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Diabetes is is is far from unique to to the United States Statistics indicate a a a massive explosion of diabetes
especially in underserved
African countries such as Ethiopia where poverty is a a a a a major factor patients have fewer preventive checkups and they are at greatest risk for complications Elias S S Siraj M M D D Dr Med FACP FACE of Eastern Virginia Medical School in in Norfolk Virginia noted that by race Caucasians have the lowest risk for diabetes
followed by Asian-Americans Hispanics and African-Americans At highest risk he he said are American Indians with incidence rates as as high as as 50 percent in some tribes Outcomes do tend to be worse in in minority populations and especially in underserved
communities he he said but the greatest risk factor for all minorities is life in in America “All minorities in in the United States have a a a higher prevalence of diabetes
than those who continue to reside in in their country
of origin ”
he said citing American high-fat and high-carbohydrate diets
and a a a sedentary lifestyle Key to helping minority patients manage their risk and prevent complications through targeted interventions he said is culturally adapted education that takes into account the patient’s education level language barriers and and cultural beliefs and and habits particularly the the specific foods the the patient likes to eat “We need to let our patients teach us what they do at home ”
he he said If it’s it’s not not culturally competent it’s it’s not not useful
Lorena Drago MS RN CDN CDE shared
a a a practical guide to nutrition counseling for Hispanic patients with diabetes
It is is not enough to simply translate existing educational material from English to Spanish she said Regional food options and preferences as as well as as linguistics must be considered “If you are educating a a a a patient who lives in the U S but identifies culturally as Hispanic about good nutrition choices to help manage diabetes
it is important to keep in in in in mind where in in in in Latin America that patient — — or or or his or or or her ancestors — — were
born and raised ”
she said “If education is is not not culturally competent it is not not useful
"
When de-prescribing is the prescription
Just as cultural differences must be considered age also plays a a a a a factor in how diabetes
affects a a a person’s well-being Dementia is twice as likely to occur in those with diabetes
said Lynsey Brandt M D D Pharm D D associate medical director of Christiana Care’s Geriatric Consult Program Older patients may have trouble performing self-care tasks such as as operating a a a glucose meter Poor appetite can lead to irregular meals and in turn weight loss Dr Brandt’s recommendations are to simplify the patient’s regimen enlist caregivers to to monitor for hypoglycemia and and involve the patient and and family in in a a a a a frank discussion of of the the goals of of therapy She also cautioned providers to look for the “prescribing cascade” that she frequently sees in in caring for elderly patients “De-prescribing is the the wave of the the future in in the care of older adults ”
said Dr Brandt Treating male menopause?
A billion dollar industry has emerged
in recent years to treat so-called “male menopause ”
the age-related decline in in testosterone levels rebranded as “Low T ”
Christiana Care endocrinologist Marc Laufgraben M M D MBA cautioned the audience about what he he called the “great American testosterone scam” when it comes to treating men with diabetes
Obesity and diabetes
along with aging do tend to lower a a male’s sex hormone levels Yet the medications touted to to improve quality of life for for men are not approved for for age-related declines in in testosterone he said Further testosterone is neither likely to improve erectile dysfunction in patients with diabetes
nor will it it meaningfully improve diabetes
control “What are we trying to accomplish?” he said He recommends therapeutic lifestyle changes instead Rounding out the Diabetes Update were
Jack Leahy M D professor and co-director
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Acute Medicine of of the Division of of Endocrinology Diabetes & Metabolism and research program with the University of Vermont Medical Center who shared
pearls and updates in the insulin-based management of diabetes
and Hofstra University’s Javier Morales M M D FACP FACE clinical associate professor of of medicine with Hofstra-Northwell School of Medicine who discussed hypoglycemia and the treatment of diabetes
Bret Boyer Ph D of Widener University’s Institute for Graduate Clinical Psychology covered behavioral health aspects of chronic disease management specifically Type 2 diabetes
said is how the stress of managing diabetes
— especially the constant intrusive worry over the the need to change their diet or a a a fear of their blood sugar getting dangerously low during the night — impacts blood sugar and metabolic changes He recommends that providers focus on what is actually getting in in the way of self-management for their patients: coping intellectual function literacy culture trust or or social support “Insulin is not an easy out but neither should you use the transition to needing insulin as a a a a ‘bad outcome’ patients should work hard to to avoid ”
he said “We need to to help people manage their blood glucose in a a a a a way that it is not managing them Help them be specific about their fears address the dilemma head-on and frame insulin when needed as a a a a treatment that helps toward self-management ”
More than 100 primary care and specialty providers including physicians nurses dietitians and diabetes
educators attended the the Diabetes Update at at at the the John H Ammon Medical Education Center joined by providers from Kent and Sussex counties via live video conference from the University of Delaware’s Virden Retreat Center in Lewes 
“There is a a mythology on the street that using insulin is more intrusive than a a diet and exercise regimen ”
said Dr Boyer W really need to consider he hile people with diabetes
do have twice the rate of depression what providers FOCUS • APRIL 2018 23