February 3, 2006

Vanderbilt clinic takes on Hispanic diabetes epidemic

Featured Image

Michael Fowler, M.D., communicates in Spanish with patient Rosalea Rodriguez during a clinic visit.
Photo by Dana Johnson

Vanderbilt clinic takes on Hispanic diabetes epidemic

For Michael Fowler, M.D., Tuesdays often are the longest and most rewarding day of the week.

After a full day of work at Vanderbilt, Fowler heads to the Siloam Clinic in downtown Nashville to combat an enemy that is threatening the health of the fastest-growing population group in the United States, Hispanic Americans.

That enemy is diabetes — and it is advancing at an incredible pace.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, Hispanics are nearly twice as likely to develop diabetes as white, non-Hispanics. About 2.5 million Hispanic Americans have been diagnosed with diabetes, and millions more may have the disease without knowing it.

“Diabetes is flourishing, not only in the general population, but especially in the Hispanic-American community,” said Fowler, an assistant professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism.

Diabetes in this population likely results from a combination of factors — genetics, a diet traditionally high in calories and carbohydrates, and lower levels of leisure time and physical activity than other U.S. ethnic groups.

While the incidence of diabetes is low in their native countries, their adoption of an “American” lifestyle after entering this country prompts a rapid rise in disease incidence.

“I think we should hand out diabetes medicines at the border, when people come in to the country,” Fowler said.

The impact of this epidemic is felt at the Tuesday night clinics, Fowler says.

“It's always a packed house. It's just a question of how many hours we are able to spend (at the clinic). The human need outstrips the supply at this point.”

While his efforts at Siloam continue, Fowler is working to establish a practice at the Vanderbilt Eskind Diabetes Clinic specializing in treating diabetes in the Hispanic population.

Through advertising campaigns in Spanish newspapers and simple 'word-of-mouth,' Fowler hopes to draw Spanish-speaking patients to Vanderbilt for their diabetes care. This could help lighten the load on the Tuesday night clinics at Siloam and also reach out to those who have not yet sought treatment for their diabetes.

“Michael's service to underserved groups represents an important component of the outreach that we want to be about in the Eskind Diabetes Clinic,” said Tom Elasy, M.D., M.P.H., medical director of the Vanderbilt Eskind Diabetes Clinic.

“Accompanying this calling to serve is a disciplined mind. Michael epitomizes much of what is good in a Vanderbilt Physician,” Elasy said.

Fowler recently secured grant support to systematically study how best to design, implement, evaluate and sustain these types of services between the clinic and the community.

“At this point, our major effort is concentrated at education and screening,” Fowler said. The key to doing this effectively, however, is bridging the language barrier.

Non-English speaking patients often harbor an entrenched distrust of medical science. But Fowler, who majored in Spanish in college and has studied abroad in Madrid, Spain, finds that having a Spanish-speaking medical staff helps break down the walls and puts patients at ease.

“Speaking Spanish helps,” Fowler said. “If (the patients) can explain things to you in their own native tongue, they are much more comfortable with the doctor, and they seem much more trusting.”

In addition to Fowler, several lab staff, nurse educators and dietitians at the Vanderbilt Eskind Diabetes Clinic also speak Spanish. Fowler hopes to increase this number with the recruitment of additional Spanish-speaking faculty and by encouraging other faculty to learn Spanish.

Learning a new language may take time and effort, but the payoffs for the patient are clear.

“If the doctor spends extra time explaining what the problem is, and the ramifications that diabetes could have, the patients are much more receptive. They have more trust, and they are more willing to monitor their blood sugar and to engage in therapy if needed.”

Patient education and their compliance with treatment is the first step to halting the progress of diabetes.

“The complications (of diabetes) are preventable, and diabetes is absolutely controllable — if we catch it in time,” Fowler said. “That's why it is important for us to go out and find people now before bad things happen to them.”

The long days at the clinic and the extra time taken with patients are rewarding, Fowler said.

“When you are taking care of folks who are not from the United States, they are some of the most grateful and generous people that one would ever meet.”