Asian Americans are at high risk to develop Type 2 diabetes. As with many health disparities faced by Asian Americans, the Charles B. Wang Community Health Center provides specialized care for our diabetes patients. We talked to Registered Dietitian and Certified Diabetes Educator Daniel Wong, RDN, CDN, CDE, about our diabetes care program—and what having a patient-centered medical home means for our community.
DN: What is your role in supporting our patients managing diabetes?
DW: I am referred both patients who are pre-diabetic and those who have diabetes. Some of our patients manage their diabetes well; some do not manage diabetes well at all. I support them on insulin injection and blood sugar checking skills, creating exercise plans, and managing their diet through meal planning, portion control, and reading food labels. I also educate them on foot care, eye care, and dental care, which is all affected by diabetes.
DN: What are barriers that diabetic Asian Americans face to manage diabetes?
DW: There are socioeconomic reasons that make it difficult. Many of our patients are Chinese American immigrants, who work long hours and have difficulty making time to go to the doctor. Some are under-insured or have no insurance. Some do not visit a doctor for decades, and at that point they may not know they have diabetes or that their diabetes is uncontrolled.
I also find that there are cultural barriers. Chinese Americans don’t like to take medicine—they think it is unnatural and often think medications damage their bodies. When our patients are diagnosed with pre-diabetes, they turn to herbal medicine and traditional Chinese remedies. After a few years of this, their pre-diabetes turns into diabetes.
Like in many cultures, diet can be difficult to change for Asian Americans. Cutting down on starches such as rice, noodles, and bread is hard when it is a staple part of their diet. Also, Asian Americans have a lower BMI cut-off to be considered at risk for diabetes. If a doctor is not familiar with this, their Asian American patients at risk for diabetes can easily be overlooked.
DN: Can you tell us about a patient who you had success in breaking through these barriers?
DW: We had a patient in his 30’s who came in with pre-diabetes. We didn’t see him again for three years. When he finally came back, his pre-diabetes developed into uncontrolled diabetes. His blood sugar was alarmingly high. His absence was due to being incredibly busy, and feeling like he didn’t have symptoms worth visiting a doctor. This is very typical for my diabetes patients. He came to see me to learn how to take his insulin, to check blood sugar at home, and how to manage his diet better. After learning about the severity of his diabetes, he cut out starch completely and experienced low blood sugar symptoms. This isn’t necessarily good either. He lost a lot of weight in a very short period of time. We worked together on medication management, meal plans, a balanced diet, and integrating exercise into his lifestyle. Within a month his diabetes was controlled and managed.
DN: Charles B. Wang Community Health Center is a patient-centered medical home. What does that mean for our diabetes patients?
DW: Charles B. Wang Community Health Center truly does have comprehensive services, especially for those with chronic conditions that need extra care. Most people living with diabetes have a doctor who treats their condition. In addition to our clinical team, we have case managers and a dietitians, like me, who educate and support our patients to manage their diabetes. We have certified diabetes educators who host diabetes support groups, workshops, and provide individual counseling. We have social workers that will work with our patients to get health insurance, if that is an issue. Some of our diabetes patients have depression as a result of their diagnosis. We have therapists to support those patients. All members of our team provide language and culturally appropriate care.
As a Federally Qualified Health Center (FQHC), we are held to a very high standard of care. Having improved health indicators is both important to us and expected of us. As a result, we provide top quality services to community members who really need them—like those living with diabetes.