Por Margarita Persico
(Baje para la versión en español)
Nancy Rivera’s type 2 diabetes had been so out of control she feared for her life.
“I was a walking time bomb… waiting to explode,” says Rivera, a 48-year-old mother of four who was diagnosed with type 2 diabetes.
She had all the symptoms: she was overweight, constantly tired and always thirsty. Her blood sugar level was over 500, more than quadruple a normal blood glucose reading, which should typically fall between 80 and 120. She could have been in a coma.
According to the American Diabetes Association (ADA), Rivera is one of nearly 24 million diabetics in the United States, a number expected to double in four decades. As a Latina, she is part of the nation’s fastest growing ethnic group — one that’s also being diagnosed with diabetes and its many complications at nearly twice the rate of the general population.
Even though type 2 diabetes is associated with the elderly, it is no being diagnosed in younger people, including children and adolescents. One in every three Americans and one in every two Hispanic females born in the United States after 2000 are at lifetime risk of diabetes, according to a 2008 Center for Disease Control and Prevention (CDC) report. Worse, it is estimated that 5.7 million people are unaware that they have diabetes, according to the ADA.
“Diabetes is … probably one of the most challenging problems that are going on right now in the Latino community in terms of health,” says Dr. Alexander Green, associate director of the Disparities Solutions Center at Massachusetts General Hospital (MGH) in Boston. The numbers have driven many health organizations to start diabetes initiatives and outreach interventions. For example, MGH started the Disparities Solutions Center nearly four years ago to seek answers to persistent racial and health disparities.
One of their projects is the Diabetes Initiative, started in Chelsea in part because of the Boston suburb’s high population of Latinos — 48 percent, according to the last census. Green says nearly 50 percent of the initiative’s diabetic patients are Latinos.
“If [patients] don’t have education in Spanish, for example, they may not be able to understand diabetes as well,” Green says.
At MGH’s Chelsea HealthCare Center, where Rivera is a patient, Spanish speaking diabetes coach Eddie Horta works with patients to take control of their diabetes. As a liaison between doctor and patient, he triesto fi gure out what barriers the patient is facing and tries to devise solutions — within a patient’s budget or health care plan. Some physicians have learned that patients may not be able to afford their medications, but are too embarrassed to say as much. “Some are on a fi xed income or get paid only when they work,” says Dr. Enrique Caballero, director of the Latino Diabetes Initiative at the Harvard- affi liated Joslin Diabetes Center. “They don’t have the luxury to take a day off to go to the doctor … because that may cost them money.”
Another problem is the cost of “eating healthy” and the relative lack of stores that sell healthy foods in communities of color. To close that gap, Joslin’s Latino initiative sent two of its health offi cials and several patients to a local supermarket where they shopped for healthy foods on a budget.
“Sometimes healthier foods are more expensive, but not all the time,” says Caballero.
“So even within a limited budget, people can make better choices. And so now we go exactly to where people buy the food and teach people how to do that in a better way.”
Latino patients, though, face more than economic barriers. Diabetes runs in Rivera’s family. “I have two [younger] brothers that are diabetic, my mom is diabetic, my [step] dad is diabetic, my grandmother was diabetic,” says Rivera, a patient access representative at Boston Medical Center.
CULTURAL COMFORT IN TREATING DIABETES
Caballero, a Latino himself, says that lifestyle factors — such as poor diet and lack of participation in physical activities — can greatly affect the probability of Latinos developing diabetes. Rivera agrees.
“We know that, unfortunately, in the Latino population, insulin doesn’t work as well, and that is what is called insulin resistance,” says Caballero. “And the prevalence of insulin resistance is higher in Latinos than in the white population.” For Rivera, her biggest obstacle are carbohydrates and foods containing a lot of fat. She doesn’t like sweets, but says she loves pork loin and “pasteles” — stove top cakes made from root vegetables and plantains, usually fi lled with meats and wrapped in banana leaves. Until last month, she explains, her typical breakfast was “sausage, home fries, eggs, [and] toast.”
