Members of the LGBTQ community can encounter diabetes treatment disparities just like any other minority group. They may lack insurance, financial resources, transportation, or family support, among other things. And patients in the trans- and gender-diverse population who receive diabetes care while taking gender-affirming hormone therapy face even more challenges.
“Our health care systems are really structured around the idea that people fall into two boxes—men and women,” said Jamie Feldman, MD, Associate Professor at the Institute for Sexual and Gender Health, University of Minnesota Medical School. “Everything is, ‘Please check off your sex. Are you a guy or are you a girl?’ They don’t account for the fact that we have the difference between sex and gender, and that bodies change in terms of their organ systems over time.”
Dr. Feldman will chair the Scientific Sessions symposium Diabetes, Metabolic Health, and Clinical Care among People Who Are Lesbian, Gay, Bisexual, Transgender, Gender Diverse, Queer, or Questioning. The two-hour session, which will be livestreamed for virtual meeting attendees, begins at 4:30 p.m. CT Sunday, June 5, in La Nouvelle Orleans Ballroom B at the convention center.
In addition to chairing the session, Dr. Feldman will discuss diabetes treatment barriers for people who are transgender and gender diverse. Overcoming many of these barriers begins with health care providers acknowledging and recognizing trans- and gender-diverse patients through every step of the process and ensuring that all providers included in the process are culturally competent and aware of the specific needs of trans- and gender-diverse people, she said.
Trans- and gender-diverse people often shy away from diabetes treatment if they sense that their provider wants them to discontinue gender-affirming therapy or reduce their hormone doses, added Dr. Feldman. Reassuring hesitant patients that they can continue their hormone therapy is essential. But this requires teamwork.
“Rather than having providers in pockets or little silos with nobody talking to each other, the approach needs to be, ‘We’re going to make this work for you. We’re going to make sure you get your hormone therapy and we’re going to make sure you get your diabetes care,’” Dr. Feldman said.
Diabetes care providers can also help LGBTQ patients overcome barriers arising from stigma and discrimination, but that means asking the right questions and having open discussions about gender preferences.
“We need to be able to acknowledge people’s pronouns and we need to be able to acknowledge their gender as well as their sex assigned at birth,” Dr. Feldman said. “That should be a normal part of everybody’s health care systems.”
Lauren B. Beach, JD, PhD, Research Assistant Professor of Medical Social Sciences and Preventive Medicine at the Feinberg School of Medicine, Northwestern University, will discuss representation of LGBTQ individuals in diabetes research and the limitations of current data. Data identifying LGBTQ patients are often missing from research studies, as well as electronic medical records, federal surveillance, and epidemiological surveillance activities, she said.
“LGBTQ-plus people are everywhere but they’re invisible in many data systems,” Dr. Beach said. “People generally have abstracts or programs accepted that use cohort data or electronic medical records data or randomized clinical trial data. They look at diabetes incidence or prevalence, and risk factors in these very high-quality studies. But the quality of the data for LGBTQ-plus people is often lower.”
But she’s seeing a shift, she said, noting that many health care systems are starting to ask questions to identify sexual and gender minority patients.
“But that’s still a slow process,” Dr. Beach said. “We have some datasets that ask the questions, but the rigor and quality of the data sources themselves is not as robust and certainly is not the type of thing you would usually see featured at the American Diabetes Association’s meeting.”
Also during the session, Nicole VanKim, PhD, MPH, BS, Assistant Professor in the School of Public Health and Health Sciences at the University of Massachusetts Amherst, will discuss social determinants of health and their relationship with metabolic health, with a focus on LGBTQ populations. And Carl Streed, MD, Assistant Professor at Boston University Medical School, will discuss disparities in diabetes risk factors, disease prevention, and complications among LGBTQ populations.
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