Ethno-Cultural Considerations in Personalized Diabetes Management

Shashank Joshi, MD, Lilavati Hospital and Research Centre, Mumbai, spoke to MD Magazine about the cultural considerations when attempting to personalize diabetes care.

According to Joshi, personalized diabetes care is where the whole world is moving, because every type 2 diabetic is different with his own set of genes, his own phenotype, its own signature written on the disease profile, and therefore behaves differently. Physicians are called to specifically tailor the therapy, so that they involve the patient in the shared decision-making process.

Joshi explained there is a trans-cultural endocrinologic task force handled by the president, Jeffrey Mechanick, MD at the American College of Endocrinology. “He has had a global footprint, because now we live in a global village connected digitally, therefore people from all ethnic groups have an ethno-cultural inputs. Food cooked in every household is different, the lifestyle they follow is different, and the religious and cultural practices they follow are different.”

Therefore, the profile of management is different based on the geography of earth where they are located, the type of food they eat, weight of physical activity they do, cultural practices, or addiction practices. Joshi also explained that personal diabetes care is not only about lifestyle, but also about genomics, because some people will respond to a given drug at a lower dose. For example in India, people respond to drugs at a lower dose, so they don’t need the standard doses, which are used for Caucasians.

“Their phenotype is also different, because they are thin and fat; they have a lot of fat in the adipose tissue, but they look very thin — therefore their behavior of drugs is different,” Joshi said. They eat more carbs and fats, they are predominantly vegetarian, and they eat less proteins so their muscle mass is less but body fat composition is more, and that is the phenotype. So, when you look at drugs, Indians or Asians on the south of Asia or east of Asia respond better because they have a larger exposure to carbohydrates and their drop of A1C is better compared to Caucasians. “So, obviously personalized diabetes care is about understanding based on the ethno-cultural output.” Joshi’s team had created an algorithm, which was originally published in 2012, and recently validated its latest version from India as well as many parts of the world (Malaysia, US, Europe, Venezuela, South America). According to Joshi, this algorithm takes into account the ethno-cultural input, the BMI, the physical activity parameters, cardiometabolic cluster, and their risk profiles, and integrates that into a lifestyle approach, so that people can follow and get better outcomes. “We’re all here for a common enemy, which is diabetes, and we want to ensure that every person gets a better glucose control.”