• People from China, India and the subcontinent, South East Asia, Middle East, North Africa are more pre-disposed to develop type 2 diabetes. (Flickr)Source: Flickr
Diet and exercise aren't the only two factors we need to pay attention to in order to prevent and manage type 2 diabetes. Experts warn that we need to consider cultural background, as we may be predisposed to a geographical genetic risk.
By
Yasmin Noone

15 Jul 2016 - 10:34 AM  UPDATED 15 Jul 2016 - 10:57 AM

Your risk of developing diabetes doesn’t just depend on the kinds of foods you eat or how much you exercise. According to CEO of Diabetes Australia, Greg Johnson, it also depends on your cultural heritage.

“There are many populations of people, living in Australia, who are more pre-disposed to developing diabetes because of their genes,” says Johnson.

“People from China, India and the subcontinent, South East Asia, Middle East, North Africa are more pre-disposed to develop type 2 diabetes than people who aren’t from these countries.

According to the International Diabetes Federation (IDF), there were over 78 million people living across South East Asia with diabetes in 2015. This is expected to increase to 140 million by 2040.

Research has also identified type 2 diabetes an increasing epidemic in Asia, characterised by an onset at a relatively young age and low body mass index. This may be because Asian people are genetically more likely to have less muscle and more abdominal fat, which increases insulin resistance.

“There are many populations of people, living in Australia, who are more pre-disposed to developing diabetes because of their genes."

However, the highest diabetes prevalence in the world (relative to the population) is found in the Middle East and North Africa, as it’s estimated that one in every 10 people living in the region has the disease. Across the Middle East and North Africa, there were around 35 million people living with diabetes in 2015, with IDF anticipating an increase to 72 million by 2040. It’s believed that rapid economic growth is partly to blame, as fast rates of industrialisation across the region may be translating into higher obesity rates, more fast food, less exercise and poorer lifestyle choices.

“That’s why it’s important to get healthy messages about food and lifestyle out to these CALD communities, so they can better understand what they are eating and how to be more physically active, in a way that is appropriate to that culture,” says Johnson.

An Australian Institute of Health and Welfare report indicates that migrant adults from the Middle East, North Africa, Southern and South-East Asia are most at risk of type 2 diabetes, while individuals from the South Pacific, Middle East, North Africa and Southern Europe present with the highest number of diabetes-related hospitalisations.

Although people from these CALD groups are genetically predisposed to diabetes, additional factors are at play, influencing whether a person develops the disease. According to an NSW-based report into CALD communities, these groups may also have an increased prevalence risk for type 2 diabetes because they are at risk of obesity, cardiovascular disease, high blood pressure and gestational diabetes, and have impaired glucose tolerance and fasting glucose levels.

Some CALD groups also report that language barriers, poor health literacy rates and lack of access to culturally appropriate care may prevent them from accessing the support they need to prevent and manage diabetes.

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Diabetes nurse educator for Monash Health Community, Anna Ottenfeld, regularly works with refugees, newly arrived migrants and long-term residents of Australia from CALD backgrounds who are living with type 2 diabetes.

Ottenfeld says many of her clients have no prior knowledge of the term ‘diabetes’ before they are diagnosed with it in Australia.

“Some of the people we work with don’t realise they have diabetes until they have gone to the hospital with an event, like a stroke, heart attack or infection in their feet that is not healing,” says Ottenfeld.

“Many also think that because they found out they had diabetes after they came to this country, that Australia has given them diabetes. They often say ‘I came here for a better life but now I have diabetes’.

“So I explain to them what diabetes means and tell them what’s happening in their bodies. I also tell them that they have diabetes, not necessarily because they are inactive or unhealthy but, unfortunately, because there may be a cultural element to their risk – genetics or a family history of diabetes – that they can’t change.”

But it’s not all bad news. As part of Ottenfeld’s job, providing culturally appropriate type 2 diabetes care and support, she also educates clients on the risk factors that they can control and improve to balance out other risk factors.

“To reduce your risk, you can change your food intake to make healthier. You can quit smoking if you are a smoker or reduce your alcohol consumption if you drink a lot. You can also reduce your cholesterol and blood pressure by taking medication.”

“Many also think that because they found out they had diabetes after they came to this country, that Australia has given them diabetes. They often say ‘I came here for a better life but now I have diabetes’."

Ottenfeld stresses that culturally specific diabetes support is vital to overcoming diabetes in various communities. She says providing advice on diet and lifestyle, targeted the beliefs and practices of each CALD group, often helps people to accurately understand and control the disease.

“For example, in the [Burmese] culture, oil is seen as a luxury item. When people from this cultural group live in Australia, they can afford to buy it. Often, their food is cooked swimming in oil.

“So our dietitian runs basic cooking sessions with Burmese groups to show people the benefits of air frying instead of deep-frying.”

Ottenfeld is involved in offering one-on-one CALD support and organising interpreters to help bridge language gaps. She also helps deliver a six-week diabetes management program, based in the south east Melbourne region, that targets specific cultural groups, from Vietnamese to Burmese, Samoan and Cambodian.

“We focus the information provided on a group’s particular foods and lifestyle choices.

“So we often find that people who have a similar cultural background may like similar types of music, which we can target our exercise programs towards. Pacific Islanders are known for having big musical gatherings where they get up and dance together. So I say ‘rather than go for a walk, when you have a gathering, get up and dance’. They accept that advice because music and dancing are parts of their culture.”

“In many cultures, diabetes may also have a stigma attached to it, so some people may not want to recognise they have the disease.”

Sizing up the problem

National programs advisor at Diabetes Australia, Angela Simon, explains that even though there are many effective CALD programs being run around Australia, like those offered by Monash Health Community, more work needs to be done.

She adds that the true extent of how the disease impacts CALD groups living in Australia is unknown. Self-reporting is Australia’s main source of data on the matter, which is problematic because many people from CALD backgrounds don’t know they have type 2 diabetes or face cultural barriers in accessing treatment and reporting their health.

“We know there’s a group of people who don’t go to the doctor to be diagnosed or treated for diabetes because they don’t speak English and often present later with the disease [through the hospital system],” says Simon.

“In many cultures, diabetes may also have a stigma attached to it, so some people may not want to recognise they have the disease.”

Johnson believes type 2 diabetes is under-reported and under-treated in many CALD groups. He says a lack of research, true prevalence figures and hard data on diabetes and CALD communities is a real problem, which hopefully can be addressed in the future with more funding.

“It’s a struggle at the moment, because the size of the funding that organisations dealing with diabetes have access to is not proportional to the challenge at hand,” says Johnson.

“Managing diabetes in CALD communities is a really big challenge. We don’t have a great deal of information about it and we need to do a lot more.

“We are probably just scraping the surface with what we know about CALD-related issues and diabetes in Australia.”

To access diabetes help, visit Diabetes Australia online or call the organisation's information line on 1300 136 588.

Image courtesy of Flickr/Matti Mattila.