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Jun 5 β€’ 21 tweets β€’ 10 min read
I'm now attending the symposium at #ADA2022 on diabetes care among people who are LGBTIQA+ πŸ³οΈβ€πŸŒˆπŸ³οΈβ€βš§οΈ

Great to see this on the program, especially during Pride Month.

(pinging @edjpedjp and @KaiSchweizer as you might want to follow the ADA hashtag for this session!)
First is Dr Nicole VanKim (umass.edu/sphhs/person/n…) speaking on social determinants of health.

Lesbian and bisexual women had a higher risk of T2D than straight women. This varied by age: 144% higher in those aged under 39

Dr VanKim:

Prevalence of poverty is also higher in the LGBT community.

This statistic comes from the "LGBT poverty in the United States" report by Badgett et al: escholarship.org/content/qt37b6…

Dr VanKim: a lot of the research in this space focuses on sexual orientation, there's less research among trans and gender diverse populations #ADA2022
Dr Jamie Feldman: barriers in diabetes care for people who are transgender or gender diverse.

Important to consider minority stress. Trans people experience stressors at a higher rate than straight people, and also more than other groups in the LGBTQIA+ community

Dr Jamie Feldman: the trans and gender diverse population also tend to be more racially diverse and sexuality diverse. This means that they may also be more likely to experience racial minority stress

Dr Jamie Feldman: unfortunately this population also experience frequent discrimination from health care providers. There needs to be more education for health care professionals.

Dr Jamie Feldman: the trans and gender diverse population are also more likely to not have health insurance. Multiple studies have shown they experience a delay in care due to cost #ADA2022
Dr Jamie Feldman: the healthcare system is systematically not gender affirming for trans and gender diverse people. In healthcare, it's designed that legal sex = sex assigned at birth = gender. there's a lack of awareness. This is a barrier to good care.

Dr Jamie Feldman: this is an issue with electronic medical records too. For example, incorrect pronouns, deadnames being on medical records. This leads healthcare professionals to misgender their patients.

Dr Jamie Feldman: the concept of the "gender binary" is also an issue, especially when it comes to clinical guidelines and lab reference ranges e.g. creatinine

Dr Jamie Feldman:

How do we reduce these barriers?

Affirm: e.g. using right pronouns, supporting gender affirming treatments
Address: e.g. refer to mental health care team, include the trans and gender diverse community
Advocate for systemic change at all levels.

Next up is @cjstreed speaking on disparities in diabetes risk factors, disease prevention, and complications among LGBTQ populations #ADA2022
Dr Streed is sharing data from the Gallup 2021 survey on the percentage of those in the US who self identify as LGBT+


Work from Beach et al (liebertpub.com/doi/full/10.10…)

Has shown that "Sexual minorities may be at increased risk for diabetes than their heterosexual peers. This may be due partly to the chronic stressors associated with being a member of a marginalized population" #ADA2022
Work from @cjstreed and others on cardiovascular health among trans and gender diverse populations: ahajournals.org/doi/full/10.11…

"People who are TGD experience significant stressors that affect cardiovascular health across the lifespan" #ADA2022
Final talk in this session from Dr Lauren Beach (@laurenbbeach)

It's on representation of LGBTQ individuals in diabetes research, and limitations of the current research and data. #ADA2022
In the national health and nutrition examination study, people over the age of 59 weren't asked any of the questions about sexual orientation. That means we're missing lots of data about the LGBT community in the 60+ age range. #ADA2022
Some good news: SOGI (sexual orientation and gender identity) data fields are becoming more common in electronic medical records. When it's available at scale, it's a very powerful tool to study diabetes in sexual and gender minority (SGM) populations #ADA2022
And some great news: pridestudy.org

"The PRIDE Study is the first large-scale, long-term national health study of people who identify as lesbian, gay, bisexual, transgender, queer (LGBTQ+), or another sexual or gender minority."

papers avail on their site

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More from @JasmineSchipp

Jun 5
Attending a very important and timely discussion at #ADA2022 on "Diabetes During Humanitarian Crises with Special Focus on Ukraine" πŸ‡ΊπŸ‡¦

(ping @DIPadvocate17)
1st @DrBobGabbay

What's important to think about in an emergency:

What information, resources + supplies do people need?
What advocacy is needed?
Are there research opportunities here? e.g. COVID pandemic
Partnerships: how can we work together?

Nuha El Sayed: When a conflict happens, there's often a limited supply of insulin. People might have to switch to a type of insulin they didn't use before. There's a good switching guide available, but it was US centric. They've adapted it for the Ukraine.

Read 10 tweets
Jun 5
At #ADA2022 this morning, Dr Anne Peters talking on "diabetes technology - panacea meets reality"

There's been a marked increase in the use of technology in the last decade. Mean A1c has improved significantly, but not enough to meet guidelines. Hospitalisations haven't reduced.
We have to take social determinants of health into account, and common stressors (e.g. deportation, loss of job, imprisonment, food insecurity). Giving people who are struggling devices won't necessarily help, and they're often stolen.

Having stressors like this makes it really hard to manage an already difficult condition.

It's also really hard to get help if you don't speak English. For example, calling a pump company if you require a translator often involves much longer hold times.

Read 9 tweets
Jun 4
Always great to see a familiar face at #ADA2022! @janespeight from the @ACBRD is presenting on diabetes stigma

Diabetes has an image problem: it is often represented inaccurately in the media e.g. stock images of sugary foods. The first slide of Jane's presentation. Jane is pictured on
The language used about diabetes is often stigmatising too. People with diabetes can experience stigma from the media, but also family, friends and health care professionals.

Consequences include emotional distress, hiding their diabetes, and impaired self-care

4 in 5 people with diabetes have some experience of stigma. Up to 20% have been discriminated against at work due to their diabetes.

Read 8 tweets
Jun 4
Dr Rebekah Walker speaking at #ADA2022 about the influence of food insecurity on quality of life.

food insecurity = uncertain of having or being unable to get enough food because of insufficient money/other resources
10.5% of US households were food insecure at some time during 2020. Those with diabetes and prediabetes are more likely to be food insecure. #ADA2022
Food insecurity in those with diabetes is associated with higher levels of diabetes distress, lower self efficacy, and worse glycemic outcomes. But what about quality of life? #ADA2022
Read 5 tweets

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