Frequent exercise is critical to higher survival rates — as is cultural comfort. “One example of our culturally oriented activities is that we just created a pilot [program] of salsa dancing,” Caballero says. “Many of our patients said they … didn’t like to run or jog, but that they would dance.” As a result, Caballero and his team hired a salsa instructor for a monthly meeting at a Jamaica Plain church. This year, Rivera says she wants to lose weight. She says she wants to be around to spend time with her grandkids; to celebrate her granddaughter’s “quinceañera,” or 15th birthday, and her daughter’s wedding next year.
Rivera says she is controlling her diabetes now by watching her diet and following her doctor’s advice. She is taking insulin, and the result is a blood sugar level that now ranges between 155 and 165. It’s still not perfect, but it’s much better than before.
“I have two angels watching over me,” Rivera says, referring to her medical doctor and nurse practitioner. “They never gave up on me, even though I would give up on myself.”
Un Enfoque Cultural para Aliviar la Diabetes
La diabetes tipo 2 de Nancy Rivera se había descontrolado hasta el punto de poner en riesgo su vida.
“Yo era una bomba de tiempo”, dice Rivera, de 48 años, madre de cuatro hijos que sufre de diabetes tipo 2.
Ella tenía todos los síntomas: sobrepeso, cansancio y sed constante. Su nivel de azúcar en sangre era superior a 500, cuatro veces mayor a lo normal, que es entre 80 y 120.
Según la Asociación Americana de la Diabetes (ADA, por sus siglas en inglés) hay 24 millones de diabéticos en Estados Unidos. Y estima que 5.7 millones de personas desconocen sufrir esta enfermedad.
“Hablando en términos de salud, la diabetes es uno de los mayores retos de la comunidad latina”, dice el Dr. Alexander Green, director asociado en el Centro para las Disparidades de la Salud en el Hospital General de Massachusetts, en Boston.
Algunos doctores se han dado cuenta de que sus pacientes no tienen sufi ciente dinero para pagar los medicamentos.
“Muchos poseen salarios ajustados o sólo reciben dinero cuando trabajan”, dice el Dr. Enrique Caballero, director de la Iniciativa para Latinos Diabéticos en el Centro para la Diabetes Joslin. “Ellos no se pueden permitir el lujo de tomar un día libre par ir al doctor, es dinero que dejan de ganar”.
Otro problema es el costo de “comer sano” y la relativa falta de establecimientos adecuados en las zonas donde viven. Además, inciden el factor genético y el estilo de vida asociado con los latinos. “Tengo dos hermanos [menores] que son diabéticos, mi madre es diabética, mi padrastro es diabético, mi abuela era diabética”, dice Rivera, que ahora está preocupada por su hija, que va camino de tener los mismos problemas.
“La enfermedad es producto de una mezcla genética y de estilo de vida”, dice Caballero. “Sabemos que,desafortunadamente, la insulina no es del todo efectiva en la población latina, que poseen una mayor resistencia a la insulina que la población blanca”.
Caballero dice que el estilo de vida tiene mucho que ver en el desa-rrollo de la enfermedad. Tanto la mala alimentación como la falta de ejercicio incrementan las posibilidades de desarrollarla.
“Mi abuela comía lo que le daba la gana porque decía que se iba a morir de todos modos, y que se moriría feliz”, dice Rivera, que admite enfocar el problema con “la misma actitud”. Pero además de la dieta, el ejercicio es básico para evitar los efectos de la diabetes.
“Muchos de nuestros pacientes admiten no querer correr, sin embargo, sí están dispuestos a bailar un poco de salsa”, dice Caballero, que considera el factor cultural también importante a la hora de enfrentar los problemas de la diabetes.
Como resultado, Caballero y su equipo han contratado a un instructor de salsa con el que se reúnen mensualmente en una iglesia en Jamaica Plain.
Rivera dice que está controlando su diabetes mediante la dieta y siguiendo los consejos de sus doctores. Está utilizando insulina y sus niveles de azúcar en sangre están entre 155 y 165. No es lo óptimo pero si está mucho mejor que antes.
