Sexual Minority: The Invisible Diabetes Disparity

What does sexuality have to do with diabetes? A lot, according to research findings that have revealed a group of people with diabetes as large as the type 1 or gestational diabetes community. Estimates suggest that 1.3 million lesbian, gay, and bisexual (LGB) individuals have diabetes-at least 5 percent of the 23.6 million people with the disease in the United States.

A sexual minority is a group whose sexual identity, orientation, or practice differs from the majority of society. For the purpose of this column, the term refers to lesbian, gay, bisexual, and transgender (LGBT) people. LGBT people have high rates of type 2 diabetes.  They also have unique health characteristics, disparities, and barriers that increase their risk for diabetes and its complications. Some examples include the following.
• The LGBT community has the highest cigarette smoking rates of any group (ranging from 38 to 59 percent among youth and from 11 to 50 percent among adults). Smoking increases insulin resistance and is a risk factor for type 2 diabetes.
• Lesbians have the highest rate of polycystic ovarian syndrome (PCOS) (38 percent, vs. 14 percent among heterosexual women). PCOS is a risk factor for type 2. At a national conference, I heard a professor stress the importance of screening sisters and daughters of women who had PCOS as a way to prevent type 2, but she did not mention that lesbians are at highest risk. When I asked if she knew this, she acknowledged that she did.
• LGB African-American adults have the highest diabetes rates (transgender omitted due to lack of data).
• Lesbians have higher overweight and obesity rates than heterosexual women.
• Lesbians, bisexual women. and LBG Latino adults have the highest uninsured rates and most difficulty obtaining medical insurance.
• LGB African-Americans have the highest rates in delaying or not filling prescription medicines.
• LGB individuals have the highest depression rates and suicide attempts.
• LGB Asian or Pacific Islander adults are most likely to experience psychological distress.
• The LGBT community has high rates of illicit substance use; LGB Latino adults are more likely to abuse alcohol than any other group.
• LGBT adolescents make up 40 percent of all homeless adolescents.
• Up to 39 percent of transgender people face harassment when seeking routine healthcare.

Many people put off going to the doctor or getting healthcare because of high cost and lack of time. The sexual minority, however, has an added reason not to go: fear of outright hostility from care providers. The internal dialog goes something like this: “My doctor should know everything. Should I tell her I’m gay? I don’t feel well, and I don’t have the energy to deal with being rejected, getting poor care, and possibly having to find a new doctor, but she should know so that if I am hospitalized, my partner can visit me.”

As a passionate diabetes educator who belongs to this minority group, I have experienced and witnessed homophobia firsthand many times in my career. The stories that patients tell me are equally unbelievable. A gentleman with type 1 diabetes told me that when he finally made the difficult decision to come out to his doctor, his endocrinologist told him that he “deserved every low blood sugar.”

Against some colleagues’ advice, I am coming out to be a resource for sexual minorities with diabetes and the practitioners who provide their care. No longer do sexual minorities with diabetes have to be in the shadows, invisible or afraid to speak up for their diabetes issues. Thanks to Diabetes Health, we have a safe forum to connect.  I will be writing columns here on a regular basis. Please send me your questions so that we may learn together.

“If a bullet should enter my brain, let that bullet destroy every closet door.” Harvey Milk

Garnero TL: Providing Culturally Sensitive Care and Education for the Lesbian, Gay, Bisexual, Transgender (LGBT) Community. Diabetes Spectrum. August 19, 2010 vol. 23 no. 3 178-182.

Theresa Garnero is an Advanced Practice Registered Nurse, board certified in Advanced Diabetes Management, with a master of science in nursing. She is a Certified Diabetes Educator, author and illustrator of Your First Year with Diabetes, and founder of “Dance Out Diabetes.” Ms. Garnero is also the Clinical Nurse Manager at the Center for Diabetes Services at California Pacific Medical Center. She will be speaking at the American Association of Diabetes Educators conference on August 5, 2011.

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