Culturally tailored DSMES: A new key for South Asian patients with Type 2 Diabetes Mellitus

Abstract

South Asians have an exceptionally high risk for developing Type 2 diabetes mellitus. It is very challenging for healthcare providers to successfully manage diabetes and control glucose levels at target due to the unique lifestyle of the South Asian population. Culturally tailored diabetes self-management education and support (DSMES) can be more effective in guiding South Asian patients with Type 2 diabetes. Unique considerations to address lifestyle modification for South Asians include a diet that typically consists of a high carbohydrate to lipids/proteins ratio, preference for high glucose index fruits, regular intake of traditional sweets or desserts, late afternoon tea break followed by late dinner, lack of vigorous exercise (yoga or walking being the preferred activity), lack of DSMES knowledge and skills, and poor access to culturally appropriate resources for diabetes care. We present a 38-year-old male diagnosed with diabetes four years ago who showed poor glucose control before our intervention. Our interventions included education on the importance of blood glucose monitoring, exercise, and diet. Based on our experience with this case, we propose the following recommendations for a tailored approach to DSMES for South Asian patients with Type 2 diabetes: make appropriate dietary changes (decrease total daily caloric intake, decrease the percentage of carbohydrates, add
low glucose index fruits and vegetables, avoid late afternoon tea breaks, eat dinner before 8 PM); incorporate appropriate daily physical activity; and monitor blood glucose daily for prompt feedback.