(Baje para la versión en español)
Nancy Rivera’s type 2 diabetes had been so out of control she feared for her life.
“I was a walking time bomb… waiting to explode,” says Rivera, a 48-year-old mother of four who was diagnosed with type 2 diabetes.
She had all the symptoms: she was overweight, constantly tired and always thirsty. Her blood sugar level was over 500, more than quadruple a normal blood glucose reading, which should typically fall between 80 and 120. She could have been in a coma.
According to the American Diabetes Association (ADA), Rivera is one of nearly 24 million diabetics in the United States, a number expected to double in four decades. As a Latina, she is part of the nation’s fastest growing ethnic group — one that’s also being diagnosed with diabetes and its many complications at nearly twice the rate of the general population.
Even though type 2 diabetes is associated with the elderly, it is no being diagnosed in younger people, including children and adolescents. One in every three Americans and one in every two Hispanic females born in the United States after 2000 are at lifetime risk of diabetes, according to a 2008 Center for Disease Control and Prevention (CDC) report. Worse, it is estimated that 5.7 million people are unaware that they have diabetes, according to the ADA.
“Diabetes is … probably one of the most challenging problems that are going on right now in the Latino community in terms of health,” says Dr. Alexander Green, associate director of the Disparities Solutions Center at Massachusetts General Hospital (MGH) in Boston. The numbers have driven many health organizations to start diabetes initiatives and outreach interventions. For example, MGH started the Disparities Solutions Center nearly four years ago to seek answers to persistent racial and health disparities.
One of their projects is the Diabetes Initiative, started in Chelsea in part because of the Boston suburb’s high population of Latinos — 48 percent, according to the last census. Green says nearly 50 percent of the initiative’s diabetic patients are Latinos.
“If [patients] don’t have education in Spanish, for example, they may not be able to understand diabetes as well,” Green says.
At MGH’s Chelsea HealthCare Center, where Rivera is a patient, Spanish speaking diabetes coach Eddie Horta works with patients to take control of their diabetes. As a liaison between doctor and patient, he triesto fi gure out what barriers the patient is facing and tries to devise solutions — within a patient’s budget or health care plan. Some physicians have learned that patients may not be able to afford their medications, but are too embarrassed to say as much. “Some are on a fi xed income or get paid only when they work,” says Dr. Enrique Caballero, director of the Latino Diabetes Initiative at the Harvard- affi liated Joslin Diabetes Center. “They don’t have the luxury to take a day off to go to the doctor … because that may cost them money.”
Another problem is the cost of “eating healthy” and the relative lack of stores that sell healthy foods in communities of color. To close that gap, Joslin’s Latino initiative sent two of its health offi cials and several patients to a local supermarket where they shopped for healthy foods on a budget.
“Sometimes healthier foods are more expensive, but not all the time,” says Caballero.
“So even within a limited budget, people can make better choices. And so now we go exactly to where people buy the food and teach people how to do that in a better way.”
Latino patients, though, face more than economic barriers. Diabetes runs in Rivera’s family. “I have two [younger] brothers that are diabetic, my mom is diabetic, my [step] dad is diabetic, my grandmother was diabetic,” says Rivera, a patient access representative at Boston Medical Center.
CULTURAL COMFORT IN TREATING DIABETES
Caballero, a Latino himself, says that lifestyle factors — such as poor diet and lack of participation in physical activities — can greatly affect the probability of Latinos developing diabetes. Rivera agrees.
“We know that, unfortunately, in the Latino population, insulin doesn’t work as well, and that is what is called insulin resistance,” says Caballero. “And the prevalence of insulin resistance is higher in Latinos than in the white population.” For Rivera, her biggest obstacle are carbohydrates and foods containing a lot of fat. She doesn’t like sweets, but says she loves pork loin and “pasteles” — stove top cakes made from root vegetables and plantains, usually fi lled with meats and wrapped in banana leaves. Until last month, she explains, her typical breakfast was “sausage, home fries, eggs, [and] toast.”
