Constance Brown-Riggs, RD, CDE talks about what challenges she is seeing in her practice and what educational strategies and initiatives she is employing to help stem the tide of diabetes within this patient population. 

By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net 
 

The statistics of diabetes as it relates to African-Americans are staggering.

According to the American Diabetes Association (ADA), 3.7 million African-Americans aged 20 or older have diabetes; and African-Americans are 1.8 times more likely to have diabetes as non-Hispanic whites. In terms of complications, this group is overall 50 percent as likely to develop diabetic retinopathy as compared to non-Hispanic whites; 2.6 to 5.6 times as likely to suffer from kidney disease; and African-Americans are 2.7 times as likely to suffer from lower-limb amputations, again according to ADA statistics. 

Some of the big picture reasons for this population group suffering greatly from diabetes include genetics and socioeconomic disparities. And as diabetes continues to affect the African-American community, a better micro picture with a more in-depth understanding is needed to both identify why this group continues to be the highest at-risk population in the U.S., and what treatment strategies are most helpful.

Registered Dietitian and diabetes educator Constance Brown-Riggs RD, CDE, is witnessing firsthand what is taking place. Brown-Riggs has been in private practice for over 25 years, and while she has a business that serves all types of clients, a large segment of her practice is made up of African-Americans with type 2 diabetes.

Brown-Riggs (pictured, lower right) is a highly respected medical provider with a wealth of professional experience. She has worked with the ADA, served as a consultant for Eli Lilly and is a featured expert for DLife. She is a spokesperson for the Academy of Nutrition of Dietetics, and will be presenting at the upcoming Academy conference in Philadelphia.

Brown-Riggs is also the author of two books: The African American Guide To Living Well With Diabetes, and Eating Soulfully and Healthfully with Diabetes.

In writing her books, Brown-Riggs wanted to address the Diaspora that is the African American population, espcially the difference in diets. She wanted to cover nutrition for both people who have lived in the U.S. for generations and might be inclined to eating more southern food, as well as those who are newer to the U.S., coming from Africa or the Caribbean in recent years and bringing with them the traditional foods of their countries. 

As part of her practice, Brown-Riggs also goes out into the community to speak to groups about diabetes, and churches especially. Generally speaking, Brown-Riggs says African-Americans are a spiritual group, and meeting with people at churches and speaking to them about the disease has been effective for her in delivering the message, especially as she believes providers need to target the right organizations and places.  

Brown-Riggs understand the plight of this group and works diligently to educate and care for them.

DiabetesCare.net spoke to Brown-Riggs talks about some of the biggest challenges facing African-Americans with regards to diabetes, and how she is successfully treating people with the disease.

DiabetesCare.net: With African-Americans more at risk of diabetes and many of the comorbidities associated with the disease, do you have any specific recommendations for this at-risk population? Do you request your clients go to other specialists (ophthalmologists, podiatrists, endocrinologists)?

Brown-Riggs: I look at each client on a case-by-case basis, but in general I would say yes I do recommend clients go to specialists. It’s something I point out in my book, The African American Guide To Living Well With Diabetes, about having a diabetes dream team of providers. I want to be sure they  understand that because diabetes affects so many parts of the body, one healthcare provider may not be able to provide all the care they need and that is one of the reasons why it requires seeing various specialists, not just a general practitioner. 
 
One of the major conversations I have with people whose glucose levels are out of control is that diabetes needs to be managed or clients will end up dealing with complications or comorbidities of some type.

I will often refer clients to an endocrinologist, an ophthalmologist, or podiatrist.

DiabetesCare.net: You mentioned one of the books you wrote and you have another geared towards African-Americans and diabetes. Why the decision to do so?

Brown-Riggs: If you think of the food African-Americans eat, as well as the overall group’s tendency to seek out and have some type of spirituality, none of that was being addressed in the public. There weren’t any diabetes books at that time discussing the specific nutritional needs of the African-American population. 

African American clients would come into my office, and when I would show them educational materials, they would always ask about foods from the south. They didn’t see these foods on the traditional food pyramid, and they would ask how  they fit in? Their questions  prompted me to develop an educational tool called the Diabetes Soul Food pyramid. In expanding that, I wrote another little booklet that was called Eating Soulfully and Healthfully with Diabetes.

From there I went into publishing my first book, Eating Healthfully and Soulfully with Diabetes. Often, African-Americans are grouped together; yet we know there are people within this race who make up a variety of groups. For example, we have many African-Americans who have been living in the U.S. for generations; and there are others who are immigrating from Africa or from the Caribbean. Particularly in my first book, my goal was to fill the gap to include these traditional foods from other parts of the world along with the foods from the south.

The second book I wrote, The African American Guide To Living Well With Diabetes, takes a more holistic view. I wrote this book bearing in mind that if it is the only diabetes book a person picks up, it is comprehensive and covers all areas of diabetes self-management.

