BPC 2009: Dismissing health inequalities in diabetes care

by Francesca Rivers and Nicola Cree

Diabetes is fast becoming a global epidemic — and the therapeutic options available are developing almost as rapidly. With diabetic patients often taking several drugs, medicines management is key to tackling the disease. Francesca Rivers and Nicola Cree report from BPC 2009


Cultural aspects affect the treatment of diabetes, Alia Gilani, health inequalities pharmacist, NHS Greater Glasgow and Clyde, told the conference.

The occurrence of diabetes is six times higher in those of South Asian origin than in white Europeans. In the area Miss Gilani works in Glasgow, there is a high number of such patients.

Within their culture many have a fatalistic attitude to the disease with a belief that their fate is in the hand of god, Miss Gilani explained. A lot of family life revolves around food and exercise is not common — with some believing prayer is a form of exercise, she added.

There are concerns about the side effects of treatment and there is frequently a social stigma attached to the disease. It is also important to consider that patients may want to fast or take part in the haj, she said.

In addition to all the cultural considerations she has to consider when treating diabetes in patients of South Asian origin, Miss Gilani also explained how genetics can lead to a higher risk of long-term conditions. Although their body mass index is the same as that of patients of other origins, patients of South Asian origin have more centrally oriented fat distribution, which is a risk factor for cardiovascular disease.

And although their total cholesterol measures are similar to those of indigenous populations, patients of South Asian origin have a lower high-density lipoprotein and a higher triglyceride level, she explained.

Many patients of South Asian origin also have problems accessing healthcare. To combat this problem Miss Gilani told participants how she works in the minority ethnic long-term medicines service (MELTS) — a service that invites patients to attend healthcare services conducted in their native language and operates outreach clinics in places such as mosques, Sikh and Hindu elderly centres, volunteer groups and community pharmacies. Miss Gilani also works with other ethnic minorities as well as those of South Asian origin.

Patients can be referred into the service by others and she currently has 80 patients. With an average of two appointments per patient, Miss Gilani explained that her job entails undertaking a medication review and referring patients on to other services they may require, such as podiatry, exercise or social work.

Miss Gilani said that she frequently texts patients to remind them to go to these appointments. In her clinic she is able to prescribe or change oral antiglycaemic agents, statins, antiplatelets and antihypertensives. The consultations have also led to the diagnosis of other conditions, such as cancer and thyroid disease, she added.

She works closely with doctors, social workers and diabetes specialist nurses. The service also gets patients’ families involved, since the culture is often family based, she said.

Citing an example of a 36-year-old African-Caribbean male, Miss Gilani told  the conference how it took her 18 months — including three letters and six telephone calls — to get him into the service. The patient believed he was not diabetic because this is what he had been told by a doctor in Africa, she said. Miss Gilani explained that she managed to get him to have blood tests and start taking an oral antidiabetic drug to treat the disease.

Citation: The Salvadore URI: 10984255

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