Culture phenomena: Hispanics & Diabetes in the U.S. (Post 5)

STATS:

• The Hispanic or Latino population is the largest minority group in the United States, currently representing 13.7% of the total U.S. population. 

• Hispanics or Latinos usually suffer from higher rates of type 2 diabetes, obesity, metabolic syndrome, and their multiple vascular complications. 

• Inadequate nutrition and reduced physical activity in the setting of an increased genetic predisposition to type 2 diabetes have contributed to the inexorable rise in metabolic abnormalities in Hispanics in the United States, which now affect many children and adolescents.

How does cultural phenomena/politics intersect with diabetes and hispanics?

• It is evident that multiple medical, cultural, and socioeconomic factors influence the development of diabetes, its course, and its consequences. However, our health care system is barely prepared to face the challenge of managing diabetes in this high-risk group. Why?

For starters knowing the difference between Latino or Hispanic...For example: I am from Guatemala, making me Guatemalan; Hispanic.

So what now?

• Healthcare providers need to spread awareness, provide culturally oriented clinical care, education, outreach and research programs to better identify the challenges and to create opportunities to improve the lives of Hispanics or Latinos with diabetes or at risk for the disease. 

Reference:
Caballero, A. E. (2005). Diabetes in the Hispanic or Latino population: genes, environment, culture, and more. Current diabetes reports, 5(3), 217-225. 

Poor Food Purchasing Selection Due to Low-Income (Post 4)

In todays post, I will be explaining the research, findings and the impact Cortes et al., peer reviewed article, Food Purchasing Selection Among Low-Income, Spanish-Speaking Latinos made in diabetes research.

According to Cortes et al., Latinos in the U.S. are disproportionately affected by poverty, and over the past 10 years, the percentage of overweight U.S. Latino youth has approximately doubled. Buying low-cost food that is calorie-dense and fılling has been linked to obesity. Low-income individuals tend to favor energy-dense foods because of their low cost, and economic decisions made during food purchasing have had physiologic repercussions. Diets based on energy-dense foods tend to be high in processed staples, such as refıned grains, added sugars, and added fats. Examples of some traditional dishes from various Latino countries are pupusas, tacos, and tamales. (All high in fat content.) These diets have been linked to a higher risk of obesity type 2 diabetes, and cardiovascular disease.

The purpose of their research was to understand grocery shopping practices among Spanish-speaking, low-income Latino families. The purpose was to analyze food selection practices in order to determine the effect of nutrition education on changes in shopping practices to later develop educational tools to promote selection of healthier food options. Cortes et al., performed their research by using 20 Spanish-speaking, low-income Latino families to participate in their research pilot. They received tailored, interactive, nutrition education during three to fıve home visits and a supermarket tour. Grocery store receipts for grocery purchases were collected after each purchase and at the end of the project so that the researchers could analyze each families nutritional content of purchased foods. (Side note: Nutritional content was measured with these factors in mind: quantity, calories, fats, carbohydrates, fıber, protein, and percentage of sugary beverages and processed food. Data was collected in 2010–2011 and analyzed in 2011–2012.)
 
After receiving between three and fıve home-based nutrition education sessions and a supermarket tour over a 6-month period, many families adopted instructions on buying budget-friendly, healthier alternative foods. Findings indicate that participating families decreased the total number of calories and calories per dollar purchased from base line to post-education. The median grams of carbohydrates per dollar and median calories from processed food were not reduced.
 
In conclusion, the pilot study demonstrated that grocery shopping practices are an important factor to address in nutrition education among Spanish-speaking, low-income individuals, and that there may be ways to encourage low-income, Latino families to purchase healthier foods.

The question now is, what ways can healthcare providers encourage low-income, Latino families to purchase healthier foods, since it's a known fact that healthier food is more expensive?

Do you think that the FDA should be held responsible and that they should pull certain "foods" off the market?

Should the government continue to implement Michelle Obama's "Let's Move" campaign in public schools and offer free "healthier food" at school and resources for their homes to those low-income families?

Reference:

Cortés, D. E., Millán-Ferro, A., Schneider, K., Vega, R. R., & Caballero, A. E. (2013). Food purchasing selection among low-income, Spanish-speaking Latinos. American journal of preventive medicine, 44(3), S267-S273. Retrieved from http://www.sciencedirect.com/
science/article/pii/S0749379712008756

http://www.letsmove.gov/about

Enrique Caballero, MD: QUE ORGULLO! (Post 3)

Enrique Caballero, MD, is the Director of the Latino Diabetes Initiative, Director of Medical Affairs of Professional Education, Staff Endocrinologist and Clinical Investigator at Joslin Diabetes Center in Boston, MA. He is Assistant Professor of Medicine at Harvard Medical School. 

Dr. Enrique Caballero is truly an "orgullo" for the Hispanic/Latino community. Dr. Caballero has accomplished so much in his career; he developed the Joslin Latino Diabetes Initiative that was launched in the summer of 2002. This is a comprehensive effort that integrates culturally oriented activities in the areas of patient care and education, community outreach, research and professional education. Through his work, Dr. Caballero is committed to identifying effective culturally oriented and community-based strategies that may contribute to the elimination of health care disparities. Thus, his hard work has received local, regional, national and international recognition.

