Title: Can culturally individualized healthy nutrition reduce and prevent T2DM complications?
Soy Ramsumeer DNP, FNP-BC, MSN, BScN, RN, DM Educator, Foot Care Cert., Pete Nathans
Comprehensive T2DM Services and A-Z Diabetes & Wound Care Services, USA
Introduction: This presentation expands on my doctoral dissertation on teaching Registered Nurses (RNs) healthy nutrition based on the Hispanic-Mexican diet to improve their knowledge to counsel Type 2 Diabetes Mellitus (T2DM) patients on dietary intake. According to Weisman, Fazli, Johns, and Booth (2018), T2DM affects 8.8% of the world’s population; it’s the fourth leading of death with 9.6% mortality rate (Mohamad et al., 2018). The International Diabetes Federation reported that its prevalence was 381.8 million in 2013 with an expected increase of 591.9 million by 2035 (Beagley, Guariguata, Weil, & Motala, 2014).
Globally this illness continues to rise with the highest rates found in the Middle East, followed by Eastern Mediterranean (9.2%), then North America (8.4%), which includes the Western Pacific with 67 million, trailed by Europe with 53 million; followed by India in the top ten with 40.9 million, lagged by China with 39.8 million, then the United States of America, Russia, Germany, Japan, Pakistan, Brazil, Mexico, and Egypt (Jain & Saraf, 2010).
An effective way to lower T2DM incidence and its worldwide burden, is to have nurses offer patient-centered nutritional advice based on patients’ ethnic food preferences; Weisman et al (2018), suggests physical activity and dietary intake to address its global increase. In fact, this health promotion and illness prevention activity should be incorporated into their daily schedule, which would result in cost savings with a reduction in nursing workload as the rate with its numerous complications are lessened. Weisman, et al. (2018), states that 40% of heart failure, myocardial infarction, and strokes occur in patients with diabetes. Practicing for 23 years, I have seen an increase in complications such as hypoglycemia, hyperglycemic hyperosmolar non-ketotic syndrome, and Diabetes Ketoacidosis with the frequent emergency room visits. Since the completion of the Doctor of Nursing Practice (DNP) in 2015, I’ve been focusing on controlling blood glucose based on personal and ethnic inclinations of food choices. Realizing that ‘one size doesn’t fit all’ with T2DM management, a cultural individualized approach is the key to decrease complications and increase compliance. Patients are more likely to adhere when presented with foods they’re accustomed to.
Additionally, this culturally patient-centered approach helps to reduce healthcare costs while educating, empowering, and supporting T2DM patients, caregivers, and families via a team approach. Many T2DM patients do not receive timely or any diabetes education upon diagnosis as there aren’t enough diabetes educators available to reach everyone; so, while nurses are monitoring blood glucose levels, they could offer nutritional advice. Utilizing cultural foods would stabilize glycemic values and lessen micro and macrovascular complications such as retinopathy and nephropathy.
My goal is to reduce T2DM in the world as I have witnessed the suffering of my deceased mother, patients, colleagues, and others. “If I knew then what I know now”, my mother may still be alive, and I wouldn’t be here. She is the inspiration for my work to continue to expand evidence-based research and to pursue effective protocols for individuals with T2DM and their caregivers.
Audience Take Away:
Choosing healthy foods to lower blood glucose based on cultural and individuals’ preferences using smaller portions frequently. Learn how to empower while offering support to patients and caregivers via educational sessions on T2DM management for all ethnicities. Learn about preparation of ethnic foods, especially how to reduce simple carbohydrates or saturated fats when cooking.
The goal is to reduce nursing workload by decreasing the monitoring of uncontrolled glycemic values in T2DM patients, reduce healthcare costs associated with ER and Urgent Care visits, hospitalization, and loss of income from work.
Other faculty could use this study to expand on their research or teaching by looking at what types of foods have a higher glycemic impact on blood glucose, and then examine the timing of oral intake of those foods to ascertain if eating them earlier than later will impact glycemic value differently; white rice or pasta in the mornings compared to evenings and how to prepare them.
The designer’s job could be more effective once s/he knows of the patients’ preferences and ethnicity by using various types of foods from that specific culture with the caloric values and suggestions of meals and snacks schedules. Additionally, the amount of physical activity that the patient performs would need to be considered to avoid hypoglycemia.
Certainly, research could build on this area as I am currently doing from original dissertation for the DNP project, which only addressed the Hispanic-Mexican cultural foods. I’ve been seeing improvement in glycemic values when the meals are tailored to the individual’s ethnic preference, example with Asians, Native American Indians, West Indians, South Americans, among others. Regardless of the ethnicity, cultural foods low in saturated fats and high in fiber including vegetables and fruits, along with physical activity have been linked to risk reduction for T2DM (Elling, Surkan, Enayati, & El-Khatib, 2018).
Nursing/medical schools could implement a specific part of the curriculum to address oral intake based of individual/cultural preferences with portion control and blood glucose monitoring; this will help to alleviate the high number of patients waiting to consult with a diabetes educator, nutritionist, or endocrinologist. Elling et al. (2018), states that women have a higher body fat composition with a greater risk for T2DM than men; however, insulin resistance has been associated with abdominal fat distribution in males, concluding that both biological and cultural differences could be responsible for its global increase in prevalence. Therefore, teaching RNs and other medical professionals about cultural foods could lead to a reduction in its rate and associated complications.
Soy Ramsumeer FNP-BC, DNP, MSN-Leadership, BScN, RN, Diabetes Educator, Foot and Wound Care 5 years in accounting and finance. Worked in Toronto, Canada (Geriatrics rehabilitation, CCU, LTC, Foot and Wound Care, Home Health), Outpost nursing in Arctic Canada, House Supervisor, Pre-Op RN, DON) Volunteer for CDA, ADA, AIDS Committee of Toronto, PWA Foundation, Fashion Cares, St Michael’s Cathedral, Sherbourne Health Bus, CCRA income tax program, scrutineer for a provincial Political Party. Enjoys researching, travelling, and watching old movies or sitcoms, dinning out and spending time with family and friends. My goal is to not have anyone suffer with T2DM like my deceased mother. On a personal note, my mother was diagnosed with T2DM for 20 years and was given one-week to live following a stroke but survived almost 3 more years. This was accomplished by a diabetes educator in Toronto, Canada who took the time to empower and support me to monitor her blood glucose and prepare healthy meals based on my mother’s food preferences for South American meals. My mother succumbed to pneumonia, not diabete