There are more than 30 million U.S. adults with type 2 diabetes and another 84 million with prediabetes. This epidemic continues to increase with the prevalence of type 2 diabetes rising rapidly since 1980, according to the World Health Organization. And of those with a diabetes diagnosis, the majority of patients are African-American, Hispanic, Native American or Asian. By recognizing the barriers to care for minority patients, physicians look to prevent and manage type 2 diabetes.
“What if we dreamed big and we could, together with our partners, have the greatest public health and health care success of our lifetime by being able to state together that there are no new cases of preventable type 2 diabetes?” Christopher Holliday, PhD, said during a recent AMA discussion panel. Holliday is the director of population health and clinical-community linkages at the AMA.
“About a third of my patients are seniors and 90 to 95 percent are African Americans,” said AMA member and Internist Niva Lubin-Johnson, MD, at the event. “A lot have chronic diseases. A lot have diabetes [and] a lot more have prediabetes.”
The struggle and challenge with taking care of patients who have a chronic disease is getting them to understand that while it is chronic, it can be changed, said Dr. Lubin-Johnson who first became an AMA member in 1982 as a medical student and is affiliated with the Women Physicians Section and General Council. She is also president-elect of the National Medical Association—the third person, and first female, to serve as president, speaker and chair of the Board of Trustees.
Here is how she overcomes the barriers to caring for minority patients with chronic diseases, such as type 2 diabetes.
Stress things in the patient’s control
To help prevent and manage type 2 diabetes, Dr. Lubin-Johnson stresses things that are in her patients’ control such as diet, exercise and getting enough rest. These factors are especially necessary for patients with prediabetes. A small amount of weight loss can prevent the development of diabetes.
“The other challenge is time management,” she said. “It’s not easy for a single mother with school-aged children to go grocery shopping or find time to exercise. You have to spend the time to talk with them about how it can be done.”
Since she began practicing medicine, Dr. Lubin-Johnson’s style has evolved to a more teamwork approach with her patients. This means working with the patient to find a solution by saying, “This is what you should do. Let’s talk about what you are willing to do now.”
“It is individualizing the plan for each patient in order to help them see what they can do, what they should do,” she said.
Pay attention to messaging
Social determinants of health play a big role in barriers to patient care. One in four U.S. dollars is spent on care for patients diagnosed with diabetes and about one in three adults have prediabetes, according to the American Diabetes Association. The challenge is decreasing the number of patients with diabetes.
To decrease this number, though, the messaging needs to change. If a patient has a family member that has diabetes and they think it is normal, they aren’t necessarily around to see an up close view of what the disease progression looks like.
Many of Dr. Lubin-Johnson’s family members, including both of her grandfathers, her first cousin and her brother, had diabetes. Through her personal experience with her brother, who died from complications with diabetes, she saw firsthand the challenges faced by this disease. This is why she recommends making it personal for patients.
“Unless patients have that up close personal experience to see what happens step by step by step, they may not realize the gravity of the situation when it hits them,” she said.
In October 2017, the AMA announced a multistate effort aimed at reducing the incidence of type 2 diabetes nationwide. The AMA offers online CME to expand your knowledge in diabetes management. Explore educational content such as “Prevent Diabetes STAT.”
