The Centers for Disease Control and Prevention estimates nearly a third of Americans are pre-diabetic. Many more are already diabetic.
And the economic costs of their care topped $300 billion dollars, according to the American Diabetes Association. It’s especially acute for Latinos. To tackle the problem, many experts say education is the key. But is that enough?
Previous stories in this series:
- Diabetes Among RI Latinos Rising Faster Than Any Other Group
- For Latinos, Diabetes Disparities Driven By Poverty
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Diabetes Prevention Programs
At Progreso Latino, a social service organization in Central Falls, a group of mostly retired Spanish speakers settles in for their weekly diabetes prevention class. That includes learning what and how to eat. Dominga Taveras asks everyone to pull out their pocket guide to calories.
“Por ejemplo, si vamos a hacer un sandwich, y le vamos a agregar mayonesa, sabemos aquí en la A, buscar que tipo de aceite va a usar, o que tipo de mayonesa voy a poner.”
(For example, if we’re going to make a sándwich, and we’re going to add mayonnaise, we know here under ‘A,’ to look for what type of oil you’re going to use, or what kind of mayonnaise you’re going to use.”)
Taveras says her students need help navigating the ins and outs of healthy eating to avoid diabetes. Some are already diabetic. Catching them before their blood sugar spirals out of control is key, she says. Uncontrolled diabetes can lead to a host of health problems. It’s a chronic disease, and costly to manage. Progreso Latino offers these free diabetes prevention classes in addition to a free health clinic, twice a month. That’s critical for the Latino community she says because they’re more likely to be uninsured, or too poor to afford care.
“Por eso, nosotros hemos tratado de mantener la clinica que tenemos, porque por lo menos son dos días al mes que puedes venir y hablar con la enfemera, y chequear su azúcar.”
(“For that reason, we’ve tried to keep the clinic we have open, because at least there are two days a month you can come and talk with a nurse and check your sugar.”) 
Filling in the Gaps
Another free clinic, Clinica Esperanza, caters to Latinos with free or low cost health care and a diabetes prevention class. Women and Infants Hospital sends nurses into poor communities to check blood sugar and offer other preventive services. A program out of Brown University called Food on the Move brings a mobile farmers market to underserved communities. Clinics and outreach efforts like these have popped up to fill in the gaps of traditional medical care. Dr. Sapna Chowdry is the medical site director at Thundermist Community Health Center in Woonsocket.
“We have tried very hard to all year round have once a week a farmers market that we hold down in the lobby in bad weather then out in the parking lot in summer to try to bring some fresh fruits and vegetables and some teaching to the community.”
And Chowdry says when it comes to patients too poor to afford diabetic medication or supplies –
“We’re often able to improvise. And we’ve never had to not treat someone because of their status, whether it’s a legal issue or insurance-related issue, we always have something back up in the medicine closet or something that we can improvise.”
Beyond offering a farmers market, diabetes prevention programs, and individual counseling, Chowdry says there’s not much more she can do to stem the epidemic of diabetes among her Latino patients. But Memorial Hospital’s chief of medicine Dr. Joe Diaz says patients need more resources.
“If you don’t have the resources for healthy food or don’t understand what the options are for healthy food and healthy lifestyle, if there aren’t opportunities to go to a gym or if there aren’t healthy places or safe places to exercise in your community, it’s really difficult to encourage people to exercise and go for a daily walk if there’s no good place to go for a walk.”
When Education Isn’t Enough
Healthy food can be expensive. Diabetic supplies and medicine can be expensive. Joining a gym or even finding the time to exercise can be out of reach for some. And with diabetes – the clock is ticking when it comes to lifestyle changes. The disease puts you at risk for cardiovascular and other diseases. That’s why the Mayo Clinic’s Dr. Victor Montori believes we need a brand new approach to curbing the epidemic.
“There seems to be a disconnect between the scope of the problem. We are told that 1 in 3 people live with either diabetes or they’re about to get diabetes. So that’s a large number of people in the United States. And yet the solution that’s put forward is that each of those people should go in and visit with their doctor, figure out if their sugars are high enough, and if they’re high enough they should go and change their lifestyle, eat differently, be more active.”
But that’s a tall order, says Montori, for people of lower socioeconomic status.
“There’s something very abstract and sterile about socioeconomic status. It sounds like a scientific description of what is a profound daily lived experience of people feeling that they’re second class citizens, that they don’t belong, that the systems that are in place not only are not for them but they’re against them. And we can’t solve that by identifying people with high blood sugar and sending them to the Y.”
There is some research that shows diabetes prevention programs, like those offered at YMCAs, are effective. But Montori sees them as expensive and inconsistent with the scope of the diabetes problem in this country. We need to reduce income inequality, so that more of us have access to affordable, healthy food and safe places to exercise. Memorial Hospital’s Joe Diaz agrees, but he thinks prevention programs should be part of the mix.
“If we look at how we live and the behavioral choices we’re making, it’s healthy eating and options for healthy eating, and exercise and options for exercise and making those things available. Those sorts of things in conjunction with the diabetes prevention programs I think have a lot of potential. If we’re talking about populations, we need to think about how we engage our communities in healthy living, in exercise, and make those options available for people.”
Health care providers can only do so much he says.