Frequent exercise is critical to higher survival rates — as is cultural comfort. “One example of our culturally oriented activities is that we just created a pilot [program] of salsa dancing,” Caballero says. “Many of our patients said they … didn’t like to run or jog, but that they would dance.” As a result, Caballero and his team hired a salsa instructor for a monthly meeting at a Jamaica Plain church. This year, Rivera says she wants to lose weight. She says she wants to be around to spend time with her grandkids; to celebrate her granddaughter’s “quinceañera,” or 15th birthday, and her daughter’s wedding next year.
Rivera says she is controlling her diabetes now by watching her diet and following her doctor’s advice. She is taking insulin, and the result is a blood sugar level that now ranges between 155 and 165. It’s still not perfect, but it’s much better than before.
“I have two angels watching over me,” Rivera says, referring to her medical doctor and nurse practitioner. “They never gave up on me, even though I would give up on myself.”
Un Enfoque Cultural para Aliviar la Diabetes
La diabetes tipo 2 de Nancy Rivera se había descontrolado hasta el punto de poner en riesgo su vida.
“Yo era una bomba de tiempo”, dice Rivera, de 48 años, madre de cuatro hijos que sufre de diabetes tipo 2.
Ella tenía todos los síntomas: sobrepeso, cansancio y sed constante. Su nivel de azúcar en sangre era superior a 500, cuatro veces mayor a lo normal, que es entre 80 y 120.
Según la Asociación Americana de la Diabetes (ADA, por sus siglas en inglés) hay 24 millones de diabéticos en Estados Unidos. Y estima que 5.7 millones de personas desconocen sufrir esta enfermedad.
“Hablando en términos de salud, la diabetes es uno de los mayores retos de la comunidad latina”, dice el Dr. Alexander Green, director asociado en el Centro para las Disparidades de la Salud en el Hospital General de Massachusetts, en Boston.
Algunos doctores se han dado cuenta de que sus pacientes no tienen sufi ciente dinero para pagar los medicamentos.
“Muchos poseen salarios ajustados o sólo reciben dinero cuando trabajan”, dice el Dr. Enrique Caballero, director de la Iniciativa para Latinos Diabéticos en el Centro para la Diabetes Joslin. “Ellos no se pueden permitir el lujo de tomar un día libre par ir al doctor, es dinero que dejan de ganar”.
Otro problema es el costo de “comer sano” y la relativa falta de establecimientos adecuados en las zonas donde viven. Además, inciden el factor genético y el estilo de vida asociado con los latinos. “Tengo dos hermanos [menores] que son diabéticos, mi madre es diabética, mi padrastro es diabético, mi abuela era diabética”, dice Rivera, que ahora está preocupada por su hija, que va camino de tener los mismos problemas.
“La enfermedad es producto de una mezcla genética y de estilo de vida”, dice Caballero. “Sabemos que,desafortunadamente, la insulina no es del todo efectiva en la población latina, que poseen una mayor resistencia a la insulina que la población blanca”.
Caballero dice que el estilo de vida tiene mucho que ver en el desa-rrollo de la enfermedad. Tanto la mala alimentación como la falta de ejercicio incrementan las posibilidades de desarrollarla.
“Mi abuela comía lo que le daba la gana porque decía que se iba a morir de todos modos, y que se moriría feliz”, dice Rivera, que admite enfocar el problema con “la misma actitud”. Pero además de la dieta, el ejercicio es básico para evitar los efectos de la diabetes.
“Muchos de nuestros pacientes admiten no querer correr, sin embargo, sí están dispuestos a bailar un poco de salsa”, dice Caballero, que considera el factor cultural también importante a la hora de enfrentar los problemas de la diabetes.
Como resultado, Caballero y su equipo han contratado a un instructor de salsa con el que se reúnen mensualmente en una iglesia en Jamaica Plain.
Rivera dice que está controlando su diabetes mediante la dieta y siguiendo los consejos de sus doctores. Está utilizando insulina y sus niveles de azúcar en sangre están entre 155 y 165. No es lo óptimo pero si está mucho mejor que antes.
