Are most health care providers attuned to the needs of their diabetes patients who are lesbian, gay, bisexual, and transgender (LGBT)? Does it matter? No and yes respectively, according to certified diabetes educator Theresa Garnero.
More than half of medical school curricula include no information about LGBT people, and most multidisciplinary professionals have not received tools to care for LGBT individuals, Ms. Garnero said at the annual meeting of the American Association of Diabetes Educators.
A number of factors that increase the risk for developing diabetes are highly prevalent among people who are LGBT. For example, obesity and polycystic ovary syndrome (PCOS), both strong risk factors for type 2 diabetes, are more common among lesbians than among heterosexual women. Indeed, in one study, PCOS was identified in 38% of lesbians vs. just 14% of heterosexual women.
Antiretroviral drugs used to treat HIV/AIDS often lead to insulin resistance and type 2 diabetes. Men on HIV treatment have four times the risk of diabetes as do HIV-negative men. Moreover, cigarette smoking, alcohol abuse, and illicit drug use, all of which particularly endanger the health of those with diabetes, are frequent behaviors among LGBT individuals.
Depression is common in both LGBT individuals and people with diabetes. Withholding of insulin among closeted LGBT youth with type 1 diabetes could be a suicidal gesture rather than diabulimia.
How many LGB people have diabetes? It’s extremely difficult to obtain statistics – and there are virtually none for transgendered people – but based on self-reported health data, roughly 1.3 million LGB people have diabetes, a number approximately equal to that of type 1 or gestational diabetes, Ms. Garnero said.
So why does it matter? Lack of awareness and presumption of heterosexuality can lead to mistakes that alienate patients, such as lecturing a young lesbian with diabetes about the need for birth control or expressing negative attitudes toward patients who want to bring their same-sex partners to diabetes-education classes.
Importantly, patients who perceive that they can’t be open with their health care provider about sexual orientation may be reluctant to share other health-related information.
“Individuals who approach the health care system are already vulnerable from their illness … Intolerance is the last thing anyone wants when seeking health care. It is certainly not a part of the caring diabetes professional culture,” Ms. Garnero said.
What can the health care provider do? Placing a rainbow flag sticker or nondiscrimination statement that specifically mentions sexual orientation in the waiting room is a simple way providers can let patients know that they are LGBT-friendly. Other helpful information for providers can be found here.
Bottom line, she said: “All people with diabetes deserve the benefit of our expertise and access to ongoing support.”
-Miriam E. Tucker (@MiriamETucker on Twitter)