will comprise almost 25% of the entire American population by 2050. Diabetes has been reported to occur at higher rates in Hispanics when compared with non-Hispanic white patients of similar ages. “About 2.9 million Hispanic adults have diabetes in the U.S.,” says Carlos Campos, MD, MPH, “and the number is expected to increase as the Hispanic population expands in America. Furthermore, Hispanic patients with diabetes have higher mean A1C levels than non-Hispanic white patients and are more likely to experience diabetes-related complications (eg, severe retinopathy or lower extremity amputations). They also have significantly higher rates of all-cause and cardiovascular mortality. Considering the facts, it’s critical that physicians make efforts to diagnose and treat the disease in these patients as early as possible.”

      Seek Out Diabetes at Patient Visits

      It is estimated that about 25% of Hispanics will have diabetes by age 45, and Dr. Campos says that primary care physicians (PCPs) need to aggressively diagnose the disease in this population. “PCPs can help reduce the disease burden significantly by checking higher-risk Hispanics, even if they present with simple aches or pains. We need to fish for diabetes in Hispanics, especially if they have one or more characteristics that fit the bill, such as being older, sedentary, overweight, or having elevated blood pressure or lipid levels.”

      Hispanic patients will often involve their families when they are receiving care for diabetes, and Dr. Campos recommends that PCPs take advantage of this unique opportunity. “The families are there to help patients reach their goals for controlling diabetes,” he says. “But, we should also inform the families that they are at risk for the disease as well and let them know the importance of checking their glucose levels over time. We may be able to catch two patients with diabetes for the price of one.”

      Consider Cultural Barriers

      Once diabetes is diagnosed in Hispanics, Dr. Campos says PCPs need to consider the effect of certain cultural issues in this population (Table 1). “One of the most important cultural factors among Hispanic populations is the importance of family,” he says. “Hispanics place a high value on their families, so it’s important for PCPs to emphasize that patient efforts to improve health will increase the likelihood that they’ll see their children graduate from school, get married, and/or have children of their own. We need to make this connection with patients so that they’ll do what they need to do to control their diabetes.”

      Another key cultural issue in Hispanic populations is the initiation of insulin therapy (Table 2). “Insulin is often viewed as punishment among Hispanics,” explains Dr. Campos. “We need to change this preconception and stress that insulin is a natural hormone in the body. The need for insulin therapy shouldn’t represent a failure on the patient’s part; in fact, the proper use of insulin should be seen as a success. We should inform them that diabetes is a progressive disease and that they’re likely to require insulin in the future. Put this information out there early and tell patients why it’s needed. Express to them that your primary goal is to partner with them so that they can achieve the quality of life they want and so they can enjoy their family as they get older.”

      Conquer Fatalistic Views & Be Respectful

      Hispanic patients with diabetes may avoid effective treatment plans because they have a fatalistic view of life; they may feel that they cannot control their illness. Dr. Campos says that emphasizing the efficacy of diabetes medications, including insulin, and considering patient beliefs and values are instrumental to overcoming these views. “To conquer a fatalistic view, it’s helpful to establish trust and show them that you care for their well-being. Once that trust is established, patients are more likely to adhere to treatments.”

      In addition, Dr. Campos says that PCPs should be respectful during patient encounters. “For example, shaking hands too firmly with Hispanic patients and looking them directly in the eyes may be perceived by some Hispanic patients that you are trying to overcome them. Simply putting your hand out and letting them dictate how the handshake should go and lowering your eyes, especially with older patients, shows more respect. Once that respect is gained, your chance of improving adherence to treatments is increased.”

      Carlos Campos, MD, MPH, has indicated to Physician’s Weekly that he has worked as a consultant for, as a paid speaker for, and has received grants/research aid from Novartis, Novo Nordisk, AstraZeneca, Merck, Sanofi-Aventis, Amylin, and Eli Lilly.