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9/12/2018
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Culture, Food and Diabetes Management
Darlene DeWitt, MS, RD, LD
Presentation Objectives O Background on Worthington, MN
O Cultural Competence and ways to
build it
O Ethnic foods
O Cultural differences/asking questions
O Diabetes Self-Management goals
O Resources
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Worthington, MN
O Hispanic 41.9%, 5,533
O Caucasian 39.9%, 5,267
O Asian 9.8%, 1,300
O African Am. 6.9%, 910
O Other race 1.5%, 205
O Total pop: 13,215 (2016)
Largest employer: 2,400
employees with 50+languages
http://www.city-data.com/city/Worthington-
Minnesota.html
Developing Cultural Competence
The Papadopoulos, Tilki and Taylor Model for Developing Cultural Competence
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Fresh Water “aqua fresca”
O Light non-alcoholic
beverages made from
seeds, flowers, or fruits
blended with sugar and
water.
O They are popular in Mexico
and the United States.
O In Mexico, it is common to
find aguas frescas in
cantaloupe, guava, mango,
melon, orange, papaya,
passion fruit, strawberry,
watermelon, pineapple
tamarind and chia, horchata
and cebada.
O Hibiscus tea, also called
agua de (Flor de) Jamaica or
sorrel, popular also in
Jamaica and West Africa
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Atole O A drink that can be sweet
or savory depending on
the region in Mexico
where you are.
O It was drank by the
indigenous people of
Mexico for breakfast or
sometimes as a meal in
itself.
O Traditionally, it is made by
dissolving ground dried
corn in milk or water, and
adding fruits or different
flavorings to it.
O Currently, Atole is also
made with cornstarch, rice
flour, oat flour, or barley.
O Its consistency ranges
from thin and milky, to
very thick.
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Building Cultural Knowledge
O Visit Ethnic grocery stores
O Find people to talk to
O Use online resources
O Try making ethnic foods
Ethnic Markets
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Herbs, Spices and Traditional Remedies
Fresh produce
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Canned Fruit and Veg
Sauces and Condiments Sodium
1285 mg
Sodium
785 mg
Sodium
680 mg
Sodium
690 mg
Sodium
290 mg
(1 TBSP)
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Sodium
1160 mg
Sodium
470 mg
Sodium
1290 mg Sodium 390 mg
African Products
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Noodles and Rice
Sugary Beverages
56 gm
carb/bottle
26 gm carb/bottle
41 gm carb/bottle
41 gm carb/bottle
31 gm carb/bottle
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Snack foods/ Desserts-Asian Store
Snack foods/Desserts-hispanic store
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Find the people
Resources for Cultural Competency
O Ethnomed: http://ethnomed.org/
O Stratis Health:
http://www.culturecareconnection.org/competent/
O http://transculturalcare.net/nutrition-and-cultural-
competence/: cultural competency assessment and
publications on culture and nutrition as resources.
Campinha-Bacote’s model of cultural competence
O http://www.ifanca.org/Pages/index.aspx : Islamic Food and
Nutrition Council of America
O Cultural Food Practices: written by Diabetes Care &
Education DPG. Cynthia M. Goody, PhD, MBA, RD and
Lorena Drago, MS, RD, CDN, CDE, eds.
(helmpublishing.com)
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Cultural Differences
Rephrasing-Time
O Tease out general time pattern
O Ex. Do you eat before or after you take the
kids to school?
O What are your break times at work?
O Look more at frequency of meals
O Ex. How many times do you eat each day?
O Is your eating pattern the same on your days
off?
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Rephrasing-Measurements
Ask:
O How much of your plate
do you fill with…?
O How does your portion
of…compare with this
one?
O How do you serve the
soup?
O How does the size of your
cup compare to this one?
Instead of:
O How much cereal do
you eat?
O How many ounces of
meat?
O How many cups of
rice?
O How many ounces of
pop do you drink?
Teach Visually
How Foods Affect Blood Sugar: A Guide for Vietnamese Patients with Diabetes Author: Elizabeth Aong,
MPH, RD for EthnoMed
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Faith and Family
O How many people are in the house?
O How do they affect what you eat?
O What Is your role in the house?
O How can your family help you be healthier?
O What religious holidays do you observe?
O Do you have any customs or traditions
involving food?
Ramadan
O A month long; one of the five pillars of Islam
O Mandatory for healthy adult Muslims; children, the
elderly, pregnant or breastfeeding or physically
unable are exempt.
O Occurs at the ninth month of the lunar-based Islamic
calendar
O Shifts approximately 11 days earlier each year. May
14-June 14, 2018
O After Ramaden, 3 day celebration called Eid-ul-Fitr
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O Abstinence from all food/drink, including
water and gum, from dawn to sunset
O Pre-fast meal-suhur
O Break their fast with meal-iftar (traditionally
starts with dates and water or milk)
O They are permitted to snack between iftar
and suhur (overnight)
O Often these meals have fried foods and
sugary sweets
O Recommendations would be high fiber
foods, lots of fluid, limit fried, sugary foods
and discuss medications with provider.
