Healthcare of an Aggregate at Risk

Hispanics/Latinos and Diabetesby

Sheneeza IqbalUniversity of Central Florida

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Diabetes was the seventh leading cause of death based on U.S. death certificates in 2007

Compared to the other races risk of diagnosed diabetes Hispanics are 66% higher ,Mexican Americans are 87% higher , and Puerto Ricans are 94% higher

(Centers for Diseases Control and Prevention [CDC],2011).

Aggregate at Risk Data…

According to the Centers for Disease Control(CDC), Diabetes affects 25.8 million people which is 8.3% of the U.S. population.

18.8 million of these cases are diagnosed while 7.0 million people remain undiagnosed.

In 2010: 10.9 million U.S. residents aged 65 years had diabetes 215,000 people younger than 20 years had type 1 or type 2

diabetes About 1.9 million people aged 20 years or older were

newly diagnosed (CDC, 2011).

Demographics, Epidemiological and Statistical Data …

A 2007–2009 national survey done by the CDC indicated that people aged 20 years or older diagnosed with diabetes were:

11.8% of Hispanics 7.6% for both Cubans and for Central and South Americans 13.3% for Mexican Americans 13.8% for Puerto Ricans 7.1% of non-Hispanic whites 8.4% of Asian Americans, 12.6% of non-Hispanic blacks (CDC,2011).

Demographics, Epidemiological and Statistical Data continued…

Social and cultural factors: Language barrier Fear of embarrassment/disrespect Fear of unacceptance by friends and family because of diabetes Fear of loss of job Fear of loss of self worth/ self esteem An experiment done on Mexican-American Elders with Diabetes by

Haltiwanger (2012)reported that many feared being seen as weak, losing respect from their friends and family if they disclosed their diabetes status, while some stated they feared embarrassment as a result of their disease. Statements from the participants in the study about their diabetes were:

“Paco revealed, at work, I am afraid of telling that I have diabetes. I might lose my job. Having diabetes is a curse in our culture.”

“Ysela expressed her social discomfort by explaining that her fear of disrespecting someone was greater than disrespecting herself, when I eat at someone’s house, I eat some of everything they serve. I don’t want to disrespect my host, or inconvenience them. I don’t want them to know that I am unhealthy, surely!”

(Haltiwanger ,2012,p.6).

Social and cultural factors…

Lack of insurance, racial minority and lower literacy skills

(Wallace, Carlson, Malone, Joyner & DeWalt, 2010,p.1)

Family history of diabetes

Gestational diabetes Obesity/alcoholism Poor diet & nutrition Elevated c-reactive

protein(CRP) level (inflammation marker)

A research study was done in the Rotterdam district of the Netherlands on 7983 individuals aged 55 and older to assess their risk for type two diabetes in relation to CRP level and other modifiable risk factors (smoking, high BMI and a high waist circumference). The result found that a high CRP was a major contributor to type 2 diabetes. It also found that the modifiable risk factors contributed to two-thirds of the risk for diabetes (Dehghan, Hoek, Sijbrands, Stijnen, Hofman & Witteman, 2007).

Political, economical & other contributing factors to diabetes…

Cardiovascular disease- diabetics are two to four times more likely to die of heart disease or experience a stroke.

Hypertension- 70% more likely to have due to diabetes

Risk of blindness, cataracts or glaucoma Kidney disease Neuropathy Gastroparesis Sexual and urological dysfunction(CDC, 2014).

Diabetes risk to health…

Hispanics/Latinos from different parts of the world have similar beliefs, but some of their practices are unique to their country of origin.

A study done by Long et al.(2012) with 24 participants on the similarities and variations in the health beliefs of the four major Latino groups( Puerto Ricans, Mexicans, Columbians & Mayans) in the United States using focused group discussion and questionnaires results showed that:

Health care provider not speaking Spanish was seen as a barrier to getting health care

80% of participants believed in getting healthcare information via their church. Mayans preferred word of mouth communication, while Puerto Ricans & Columbians prefer health fairs.

Health beliefs and practices, use of alternative/complementary therapies…

Mayans, Puerto Ricans & Columbians believed health to be holistic; some practice relaxation, meditation, deep breathing, and massage.

Puerto Ricans viewed diabetes as a part of aging; Columbians saw it as a luxury disease that took their money, Mayans related diabetes to high sugar intake and Mexicans viewed it as a malfunction of the pancreas.

All Latinos believe in the use of herbal/alternative therapy for treatment such as using herbs like cinnamon, ginger, garlic.

Columbians believe in going back to their own country to get healthcare because of high cost in the U.S.

(Long et al.,2012) .

Health beliefs and practices, use of alternative/complementary therapies continued…

D-1 Reduce the annual number of new cases of diagnosed diabetes in the population

D-2 Reduce the death rate among people with diabetes D-3 Reduce the diabetes death rate D-4 Reduce the rate of lower extremity amputation in people with

diabetes D-5 Improve glycemic control among persons with diabetes 5.1 Reduce the proportion of diabetics with A1C level more than 9

percent5.2 Increase the proportion of diabetics with A1C level less than 7

percent D-6 Improve lipid control among diabetics D-7 Increase the proportion of diabetics whose blood pressure is

under control(Healthy People 2020, 2013).

