Diabetes a major killer of Latinos

Diabetes a major killer of Latinos
By Michael Collins, Ventura County Star, September 19, 2009

Diabetes is killing Latinos in Ventura County at twice the rate it is claiming lives in other racial and ethnic groups.

Nearly 6 percent of Latinos who died in Ventura County in 2005 and 2006 were killed by diabetes, an examination of death records by The Star and Scripps Howard News Service shows.

That is twice the diabetes death rate for all racial groups and more than twice the rate for non-Latino whites and African-Americans.

Doctors say those numbers are alarming but hardly shocking. Diabetes has been increasing for years among Latinos, they say, not only among adults but also teenagers and young children.

“These numbers don’t surprise me at all,” said Dr. Theresa Cho, who runs the adult diabetes clinic at Ventura County Medical Center. “It’s just a reality that we deal with on a daily basis.’’

Reported figures probably low

The diabetes death rate might be even higher than the numbers suggest, doctors say, because people with the disease often die from other conditions. In those cases, diabetes would not be listed on the death certificate as the cause of death, although it often is a contributing factor.

“Diabetes as a direct cause of death may be underrepresented because most people die from the complications of the disease,” said Dr. Robert Gonzalez, medical director for the Ventura County Health Care Agency.

“Diabetes increases the incidence of stroke, heart disease, peripheral vascular disease, kidney failure, and all of those are major contributors to a person’s vulnerability.”

The Star examined the 474,163 deaths reported in California and the 9,679 reported in Ventura County in 2005 and 2006. The statistics were provided by the U.S. Centers for Disease Control and Prevention.

The study found the diabetes death rate in Ventura County is closely in line with statewide figures.

In California, 5.4 percent of Latinos who died during the two-year period were killed by diabetes — nearly twice the rate for all races and more than twice the death rate for non-Latino whites.

In Ventura County, the diabetes death rate for Latinos was 5.7 percent, compared with 2.2 percent for non-Latino whites and African-Americans and 2.9 percent for all racial groups combined. In hard numbers, 92 of the county’s 1,628 Latinos who died in 2005-06 were killed by diabetes.

In Los Angeles County, the diabetes death rate among Latinos was 5.6 percent. In Santa Barbara County, it was 5.7 percent.

10% of U.S. Latinos afflicted

Nearly 2.5 million Latinos in the United States, or roughly 10 percent of the nation’s Latino population, are afflicted with diabetes, according to the U.S. Department of Health and Human Services’ National Diabetes Education Program.

By 2050, the agency predicts, two of five Latino young people, and one in two Latino females born in the year 2000, will have developed diabetes.

Because of genetics and childhood obesity, diabetes is starting to show up in Latinos at a much younger age.

Recently, a 7-year-old Latino boy was treated for Type 2 diabetes by doctors at Clinicas del Camino Real, which operates 10 health clinics across Ventura County, said Dr. Anil Chawla, the agency’s medical director.

Type 2 diabetes occurs when the body doesn’t make enough insulin or cannot effectively use the insulin it makes. It usually develops in adults older than 40 but is becoming more prevalent in children and adolescents.

Chawla said she sees a lot of teenagers and people in their early 20s who have developed Type 2 diabetes. Many, like the 7-year-old boy, are overweight, she said.

Some studies have suggested Latinos might be genetically predisposed to diabetes. But doctors in Ventura County say other factors also are contributing to the diabetes death rate, including diet, economic challenges and culture.

For example, cooking with lard is still prevalent in the Latino community, which can add to weight gain and obesity. The Latino diet also is heavy in starches, which is true for a lot of cultures. Latinos, however, tend to eat a lot of starchy foods in one setting, Cho said.

“It’s something that is very much a part of the culture, to have tortillas and the beans and the rice all in one meal,” she said. “The important message we send to people is it’s not that we are asking them to stop eating those foods, but they need to eat them in moderation.”

Free screenings available

Cho’s clinic often does outreach programs that include free diabetes screenings in areas with high concentrations of Latinos in hopes of catching the disease early before serious complications set in.

“We do discover some people who actually had no idea they were diabetic,” she said.

Even when diabetes is diagnosed, medical experts say, many Latinos don’t get proper healthcare because they can’t afford it or think they can’t afford it.

Some Latinos in Ventura County are migrant workers with incomes at the federal poverty level. To them, “medical care can seem like a daunting task and an incredible economic burden,” Gonzalez said.

The Ventura County Health Care Agency, which oversees two hospitals and more than two dozen health clinics, tries to help them overcome those economic barriers by offering a self-pay discount policy in which medical fees are based on a patient’s ability to pay.

The agency also recently set up a program to provide healthcare for the uninsured. Some 12,000 people have enrolled so far, Gonzalez said, and about 40 percent have chronic illnesses, such as diabetes.

“I think we have good access to care,” Gonzalez said, “but it’s all about whether the person perceives that it’s there.”

A number of places in Ventura County offer healthcare and other services for diabetics.

Cho’s clinic, for example, has two staff dietitians, a nurse educator and a registered nurse who take a team approach to patients’ diabetes care. Once a treatment decision has been made, the educator will meet with the patient to discuss issues such as how to self-administer an insulin shot. A dietitian also will instruct the patient on what kinds of foods to eat and avoid.

Some stores color-code food

The Westminster Free Clinic, a largely volunteer clinic that provides free healthcare for disadvantaged working families in east county, offers diabetic counseling classes in Spanish.

The clinic also has a program in which foods at participating grocery stores are color-coded to promote healthy eating habits for people with diabetes and heart disease.

“I’m dealing with the poorest of the poor — people who are uninsured, working poor, uninsured-trying-to-find-jobs poor, and homeless poor,” said Dr. Steven Kamajian, the clinic’s chief medical officer.

“A lot of them are illegal aliens, and they don’t qualify for benefits in the United States. I understand that, but they still need to be properly cared for. Healthcare is not a right, it’s not a privilege, it’s a necessity. It’s like clean water.”

Many don’t trust doctors

Latinos sometimes forgo traditional medical care for diabetes in favor of home remedies, such as drinking special teas or eating large amounts of cactus to control blood sugar.

Some have a deep distrust or even fear of insulin treatments, doctors say.

They might know of a relative or friend who took insulin and suffered other complications, such as blindness or kidney failure. They incorrectly associate those problems with the insulin, even though the real problem was that the diabetes was already in advanced stages when the patient sought treatment, Chawla said.

“It takes a lot of convincing that this happens over a long time; that vision problems are associated with diabetes and are not associated with insulin,” she said. “Some of them accept that. But some of them are really adamant about these problems.”