Ann Arbor : University of California, San Francisco, 1995.
Pages:
164
Language:
English
Abstract:
Noninsulin dependent diabetes mellitus is a chronic disease that is associated with westernization of life style in many immigrant populations. This study investigated noninsulin dependent diabetes mellitus in the Hmong Southeast Asian refugee population who migrated to the United States beginning in 1978. Methods included chart review (n = 90) to determine the physiological parameters of diabetes in this group and ethnographic interviews (n = 28) to describe perspectives regarding diabetes and observations regarding diabetes management. Interview questions were based on Kleinman's (1988) explanatory models. The diabetic Hmong in this study were primarily female, middle aged and obese. Men were more likely to receive diabetes education than women but the men were also significantly younger than the women. They had a short duration of known diabetes of 3.21 years, blood sugars were poorly controlled as reflected by the glycosylated hemoglobin (HgA$\sb{\rm 1c}$) value (mean 11.16), they had multiple diseases unrelated to their diabetes and 52% had abnormal urine dipstick results. Fifty nine percent were treated with insulin and the mean insulin dosage was high at 93 units per day. There was a significant moderately positive correlation between HgA$\sb{\rm 1c}$ and insulin dosage. The interview and observation results indicated that the Hmong diabetics in this study consumed large amounts of complex carbohydrates (rice), frequently missed doses of medications, and used multiple treatment modalities including self adjustment of western medicines, Hmong traditional herbs, and shaman healing rituals. Traditional treatments persisted because of the perception that they could "cure" diabetes whereas western treatment only "controlled" diabetes. Shaman rituals were associated with family love and support and were valued because they were costly. Spiritual etiologies for diabetes were not expressed but physiological phenomena were often described in concrete terms unrelated to medical explanations. The informants generally lacked knowledge regarding the physiological effects of diabetes and had little knowledge regarding diabetes management or diabetes complications although 66% had received diabetes education. This study demonstrates that this is a population at risk for serious diabetes sequelae. Current treatment and education efforts are not meeting the diabetes information and management needs of this population.