Rosa Fuentes is a retired widow with seven grandchildren who was recently diagnosed with prediabetes. When she received information about the risks of diabetes, she did not fully understand how certain foods and recommendations were to fit into her routine given her circumstances and responsibilities to her family.
Diabetes is a chronic disease that occurs when one’s pancreas does not make insulin (type 1) or when the pancreas makes less insulin than normal and becomes resistant to the production of more (type 2). This means that one’s blood sugar level, the main sugar in your body that regulates energy, needs to be monitored as insulin is not helping convert the sugar into energy. Although symptoms and early signs can vary from person to person, they usually consist of fatigue, headaches, or higher levels of thirst and hunger. It can impact a person’s daily life if left untreated and could even lead to other health issues such as heart or kidney disease.
When discussing diabetes, it is important to note that the disease disproportionately impacts both Indigenous and Latine communities. Reports of type 2 diabetes in Latines have been significantly higher in comparison to the reports for their white non-Latine counterparts. When researching diabetes in Latino populations, Caballero (2005) notes “the lifetime risk of developing diabetes for a Hispanic person born in 2000 is 45.4% for a man and 52.5% for a woman”. With one out of two Latines being at risk for a diagnosis, diabetes is a significant health concern that sometimes goes unacknowledged. One of the cultural norms in Latine cultures is to place the importance of family over oneself. This often means working through illnesses and injuries because of familial obligations or ensuring dependants are taken care of before taking care of oneself. Because of this, going to a medical professional for a consult about potential diabetic symptoms may be placed on the back burner.
Within Indigenous communities, a similar issue is presented as screening for diabetes may not be as accessible. In his study of diabetes management in Australian Indigenous communities, Nguyen (2016) finds that “approximately 75% of Indigenous people living in non-remote areas report a sedentary lifestyle” which can increase the risk of diabetes. Indigenous communities in South and Central America have a similar lifestyle, so they are also at a higher risk of being diagnosed. Additionally, there is a history of health disparities between Indigenous and non-Indigenous populations which furthers the issue as their issues are brushed aside by medical professionals when they go to consultations.
Rosa’s doctor provided her with information about diabetes as well as recommended speaking with a grief counselor about the loss of her husband. She believed that God would help her with her pain and refused to speak with a counselor and although exercise was recommended, the YMCA she usually attended had limited hours. Since she was retired, she mostly remained at home and did chores, read, and talked with friends. Additionally, having to help take care of her grandchildren also prevented her from spending a significant amount of time on herself as she had to help those around her.
This disease can be treatable when it is addressed early when symptoms start to appear. Changes in lifestyle can help decrease the negative effects of diabetes on one’s life. Although insulin is the primary treatment method, it is not always accessible and can be expensive. An easier method is maintaining an exercise routine. Increasing your physical activity on a weekly basis can decrease blood glucose levels. This can include dancing, swimming, or even just going on a brisk walk. Another method of maintaining blood glucose levels is making changes to one’s diet. Adding beans to meals can provide additional nutrients and fiber that animal products do not provide. Fresh or frozen vegetables can be included in any dish and add healthy carbs and fiber to dishes. Frozen vegetables can be purchased in bulk and smaller portions can be defrosted when needed, providing the opportunity for many uses in different meals over time. They are also lower in sodium compared to canned vegetables or vegetables with added butter, cheese, or sauce. Making these small changes to one’s lifestyle can improve diabetic symptoms so they are less severe and do not impact daily life.
In Rosa’s case, she reduced her sugar consumption and continued to consume her caldos with vegetables. By eating papaya and mangoes instead of flan or gelatin, she was able to lower her sugar levels. She began exercising with family and friends on days she could not go to the YMCA which also helped her manage her prediabetic condition.
When it comes to diabetes in Guatemala, their population suffers greatly in comparison to other countries. In his study of accessible diabetes care, Edwin Nieblas-Bedolla (2019) found that “the prevalence [of diabetes] amongst the indigenous community is 25% and is considerably higher than the prevalence of type 2 diabetes in Central America”. Diabetes in Indigenous communities is also considerably higher compared to the prediabetes rate of 9.3% when looking at the general population. Indigenous communities in Guatemala are at a significant disadvantage when it comes to access to resources for diabetic care.
“HSP's Partners in Service program has been instrumental in fostering connections and creating meaningful impact in rural health sectors. In a recent initiative, we've collaborated with esteemed professionals from Virginia Commonwealth University and Rutgers School of Nursing to pioneer rural ambulatory diabetes screening and education campaigns. This significant effort has been enriched by the invaluable contribution of community health facilitators from AMA, who have been extensively trained in using cloud-based data management tools. ” — Ben Blevins, HSP Co-Founder
HSP and Asociacion de Mujeres del Altiplano (AMA) are working to bring resources and diabetes care plans to these communities in a way that is accessible and feasible given what is available to people. They also offer resources and information on lifestyle changes that are applicable to the local lifestyles. More recently, the International Organization of Migration has announced its plans to help fund an HSP-designed intervention this November. The intervention has allowed HSP to operate studies in rural communities to track the program’s effectiveness. Promoting these intervention programs also facilitates the development and distribution of heart-healthy foods that tie into cultural meals. This merges product marketing and public health into a comprehensive plan to target this leading disease in Guatemala.
References
Bream KDW, Breyre A, Garcia K, Calgua E, Chuc JM, et al. (2018) Diabetes prevalence in rural Indigenous Guatemala: A geographic-randomized cross-sectional analysis of risk. PLOS ONE 13(8): e0200434. https://doi.org/10.1371/journal.pone.0200434
Caballero, A.E. Diabetes in the Hispanic or Latino population: Genes, environment, culture, and more. Curr Diab Rep 5, 217–225 (2005). https://doi.org/10.1007/s11892-005-0012-5
Cigna. (2022). Diabetes in the Hispanic/latino(a) community: Four case studies. Cigna. https://www.cigna.com/static/www-cigna-com/docs/diabetes-in-hispanic-latino-community-four-case-studies.pdf
Nieblas-Bedolla, E., Bream, K.D.W., Rollins, A. et al. Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala. Int J Equity Health 18, 180 (2019). https://doi.org/10.1186/s12939-019-1086-z
Nguyen, H.D., Chitturi, S. and Maple-Brown, L.J. (2016), Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population. Intern Med J, 46: 1252-1259. https://doi.org/10.1111/imj.13123