Building cultural competency for improved diabetes care: Asian Americans and diabetes

Type 2 diabetes mellitus (T2DM) is an ever-increasing cause of significant morbidity and mortality worldwide. As one of the most common chronic diseases our nation is facing today, it is also a major contributor to rising health care costs. Complications from uncontrolled T2DM result in significantly higher per-patient health care costs for patients with diabetes compared to health care costs for nondiabetic patients. Genetic factors play an important role in the development of T2DM, with prevalence among some ethnic groups--including certain Asian American groups--considerably higher than among white Americans. Studies have shown that glucose control is also significantly poorer in this subgroup of patients. The need to address these ethnic disparities has led to the growing interest in cultural competency in medical care. While patient-centered care has tended to focus on the patient as a unique person, cultural competency recognizes that the individual is a product of his or her culture. The degree of disparity also varies, depending on how long the individuals have been living in the United States and how Americanized these individuals are. Patients whose health care providers may need a higher level of cultural competency include those who have recently emigrated from their home countries and those who have been residing in the United States for a long time but have not acculturated to the mainstream society, a scenario highlighted in the following case study.