I also wanted to talk to the spirituality aspect that is at the crux of most people of color. Even for the people who skim through the chapter, I wanted them to see the spirituality component of each chapter and at the very least internalize what is going on, reflect on their health and realize they really need to take better care of themselves and their diabetes.  

DiabetesCare.net: When you are talking about spirituality, can you explain what you mean?

Brown-Riggs: It really is very individual of course, but most African-Americans tend to have some type of spiritual base and a belief in a higher power. And some within the community, take on a fatalistic view where they might say, “if I’m going to die, it’s God’s Will.”

I want people to draw into their spirituality and use it as a foundation to take care of themselves as opposed to dismissing diabetes and having a fatalistic view.

There is a tagline in my Blog, “Don’t Claim it, Manage It,” which means you don’t have to talk about having diabetes, but you definitely have to manage it. This comes from an African-American expression, particularly in the south, where one might say something to the effect of, “The doctor told me I have diabetes, but I’m not claiming it.”  This is part of that fatalistic view, where it really is a form of denial. When people don’t claim their diabetes, they don’t acknowledge it. Therefore, people who take this position, don’t take the steps needed to take care of their diabetes.

DiabetesCare.net: Looking at diet, do you find this evolution for those eating traditional African or Caribbean diets and transitioning to one of  the American Southern diet is harmful to people who immigrant to the United States? 

Brown-Riggs: Absolutely, there is a correlation. There is a large body of research that shows as peoples’ diets become more westernized, we see more diabetes, hypertension, and cardiovascular disease.

I’m going to be presenting on this very topic at the Academy of Nutrition and Dietetics conference this coming week.

DiabetesCare.net: What are the 2 or 3 biggest challenges facing the African-American community in regards to diabetes?

Brown-Riggs: One of the major barriers is provider cultural competence. Cultural competence is not about lumping all African-Americans together. I would say with anyone from a different ethnicity or race, medical providers have to be culturally competent. Providers need better counseling skills to be sensitive to cultural differences people may have.

There is also the access to care issue. By the time most African-Americans are going into treatment for diabetes, they have developed complications.  They are entering into the medical system via the emergency room because they are having an acute health episode related to their diabetes.

DiabetesCare.net: Can you explain how providers can address cultural competence?

Brown-Riggs: First, the provider has to have a desire to be culturally competent. Once you recognize and understand any specific culture, you are going to be able to communicate with them more effectively. We have to be able to engage them. Sometimes people can go into a provider’s office and there is no connection, and providers end up talking at patients rather than talking with them.You need to set aside time to think about their cultural background. Providers should consider how people of a particular culture respond to providers. For example, when a client is looking down at the floor does that mean they are not paying attention to you or is that one of their cultural norms?

You will be able to express more empathy, and these are the kinds of things that will help people make some inroads with diabetes and its complications. 

DiabetesCare.net: How do you overcome the specific challenge of access to care?

Brown-Riggs: I believe a grassroots effort is helpful. One of the things I do and the ADA is involved in is tapping into faith-based programs. That is where you can get a large number of people in the congregation in a church, for example, meeting on Sunday. You can speak to groups about their health, and get them thinking about taking care of themselves.

It’s about meeting people where they are. I have done numerous talks in churches in association with the ADA. People want the information and once you have them in attendance, you can get them engaged. They are asking questions and we’re able to  speak to them in a language they understand.

DiabetesCare.net: Do you think we also need a public health initiative to help turn around the epidemic of diabetes in the African-American community?

Brown-Riggs: I think we have organizations in place, like the Office of Minority Health. And here where I live on Long Island, we have the Suffolk County Office of Minority Health.  Maybe it is about making more people aware of these agencies through outreach efforts, but there are programs and organizations in place to help.

DiabetesCare.net: What other education and treatment strategies have you found to be successful in this patient population?

Brown-Riggs: To understand that small gradual changes work best. This is something many providers have a hard time with as well. You have to work with the individual to find out what they are willing to do. Maybe they aren’t willing to give up their favorite food altogether—and they shouldn’t have to. Let’s say we are talking about fried chicken. Maybe they don’t want to give  up fried chicken, but they are willing to have it less often or serve it in smaller portions; these changes can make a difference.

We cannot dictate change to them; we need to negotiate. I tell my patients all the time I’m a facilitator of change. I cannot make you change. It goes back to good counseling skills and I think that is one of the strategies that will make a difference in the African American community and diabetes. 
 
For those interested in finding out more about Brown-Riggs practice, readers can click here. For those who are going to be attending the Academy of Nutrition and Dietetics conference in Philadelphia, Brown-Riggs will be speaking about how when immigrants transition to eating the traditional southern foods they increase their risks just like African-Americans who were born and lived in the U.S.