Saenz Catherine, Salinas Manisha, Rothman Russell L, White Richard O
Department of Human Sciences, Health, and Exercise Science, The Ohio State University, Columbus, Ohio, USA.
Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, Florida, USA.
J Am Nutr Assoc. 2025 Mar-Apr;44(3):198-211. doi: 10.1080/27697061.2024.2413368. Epub 2024 Oct 14.
Type 2 Diabetes (T2D) is a chronic multifaceted metabolic condition characterized by elevated blood glucose levels with varying degrees of insulin resistance and abnormal insulin production. Lifestyle modifications, such as those defined by the guidelines for diabetes self-management education and support (DSMES), are foundational for glycemic control. A current gap in T2D management is addressing DSMES which is tailored to best serve the diversity of patients with this disease. The purpose of this narrative review is to discuss the current literature related to lifestyle modification for T2D, the importance of culturally sensitive T2D management programs, and the impact culturally sensitive and diverse T2D management programs have on cardiometabolic health. Despite being disproportionately affected by T2D, racial and ethnic minorities have low referral rates for DSMES. This growing disparity may be exacerbated by a lack of awareness of how to adapt lifestyle modifications in a culturally competent manner and how social determinants of health (SDOH) may affect the infrastructure and resources available to diverse patient populations. Currently, there is limited research on how DSMES is addressed to include culturally and literacy-sensitive recommendations in the United States. Patient-centered care, emphasizing personalized DSMES, can lead to improved glycemic control, reduced healthcare costs, and improved cardiometabolic health. A key component of effective DSMES should include culturally and literacy-sensitive approaches with an awareness of the impact of SDOH. Understanding how ethnicity, race, and culture influence experiences with T2D management can help providers prescribe more patient-centered and sustainable recommendations.
2型糖尿病(T2D)是一种慢性、多方面的代谢性疾病,其特征是血糖水平升高,伴有不同程度的胰岛素抵抗和胰岛素分泌异常。生活方式的改变,如糖尿病自我管理教育与支持(DSMES)指南中所定义的那些,是血糖控制的基础。T2D管理目前存在的一个差距是如何提供适合该疾病患者多样性的DSMES。本叙述性综述的目的是讨论与T2D生活方式改变相关的当前文献、具有文化敏感性的T2D管理项目的重要性,以及具有文化敏感性和多样性的T2D管理项目对心脏代谢健康的影响。尽管少数族裔受T2D的影响尤为严重,但他们接受DSMES的转诊率却很低。这种日益扩大的差距可能会因缺乏如何以具有文化能力的方式调整生活方式改变的认识,以及健康的社会决定因素(SDOH)可能如何影响不同患者群体可获得的基础设施和资源而加剧。目前,在美国,关于如何在DSMES中纳入具有文化和读写能力敏感性的建议的研究有限。以患者为中心的护理,强调个性化的DSMES,可导致血糖控制改善、医疗成本降低以及心脏代谢健康改善。有效的DSMES的一个关键组成部分应包括具有文化和读写能力敏感性的方法,并认识到SDOH的影响。了解种族、民族和文化如何影响T2D管理的经历,有助于医疗服务提供者开出更以患者为中心且可持续的建议。