In 2009, Dr. Caballero was the 2009 recipient of the “Alberto Houssay” award by the National Minority Quality Forum for his work on health care disparities and in 2011, he was the recipient of the Outstanding Service Award for the Promotion of Endocrine Health of an Underserved Population.

His research interests include type 2 diabetes and cardiovascular disease prevention as well as diabetes in racial/ethnic minorities. He is a co-investigator of the National Diabetes Prevention Program, the LookAhead Program and the Diabetes Education Study, all sponsored by the National Institutes of Health. Dr. Caballero has written various publications on pre-diabetes, obesity, endothelial dysfunction, diabetes in Latinos and the chapter of Diabetes in Minorities in the prestigious Joslin’s Diabetes Mellitus textbook. He is also a reviewer for multiple prestigious medical journals.

Dr. Caballero frequently lectures nationally and internationally in the areas of diabetes, cardiovascular disease and diabetes in minorities. He has been appointed as the chair for the Latino Diabetes Education Program for the American Diabetes Association and has worked closely with other national and international organizations. He is also a tutor of the Culturally Competent Care Curriculum at Harvard Medical School.

Dr. Caballero graduated from the National University of Mexico Medical School where he was awarded with the “Gabino Barreda” medal for the highest level of academic achievement in his class. He then completed his residency in Internal medicine and fellowship in Endocrinology at the National Institute of Nutrition in Mexico, and went on to complete a master’s degree in Clinical Epidemiology in Mexico. In addition, he completed a fellowship program in Endocrinology and Metabolism at the Lahey Clinic/Deaconess Hospital/Joslin Diabetes Center in Boston and the Program on Clinical Effectiveness at the Harvard School of Public Health.

Urgent Health Problem in the Hispanic Community (Post 2)

   According to the American Diabetes Association (ADA), “Diabetes is an urgent health problem in the Hispanic community, with 12.8 percent of the Hispanic population living with diagnosed diabetes in the U.S.” The ADA believes that getting information to the Latino/Hispanic community about the seriousness of diabetes and providing resources to help manage the disease is essential. Its evident that the Hispanic community lacks knowledge on the disease; disparities, risk factor and the severity if left untreated. Other reasons that contribute to this health problem is that there aren’t many Spanish resources, or healthcare providers that are fluent in Spanish and/or lack the knowledge of Spanish, Central, and South Americans beliefs, traditions and culture.   I agree with the ADA that it is essential that Hispanic community be educated on the severity on this pressing issue among the Hispanic community. And I commend there effort in doing so, however, as a nurse and nursing student and daughter whose mother has type II diabetes since 1996, over the years I have seen first hand that there aren’t many Spanish resources available. Especially during the late 90s and there still is very scarce to non-existent Spanish resources when it comes to type II diabetes. For example, on HKU there is no printed information on type II diabetes either in English or Spanish. I think since HKU is a specialized unit, our educators have not put much importance on other systems/diseases. I think that as a unit with a huge Hispanic patient population, we should have more resources in Spanish, such as pamphlets and healthcare providers that are fluent in Spanish. With that being said, I think that CNMC should also hire, more Hispanic nurses, fluent in Spanish. I also think that the ADA, American Nursing Association (ANA) and Nursing schools should promote nursing more among Hispanics through their websites and functions, in order to better serve the growing Hispanic population. 
How do you think the ADA should approach this matter, how should they reach out to the Hispanic community and educate them on the severity on type II diabetes?


What suggestions would you give the ADA?


Do you think there is enough Hispanic nurses in Nursing and do you think that a Hispanic nurse would make a difference in a Hispanic patients care/learning process?
 

Article resource:

http://www.diabetes.org/newsroom/press-releases/2014/american-diabetes-association-celebrates-hispanic-heritage-month.html

What is Type II diabetes? (Post 1)

What is Diabetes?

Diabetes is a problem with your body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type II diabetes is the most common form of diabetes. If you have type II diabetes, your body does not use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it isn't able to keep up and can't make enough insulin to keep your blood glucose at normal levels.

Type II Diabetes

Type II diabetes is a chronic disease in which people have problems regulating their blood sugar. People with diabetes have high blood sugar because their bodies:

• do not produce enough insulin
• are not responsive to insulin
• a combination of both

How Type II diabetes Affects Blood Sugar

When you eat food, the body digests the carbohydrates in into a type of sugar called glucose. Glucose is the main source of energy for cells. Cells rely on the hormone insulin to absorb and use glucose as a form of energy. The pancreas produces insulin; people usually develop type II diabetes because their cells have become resistant to insulin. Then, over time, their body may stop making sufficient insulin as well. These problems lead to blood sugar, or glucose, building up in the blood. Type II diabetes usually starts as insulin resistance. Cells stop responding properly to insulin and sugar is unable to get from the blood into the cells. Over time, the pancreas cannot make enough insulin to keep blood sugars in the normal range and the body becomes progressively less able to regulate blood sugar.

