Type 2 Diabetes: Barriers to Self-Management

Posted Wednesday November 07, 2018 by healthgap



By: Moriah Israel

I will never forget the day I learned my mother had Type 2 Diabetes. I came into her room and she was sitting on her bed, watching TV. I noticed the pharmacy bag on the bed and asked her what it was for. She responded, “I have Diabetes without ever breaking eye contact from the television. I did not know whether to be more concerned with her diagnosis, or the matter-of-fact manner in which she told me she has a life-threatening illness. We have never been the mother-daughter duo to go for mani/pedi’s and wear matching outfits; we ____ and we hug when times are tough. Her emotional distance was frustrating but I did not pry. I asked my original question and walked away frustrated and afraid.

Type 2 Diabetes is often referred to a preventable disease. Although there are some genetic components, one’s personal choices has been proven to contribute to the onset of the illness. I was frustrated with my mother because I have witnessed components of a sedentary lifestyle, and afraid because I still had not gotten her Sour Cream and Chicken recipe yet and now we would only be left with those savory, savory memories.

Except, here we are years later and she has invited me over to enjoy that same meal this weekend. I know neither of us should be eating it, yet I do not know to confront the discrepancy without offending her. I am not exactly sure when the roles changed, but suddenly I feel it my responsibility to take care of her. I know she is an adult and she is ultimately reliable for her own health; however, her non-adherence to her primary care doctor’s recommendations concern me.

One in ten Americans are living with Diabetes Mellitus, and African Americans experience a higher prevalence of the illness, as well as more complications and greater mortality rates compared to their white counterparts. Despite the fact the overall rate of Diabetes Mellitus has decreased in America, the racial disparity persists, urging professionals to address social contributions to the disease. I know my mother has been under a lot of stress lately, and it is very difficult to change your diet and regulate meal times and get exercise and stop smoking and consistently take the prescribed medication. I know that access, education, and side effects of treatment can serve as barriers to self-management.  I also know that all of these things can contribute to the persistence of the illness and generate severe complications.

However, I do not know what it is like to experience constant stomach discomfort and bloating as a result of the prescribed Metformin; and I don’t know how to ask her if she is experiencing any painful urination, diarrhea, or depression so that I may encourage her to follow up with her doctor. It is one thing to treat someone with this illness, or work to educate citizens on ways to prevent its onset. Yet it is a completely different thing to change your life after negative habits have been ingrained in your self-concept. How do I convince my mother to replace years of “I just need to make sure the kids have something to eat before school” with “I need to wake up 30 minutes earlier so I can eat breakfast everyday”?

Studies have shown that barriers to adequate self-management of type 2 Diabetes include changing established habits, a negative perception of a new regimen, social reclusiveness, and environmental practicality. These changes will require a cultural shift in perceptions of health and wellness. For generations, African American communities have been primarily concerned with the maintenance of fundamental necessities and immediate needs. The concept of longevity has only recently become a topic of conversation in many low-income minority households.

Families are beginning to replace negative ideas about healthy foods and physical exercise with more positive feelings about holistic wellness.  With the help of health education programs in the community at-risk populations are learning realistic ways to manage their illness and take control of their health. Nevertheless, there is still a great deal of work to do. More culturally specific programs are necessary to provide individualized plans and address the barriers to care that are specific to individuals. African-American communities need greater access to whole grains and healthy produce, cost-friendly facilities dedicated to physical fitness, and safe spaces to discuss these barriers and develop specific intervention strategies for families in need.

 

Sources:

http://www.diabetes.org/diabetes-basics/statistics/

https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans

https://ac-els-cdn-com.proxy.libraries.uc.edu/S0749379713000184/1-s2.0-S0749379713000184-main.pdf?_tid=0b7153b3-2d88-4d85-960a-a29a67405a5a&acdnat=1541397581_fb7eefa3fb8bdc46ce36a357433a0260

https://www.mayoclinic.org/drugs-supplements/metformin-oral-route/side-effects/drg-20067074?p=1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367214/

https://www.ncbi.nlm.nih.gov/pubmed/23739524

https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

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