Setting Goals for Blood Sugar Management
O Consider personal preferences (e.g.,
tradition, culture, religion, health beliefs and
goals, economics) as well as metabolic goals
when working with individuals to determine
the best eating pattern for them. Source: American
Diabetes Association.4. Lifestyle management: Standards of Medical Care in Diabetes 2018. Diabetes
Care 2018;41(Suppl. 1):S38–S50
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Ethnic Disparities in Diabetes Care — Learn What They Are, the Cultural Differences That May Influence These Disparities, and the Role of RDs and Diabetes
Educators. Annemarie Miller, RDN, and Constance Brown-Riggs, MSEd, RD, CDE, CDN; Today's Dietitian. Vol. 18, No. 11, P. 48
AADE 7 Diabetes Self-Management Factors
FACTOR CONSIDERATIONS
Monitoring Suggest appropriate technology or language
sites or apps
Taking medication Some cultures believe medication is for short-
term illness. Stress daily routine and check in
Problem Solving They may prioritize family needs over their
own. Stress taking care of self to be able to
care for family.
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AADE7 Diabetes Self-Management Factors
FACTOR CONSIDERATIONS
Healthy Eating Include familiar foods, suggest culturally
appropriate foods
Being Active Emphasize non-exercise physical activity
Reducing Risk Some cultures view weight loss as negative.
Use client’s motivation to explain benefits.
Healthy Coping Suggest family activities, encourage making
changes together, positive support system
Meal Time Management
O Educate with the culturally
appropriate plate
O Talk about what they can eat
more of FIRST
O Stress portions and proportions
O Give options: rice, beans, tortillas
O Talk about recipe modification
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How Foods Affect Blood Sugar: A Guide for Somali Patients with Diabetes
Authors: Jocelyn James, MD and Yetta Levine
How Foods Affect Blood Sugar: A Guide for Vietnamese Patients with Diabetes
: Elizabeth Aong, MPH, RD for EthnoMed
How Foods Affect Blood Sugar: A Guide for Ethiopian and Eritrean Patients with Diabetes
Author: Mei Yook Woo for EthnoMed
How Foods Affect Blood Sugar: A Guide for Latino Patients with Diabetes
Author: Elizabeth Hulbrock para EthnoMed
Talk about what they can have MORE of FIRST
Sida Cuntooyinku u Saameeyaan Sonkorta Dhiiga: Hage loogu talogalay Bukaanada Soomaalida ee Sonkorowga
qaba. How Foods Affect Blood Sugar: A Guide for Somali Patients with Diabetes
Authors: Jocelyn James, MD and Yetta Levine
9/12/2018
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Stress portions and proportions
Give options
Los Alimentos y sus Efectos Sobre el Nivel de Azúcar en la Sangre: Guía para Pacientes Latinos con Diabetes
How Foods Affect Blood Sugar: A Guide for Latino Patients with Diabetes
Author: Elizabeth Hulbrock para EthnoMed
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Talk about recipe modification
Summary
O Work on cultural competence
O The more you understand, the more you can
help those patients
O Find people, research and experiment
O Consider religion and differences in
concepts of time, measurement and family
O Teach visually, give options and work on
proportions
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Bibliography O Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes 2018.
Diabetes Care 2018;41(Suppl. 1):S7–S12 | https://doi.org/10.2337/dc18-S001
O American Diabetes Association. 4. Lifestyle management: Standards of Medical Care in Diabetes 2018.
Diabetes Care 2018;41(Suppl. 1):S38–S50
O Miller, A., RDN, Brown-Riggs, C., MSEd, RD, CDE, CDN. (2016). Ethnic Disparities in Diabetes Care — Learn
What They Are, the Cultural Differences That May Influence These Disparities, and the Role of RDs and
Diabetes Educators. Today’s Dietitian,Vol.18 (11), 48.
O Papadopoulos I, Tilki M and Taylor G (1998): Transcultural Care: A guide for Health Care Professionals.
Quay Books. Wilts. (ISBN 1-85642-051 5)
O AADE7 self-care behaviors. American Association of Diabetes Educators website.
http://www.diabeteseducator.org/ProfessionalResources/AADE7/. Accessed August 10, 2018.
O Latin American diet foods. Oldways website. http://oldwayspt.org/resources/heritage-pyramids/latino-diet-
pyramid/latino-diet-foods. Accessed August 10, 2018.
O African heritage foods. Oldways website. http://oldwayspt.org/resources/heritage-pyramids/african-diet-
pyramid/african-heritage-foods. Accessed August 10, 2018.
O EthnoMed: http://ethnomed.org/patient-education/diabetes. Accessed August 10, 2018.
O http://www.city-data.com/city/Worthington-Minnesota.html. Accessed July 20, 2018.
O The process of cultural competence in the delivery of healthcare services. Transcultural C.A.R.E. Associates
website. http://transculturalcare.net/the-process-of-cultural-competence-in-the-delivery-of-healthcare-
services/. Updated 2015. Accessed August 16, 2018.
O https://ethnomed.org/patient-education/diabetes/WellShare%20International-
%20Diabetes%20During%20Ramadan.pdf. Accessed August 16, 2018.
O https://medlineplus.gov/languages/diabetes.html#Spanish
O https://www.cdc.gov/diabetes/ndep/communities/index.html
O http://med.cornell.libguides.com/c.php?g=761626&p=5461566
O https://oldwayspt.org/recipes/search?keys&diet%5B0%5D=97&items_per_page=12
O http://www.culturecareconnection.org/competent/
Darlene DeWitt, MS, RD, LD
Avera Medical Group
1216 Ryans Rd
Worthington, MN 56187
507 372-6586
Thank You!