Many people with diabetes can manage their blood sugar with diet and exercise, especially if they lose weight (if they are overweight). If not, medications to help control blood sugar are available. Type II diabetes is often preventable; you can greatly reduce your risk of type II diabetes by keeping your weight in its ideal range and exercising regularly. Risk factors for type II diabetes include:

• obesity
• sedentary lifestyle
• older age
• family history of diabetes
• history of gestational diabetes
• race or ethnicity

So, what is the significance and relevance of this blog?

The significance and relevance of this blog is to inform the Hispanic community due to lack of knowledge of the disease, education, and resources. As a Hispanic nurse at a CNMC, I see this problem first hand; type II diabetes has become an epidemic within my community, specifically in Hispanic children. The potential impact of blogging on this issue among the Hispanic community; it would increase Hispanics knowledge on the disease, awareness of known disparities that affect their community, risk factors, long term effects and preventions.

Why do Hispanics have such a disparity for Type II Diabetes compared to the general 
population?

According to the U.S. Department of Health and Human Services Office of Minority Health, Hispanics are almost twice as likely as Non-Hispanic Whites to be diagnosed with Diabetes. They have higher rates of End Stage Renal Disease (ESRD), caused by Diabetes, and they are 50% more likely to die from Diabetes as Non-Hispanic Whites. Hispanic adults are 1.7 times more likely than Non-Hispanic White adults to have been diagnosed with Diabetes. In 2008, Hispanics were 1.6 times as likely to start treatment for ESRD related to Diabetes, compared to Non-Hispanic White men. In 2010, Hispanics were 1.5 times as likely as Non-Hispanic Whites to die from Diabetes. Some disparities are genes, environment, culture, poor nutrition, physical activity, and increased genetic predisposition to type II diabetes, this affects many Hispanics including children and adolescents. It is evident that multiple medical, cultural, and socioeconomic factors influence the development of diabetes, its course, and possible consequences.

Long-Term Outlook for People with Type II Diabetes

Uncontrolled diabetes significantly increases your risk of long-term health problems blindness, kidney failure, and amputations among adults and even death. According to the CDC, the death rate for people with type II diabetes is twice as high as that of people the same age people without diabetes. In addition, diabetes increases your risk of conditions such as:

• heart disease
• stroke
• high blood pressure
• eye disease, including blindness
• kidney disease
• nervous system damage
• amputations
• dental problems

Fortunately, most of the complications of type II diabetes are preventable. Keeping your blood sugar under control can prevent serious complications. In addition, regular preventative care visits can help keep minor complications from becoming ones that are more serious. This requires a lifelong commitment to staying healthy, including:

• eating well
• maintaining a healthy weight
• exercising
• taking medications, as prescribed by your doctor

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Article Sources:

ADA. (2014). Diabetes basics: diabetes type 2. American Diabetes Association. Retrieved from http://www.diabetes.org/diabetes-basics/type-2/?loc=util-header_type2

ADA. (2014). Diabetes basics: diabetes statistics. American Diabetes Association. Retrieved from http://www.diabetes.org/diabetes-basics/diabetes-statistics/?loc=DropDownDB-stats.

ADA. (2014). Food & fitness: create your plate. American Diabetes Association. Retrieved from http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/.

NIH. (2011). Diabetes diet—Type 2. PubMed Health, A.D.A.M. Encyclopedia, U.S. National Library of Medicine, National Institutes of Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004671/.

NIH. (2011). Type 2 diabetes. PubMed Health, A.D.A.M. Encyclopedia, U.S. National Library of Medicine, National Institutes of Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/.

U.S. Department of Health and Human Services. (2014, June 13). Office of Minority Health (OMH). Retrieved from http://www.minorityhealth.hhs.gov

About me: Hi, my name is Wendy Morales! (Intro)

My name is Wendy Morales. I am currently in nursing school finishing up my bachelors in Nursing (BSN) at George Mason University; my expected graduation date is May 2015. I am an Acute Pediatric Registered Nurse (RN) at Children’s National Medical Center (CNMC) on the Heart and Kidney Unit (HKU). I started at CNMC in 2008 as a Childcare tech (CCT) and transitioned to a Patient care tech (PCT) during nursing school. And in 2009, I started as a new grad on the Cardiac intensive care unit (CICU). After 6 months of CICU training, I transferred to HKU. I have had many roles on HKU as a preceptor and charge nurse. Out of my seven years of nursing, I want to say the most rewarding part of my career has been working with sick children and training new nurses. Working with sick children has taught me so much over the years; like things could be worse, resilience is key and that hope gives one the will and power to want to live and see another day, in addition, being able to work with the less fortunate/the Hispanic community in the Washington, DC area has been the most rewarding because I feel like I’m giving back to my community and I'd like to continue doing so by starting this blog on Type II diabetes in honor of diabetes awareness month, and for my mother who was diagnosed with type II diabetes in 1996. Here is to my hero, my mother, mi madre, Sandra P. Morales. #ILYMOM #diabetesawarenessmonth #proudlatina #hispanicsunidos

-Wendy, RNII