Speaker: Amparo Gonzalez, MPH, RN, CDE, FAADE
Culturally Relevant Diabetes Management in Latinos
Webinar Description: Multicultural societies exist worldwide, and culture can greatly impact the success of self-managed treatment plans. Diabetes management requires that people engage in multiple healthy behaviors that are shaped by an individual’s culture, and culturally appropriate diabetes care requires practitioners to have competencies in specific areas of cultural knowledge. The Johnson & Johnson Diabetes Institute is excited to have Amparo Gonzalez, MPH, RN, CDE, FAADE present on culturally relevant diabetes care for the Latino population. >> Download Slides
How to Use a Medical Interpreter
More than 25 million people living in the US define their English proficiency as "less than very well"- Census data 2010
This population has decreased access to healthcare and has an increased risk of adverse effects.
The Civil Rights Act mandates that interpreter services be provided to patients with Limited English Proficiency (LEP).
Tips when using an interpreter
- clinician should address the patient directly
- the interpreter should sit next or slightly behind the patient
- statement should be short
- discussion limited to 3 major points
- the interpreter may serve as a cultural liaison
Phone interpretation or the use of bilingual staff members as an alternate when professional interpreter is not available.
A Physician’s Practical Guide to Culturally Competent Care
Certification Commission for Healthcare Interpreters
Cross Cultural Health Care Program
How to Communicate Effectively Through Interpreters: A Guide for Leaders
National Board of Certification for Medical Interpreters
National Council on Interpreting in Health Care
National Standards for Culturally and Linguistically Appropriate Services in Health Care
Registry of Interpreters for the Deaf
Telephone Interpreter Services (fee-based)
CyraCom Language Solutions: http://www.cyracom.com
Speaker: Teresa L Pearson, MS, RN, CDE, FAADE
Serving the Underserved: Understanding the Lower Socioeconomic Population
Webinar Description: Self-management is a critical aspect of diabetes care, but issues such as low literacy, socioeconomic challenges, and cultural differences can hinder diabetes self-management practices. It is important that such barriers be overcome through interventions that meet the needs of underserved populations. The Johnson & Johnson Diabetes Institute is pleased to have Teresa L Pearson, MS, RN, CDE, FAADE speak on the topic of underserved populations. Teresa addresses how to manage diabetes in this patient population and how to identify and access appropriate resources. >> Download Slides
For those of you who work with low-wage workers, the unemployed and the uninsured, you undoubtedly have become very aware of the socioeconomic impact on diabetes and health. Even people who have insurance but are working a low-wage job are often living on the edge of just one incident away from disaster. The following is adapted from my Editorial in the March 2015 issue of AADE in Practice entitled Poverty: the other risk factor for diabetes and its complications.
Did you know that along with physical inactivity, obesity and family history, living in poverty is a risk factor for type 2 diabetes? In fact, studies have shown that living in poverty can double or triple the likelihood of developing diabetes. While it is well known that lifestyle changes can reduce the risk of diabetes and its complications, people living in poverty have less access to the resources needed to make those changes. The communities in which people in poverty live are more likely to be food deserts, medically underserved areas and unsafe for walking all of which add to the risk. The added stress of financial pressures can increase cortisol levels thus further increasing the risk. James Levine, MD emphasizes these points in Diabetes in November of 2011. Where and how we live DOES matter. Yet, poverty is rarely focused on as a modifiable risk factor.
In a viral blog entitled “Killer Martinis: Why I make terrible decisions or poverty thoughts,” Linda Tirado writes of what life in poverty is like on a day-to-day basis. She describes the choices someone living paycheck to paycheck (at best) has to make. Things like healthcare. “Free” she says is for the rich… There's a clinic? Great! There's still a copay. We're not going… Might as well be located on Mars for how accessible it is. "Low-cost" and "sliding scale" sounds like "money you have to spend" to me...
And when it comes to trying to convince someone living in poverty to spend money on something that will help them prevent complications sometime down the road in the future Tirado says, Poverty is bleak and cuts off your long-term brain… We don't plan long-term because if we do we'll just get our hearts broken. It's best not to hope.
We try to focus on the individual and to help them create a plan that will work for them. When we ask someone to change an unhealthy habit we need to think of it from their perspective. Tirado describes her take on smoking and eating junk food referring to them as pleasures she can actually afford. “Why would we give that up?” So what alternatives do we have to offer or suggest. After all, isn’t everyone entitled to some little pleasures in their life?
These struggles are very real and often there is nothing we can do to change the situation, but we can help find a solution that is doable. It may not be perfect but it will at least be better than what they have been doing. Assessing for financial concerns is certainly part of a diabetes self-management education assessment, but we need to take it a step further. We should have a list of resources and strategies for helping these patients help themselves within their means.
In this webinar I used the framework of the AADE 7©, to address managing diabetes on a budget. The following are some additional comments from listeners that I think you might find useful when helping your patients who are living in poverty.
- Buying fruits and vegetables in season or when they are on sale
- Plan ahead – freeze in season foods to eat later
- Identify healthy options on fast food menus
- Use low cost meats such as tuna and turkey and use more beans
- Provide a list of resources in the community for low cost healthy foods such as Farmer’s Markets, co-ops, low cost grocery stores
- Frozen vegetables instead of fresh
- Rinse off the juice in canned vegetables to remove the sodium
- Rinse off the juice in canned fruits to remove the syrup
- See if your state allows double bucks for food assistance when buying at a Farmer’s Market or other healthy options
- Plan ahead – pack a healthy lunch so not tempted to buy something less healthy and more costly
- Teach people how to cook
- See article in AADE in Practice regarding healthy choices in a Dollar Store
- Participate in a community garden to get fresh vegetables
- Encourage water rather than expensive bottled drinks
We also talked about suggestions for getting physical activity on a budget and when someone lives in an environment where walking the neighborhood is unsafe.
- Physical activity at home - chair exercises, resistance bands, dancing or moving to music, going up and down the stairs
- Warm water walking/aerobic swim programs through local community centers or schools that offer free swim time
- Provide a list of free or low cost opportunities for physical activity in your community
- Use combination therapy if possible to cut down on co-pays
- Get 90-day supplies
- Apply for patient assistance programs such as www.needymeds.org
- Find a list of pharmacies that offer free or low cost generic meds
- Empower patients to openly discuss need for physician to prescribe low cost meds and not necessarily the "latest and greatest"
- Vocational rehabilitation can help for a limited time
- Tie SMBG to another daily routine so they will be more likely to remember it
- Simplify SMBG routine
- Recommend paired testing
- If patient can only test once daily, vary time of testing and write down time and results to determine pattern
- Look for affordable options for supplies
- Find free support groups in your community at churches, community centers, etc.
- Involve behavioral health professionals
Identify people in their circle who can be a support – someone to lean on
Speaker: Mohamed Hassanein MB CHB, FRCP, FRCP, MPhil
Diabetes and Ramadan fasting; a challenge or an opportunity
Webinar Description: Considered one of the Five Pillars of Islam, Ramadan is the ninth month of the Islamic calendar that is observed by Muslims as a time of fasting. Muslims with diabetes may be exempted from fasting during this period, but many choose to fast. Patients should be assessed beforehand, as dawn to dusk fasting could put them at risk for hypoglycemia, hyperglycemia, and dehydration. How can care best be individualized to meet the needs of this patient during this critical period? >> Download Slides