Healthy People 2010/20 National Objectives…

D-8 Increase the proportion of diabetics who have at least an annual examination

D-9 Increase the proportion of adults with diabetes who have at least an annual foot exam

D-10 Increase the proportion of adult diabetics who have at least an annual dilated eye exam

D-11 Increase the proportion of adult diabetics who have a glycosylated hemoglobin measurement twice per year

D-12 Increase the proportion of persons diagnosed with diabetes who obtain an annual urinary microalbumin measurement

D-13 Increase the proportion of adult diabetics who perform self glucose monitoring at least once per day

(Healthy People 2020, 2013).

Healthy People 2010/20 National Objectives continued…

D-14 Increase the proportion of adults with diabetes who received formal diabetes education

D-15 Increase the proportion of persons with diabetes whose condition have been diagnosed

D-16 Increase the proportion of persons at high risk for diabetes with prediabetes

16.1 by increasing their level of physical activity16.2 by trying to lose weight16.3 by reducing the amount of fat or calories in their

diet(Healthy People 2020, 2013).

Healthy People 2010/20 National Objectives continued…

Problem #1:Deficient knowledgeNursing Diagnosis: deficient knowledge related to

cultural factors, language barrier, and low literacy skills as evidenced by high prevalence of diabetes cases in Hispanics/Latinos population

Outcome: by educating the population in their own language and environment, their knowledge of diabetes, risk to their health and prevention methods will increase.

Prioritized problem, need and risk for Hispanics/Latinos related to diabetes

Problem #2: poor nutrition/dietary intake Nursing diagnosis: Imbalanced nutrition related to poor dietary intake and

choices related to lack of knowledge, cultural factors and low socioeconomic status.

Outcome: Hispanics/Latinos at risk and diagnosed with diabetes

will choose, prepare and eat a balanced diet rich in grains, vegetables, lean meat and low in fat and carbohydrates.

Prioritized problems…

Problem #3: risk for cardiovascular disease related to poor dietary intake, obesity and poor disease management

Outcome: Individuals at risk and diagnosed with diabetes will

understand how ineffective diabetic management, poor dietary intake and obesity increase their risk for cardiovascular disease, and how tight glycemic control, exercise and a healthy diet can decrease diabetic risk.

Prioritized problems…

Educate adults about the risk of obesity, smoking, alcohol and physical inactivity and how it contributes to diabetes.

The public health nurse can collaborate with individuals in the Hispanic community and educate the people at risk or diagnosed with diabetes on healthy eating, exercise, smoking cessation, and weight reduction to prevent and control diabetes and its complications. This can be done at community centers, health fairs or at classes organized by the church.

(Stanhope and Lancaster, 2010, p.368)

Primary prevention

Screening for diabetes can be done by the public health nurse completing a thorough history and physical assessment asking patients for their family history of diabetes or diabetic symptoms such as increased thirst, frequent urination,or increased appetite.

Public health nurses can complete finger-stick glucose checks at health fairs. ARNPs practicing in public health can order diagnostic lab for diabetes such as glucose tolerance test, glycosylated hemoglobin level, C-reactive protein level, etc.

(Stanhope and Lancaster, 2010, p.368).

Secondary prevention

Tertiary prevention aims at preventing disease complication and progression and can be achieve by:

Intense monitoring of blood glucose by at least daily finger stick blood glucose checks and twice yearly glycosylated hemoglobin level.

Annual foot and dilated eye examination Eating a balanced diet high in fiber, grains, vegetables,

lean meat and low in fats and calories. Adhering to medication regime and following up regularly

with family healthcare provider. Maintaining a healthy weight and exercising regularly.

(Stanhope and Lancaster, 2010, p.368)

Tertiary prevention.

Centers for Diseases Control and Prevention. (2014). Diabetes Health Concerns. Retrieved from

http://www.cdc.gov/diabetes/consumer/problems.htm

Centers for Disease Control. (2011). National Diabetes Fact Sheet, 2011. Retrieved from

http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

Dehghan, A., van Hoek, M., Sijbrands, E., Stijnen, T., Hofman, A., & Witteman, J. (2007). Risk of type 2

diabetes attributable to C-reactive protein and other risk factors. Diabetes Care, 30(10), 2695-2699.

Haltiwanger, E. (2012). Experience of Mexican-American Elders with Diabetes: A Phenomenological Study.

Occupational Therapy in Health Care, 26(2/3), 150-162. doi:10.3109/07380577.2012.694585

Healthy People 2020. (2013). Diabetes. Retrieved from

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=8#387490

References

Long, J.M., Sowell, R., Bairan, A., Holtz, C., Curtis, A.B., & Fogarty, K.J. (2012).

Exploration of commonalities and variations in health related beliefs across four

Latino subgroups using focus group methodology: Implications in care for Latinos

with type 2 diabetes. Journal of Cultural Diversity, 19(4), 133-142.

Stanhope, M. & Lancaster, J. (2010). Foundations of nursing in the community:

Community oriented-practice (3th ed.) St. Louis, MO: Mosby Elsevier.

Wallace, A., Carlson, J., Malone, R., Joyner, J., & DeWalt, D. (2010). The influence of

literacy on patient-reported experiences of diabetes self-management support.

Nursing Research, 59(5), 356-363. doi:10.1097/NNR.0b013e3181ef3025

References