Case Study:
Mr. Rodriguez & Cardiovascular Disease

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What unique cultural barriers to therapy might you encounter with Mr. Rodriguez?

Cultural factors that influence diabetes care in the Hispanic/Latino population

• Patient does not see connection between diabetes and heart attack, and does not take diabetes seriously.
• Patient may be unwilling to make the necessary lifestyle changes due to the abrupt onset of the disease.
• Diagnosis of diabetes may lead to repercussions, such as loss of driver's license.
• Socioeconomic issues: patient is uninsured and now confronted with expensive care.
• He is a part of a culture of male dominance, machismo.
• Patient may have a fear of insulin.

How can machismo help or hinder Mr. Rodriguez's treatment?⁶

• Positive - Encourages a respect for honor, duty, and responsibility.
• Negative - Keeps men from seeking preventive care or screening services.

Why do many Latino patients have a fear of insulin?⁷

Fast Fact Only 65% of all Latinos in the United States have health insurance coverage.8

• Injections are painful.
• Patients on insulin are seen as more debilitated than those who use oral agents or diet therapy alone.
• Patients resist increasing their insulin dose, fearing that more serious illness or complications could result.
• Financial barriers to insulin were seen as far less significant than the fear of insulin use itself.

What referrals should be considered in addressing these unique cultural barriers?

• to mental health counseling for evaluation of possible depression
• to mental health counseling for family meeting or evaluation
• to career counseling if he will be unable to stay in his current job
• to Social Services to determine eligibility for public assistance

The cardiovascular impact of type 2 diabetes becomes more accentuated in Hispanics due to sociocultural factors and economical reasons. To provide proper care it becomes necessary not only to treat these patients medically but also to establish a multidisciplinary support program.

In your treatment plan, consider the following:

• The progression and seriousness of diabetes, especially in relation to cardiovascular disease
• Other members of the health care team and the responsibilities of each of them
• Important points to discuss with the patient
• Other factors that may prevent or hinder the patient from following their treatment regimen

What do your colleagues think about this case?

Visit the message board for this case and read what others have expressed about Mr. Rodriguez; ask and answer questions about the case, and determine appropriate treatment strategies with assistance from your colleagues.

References

1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001; 285:2486-2497
2. N Engl J Med September 30, 1993; 329(14).
3. N Engl J Med September 30, 1993; 329(14).
4. British Med J 1997; 314: 1512-1515
5. Eur Heart J 2005; 26:650-61
6. Diaz VA Jr. Prim Clin Office Pract 2002; 29:503-517
7. Lipton RB, et al. The Diabetes Educator 1998; 24:67-71
8. US Census Bureau. Health Insurance Coverage: 2000. September 2001.

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