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Ethnic Minorities and Religious Issues

Diabetes - Ethnic Minorities and Religious Issues

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Introduction

There is an increased prevalence of diabetes in many ethnic minority groups particularly amongst people of South Asian and Afro-Caribbean origin.  This is usually associated with dyslipidemia, central obesity and hypertension.

The challenges of managing this are:-

Prevention

Early Diagnosis

Providing an Ethnic Specific Diabetes service that addresses the target population and is sympathetic to cultural and religious norms

Diabetes UK has a list of information leaflets in many different languages

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Prevention

Promotion of healthy lifestyle via community based targeted and culturally specific programmes will reduce incidence. 

Religious and cultural factors often inhibit use of conventional exercise facilities e.g. mixed swimming or even an active lifestyle.

Health care professionals need to be aware of acceptable facilities and practices.

Black and Ethnic Minority  (BEM) Healthy Eating Literature & support groups in the form of locality based healthy eating groups are available and should be promoted

Health care professionals and community workers have a role in alerting families with existing diabetes of the proven benefits of change for unaffected family members to reduce the risk of diabetes.

Local Health Promotion and Prevention Services
Exercise Facilities for BEM Groups
See - Diabetes Prevention

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Early Diagnosis

See -  Early Detection and Screening

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Ethnic Specific Diabetes Services

Diabetes registers should document ethnicity, religion and preferred language.

Specific religious observance eg Ramadan and specific food avoidance may have potential adverse effects on diabetes control.

Practitioners should be aware of traditional activities, food & meal times which may influence diabetes. Relevant culturally sensitive advice may need to be given. eg:

 

Recommend three well spaced meals a day with:

 

 

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small early breakfast

 

 

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reduce size of midday meal

 

 

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avoidance of very late evening meals

 

If energy deficit is required :

 

 

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reduce fat by measuring oil used and less fried foods

 

 

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reduce rice / chapatti servings and size of main dish /dishes

Diabetic treatment regimens should be tailored to recognise meal and lifestyle patterns

Appropriate cultural and language specific literature and education programmes should be available.

 

Language specific education materials are available from the Diabetes UK website.

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Use of Translation Services

There are known difficulties in obtaining unambiguous history and developing agreed goals when working through family members or friends-particularly if of different sex or age group. 

Make use of any available trained Linkworkers  / BEM Food workers or book translators or access the Phone line service.

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Barriers

Deeply seated cultural health beliefs may have an adverse effect upon diabetes control.

Weight loss may not be perceived as a healthy outcome especially by people of African, Afro Caribbean or Middle Eastern origin.

Diabetes outcome is rarely favourable in many countries from which these groups originate: this has led to deeply seated “acceptance/ fatalism” which may lead to a sense of powerlessness and reduce motivation to make positive changes.

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Religious Observance

Many religions require a form of food avoidance/fast as part of their observances i.e. Fundamental Christian sects, Sikhism, Hinduism, Islam, Judaism etc. Their impact will depend on type of fast and it’s duration, current diabetes treatment and control.

Many are daylight fasts or specific food only observances. These should be discussed with the patient to find out what is involved. For many the diabetes condition would be grounds for exemption but if a patient still wants to fast, advice on timing and dose of medication may be required to prevent swings in blood glucose level.

Ramadan

Of far greater impact is the month long observance of Ramadan during which no food or drink is taken between sunrise and sunset. People with diabetes can be exempted but many still insist on full observance. Safety is further compromised if patients also insist on avoidance of blood glucose monitoring during daylight hours. The impact of large amounts of fatty and sugar food when the daily fast is broken also needs to be considered

Issues need to be considered before the start of Ramadan:

Long acting sulphonylureas may need to be changed to short acting preparations

Doses of insulin or tablets may need to be split and/or adjusted to allow for cover of the larger than normal pre fast meal (seheri) & breaking fast meals (iftar). Some groups actually have 2-3 substantial snacks /meals between sunset & sleeping.

See -  Ramadan and Diabetes for further information.

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Useful External Links & Resources

PDF File

Luton Women's Exercise Classes Leaflet
   

View

Diabetes UK leaflets in other languages
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