Building cultural bridges: understanding ethnicity to improve acceptance of insulin therapy in patients with type 2 diabetes.

OBJECTIVES Type 2 diabetes is a significant healthcare problem in the Latino/Hispanic community. As with most patients with type 2 diabetes, Latino patients will eventually require insulin therapy to maintain glycemic control. Some cultural barriers to starting insulin therapy among Latino patients have been reported. This review explores the implications of the increasing prevalence of type 2 diabetes in Latino patients, defines cultural values and differences that may affect acceptance of insulin therapy, and reviews available strategies that may facilitate initiation of insulin treatment in this group. METHODS A literature search was conducted for publications related to Hispanic Americans, Latino persons, type 2 diabetes, and insulin therapy by using PubMed/National Center for Biotechnology Information. RESULTS Despite evidence that earlier initiation of insulin therapy improves outcomes in patients with type 2 diabetes, Latino patients appear to be more resistant to insulin therapy than non-Hispanic Whites. Physician challenges associated with addressing the negative perceptions about insulin therapy are further compounded by cultural and language barriers often encountered when treating Latino patients. Scarce information regarding specific insulin regimens in Latino patients is available. CONCLUSIONS Increased cultural awareness and competence among healthcare providers and increased use of Spanish-speaking diabetes educators seem to improve diabetes outcomes among Latino patients. Also, implementation of simpler insulin regimens may increase acceptance of insulin therapy and improve clinical outcomes in Latino patients. A relatively simple titration regimen using once-daily bedtime basal insulin glargine has demonstrated efficacy for improving glycemic control in many patients with type 2 diabetes and is a strategy that may also be useful for Latinos as an introduction to insulin therapy and as the foundation of a more comprehensive insulin regimen in the future.