One way I stay in touch with the diabetes online community (DOC) is to listen to DSMA podcasts. The shows never fail to enlighten me on some aspect of the DOC. I also very much enjoyed my experience as a guest on one of the episodes; I was quite moved by the conversation! It was through the DSMA en Vivo podcast that I learned of Lorena Drago, MS, RD, CDN, CDE*, and her work in the Hispanic community. I’m excited to share her story with you today.
As a registered dietitian, Lorena frequently works with people who live with type 2 diabetes, which is what prompted her interest in diabetes education. In working with Caribbean Hispanics, Lorena discovered that much of the available diabetes information was geared toward Mexican Hispanics, and did not speak to the foods, traditions, culture and health beliefs of the Caribbean community. This led to her desire to create culturally-sensitive diabetes education materials and advocate for cultural competency in diabetes care.
“I have tremendous passion for what I do,” she said. “My professional emphasis has been on providing diabetes education and adding the components of health literacy, and cultural and linguistic competencies. It’s important to understand from the healthcare professional’s point of view that not all Hispanic cultures have the same beliefs and attitudes. We need to understand the groups we are working with, and then tailor that message for each specific group.”
In her work as Senior Associate Director of Ambulatory Care Nutrition Programs at Lincoln Hospital in the Bronx, Lorena used her understanding of unique cultures to help draft a more relevant diabetes education curriculum. “Our patients seemed to feel that there were too many rules, in terms of carbohydrate counting, fat counting, protein counting, good and bad fats, and good and bad carbs,” she said. “That was just too taxing. People living with type 2 diabetes, based on our findings, just want to know what to do. They wanted to know, ‘If I make rice and chicken and plantains, then how can I make it better nutritionally and also acceptable to other members of the family?’”
Diabetes education needs to emphasize practicality, according to Lorena. “At the end of the day, people want to know what to do,” she said. “We found that people usually want to know, ‘Is this good or bad for my diabetes? Is this good or bad if I have high cholesterol? If I go to the small stores that are called bodegas, and I have five choices of cereal, which one should I buy?’ As diabetes educators, we’re constantly looking for practicality. Can this person now go home and perform all these tasks in a practical and safer way?”
Hispanic Foodways is Lorena’s answer to the need for culturally diverse and relevant education and information. “I felt that there was a need to understand the difference in Hispanic cultures in the United States,” she said. “By understanding the culture, a program can be tailored that will hopefully increase attendance. In providing that information, I want to empower healthcare professionals to be able to address the needs of the different Hispanic subgroups, what their foods are, who they are and their key health issues, as well as what tools to use.”
Lorena has created some diabetes education tools specifically for the Hispanic community. Her Nutriportion™ Measuring Cups list common starches and the associated carb counts, calories and food exchanges on the side of each cup, printed in both English and Spanish. The Measuring Cups help Lorena teach what she calls “carbohydrate budgeting.”
“It’s a matter of budgeting the food, the same way as we would have a budget when we go food shopping,” she explained. “If I have $50, and an item costs $40, that means I can only buy the one item. Now if two items are $25 each, then I can buy two. You have a similar budget to manage your blood glucose level. Some foods are carbohydrate expensive and some of them are more economical. It’s up to you to mix and match. By having the different types of food printed on the cup, I can see that if I have one cup of cooked broccoli, it’s 10 grams of carbs. If I have one cup of cassava, it’s 45.”
To offer a visual education tool, Lorena created her Nutriportion Food Cards, which feature pictures of different traditional foods and dishes from Hispanic countries, with food descriptions in English and Spanish. The cards are designed to help educators teach patients about portions and meal planning. The idea came to Lorena based on other cards she had seen that did not feature Hispanic foods. “Using those other cards, a patient might learn about pasta and rice, but that might only be 40 percent of what they’re consuming,” she said. “You’re not telling them about cassava or other root vegetables that they might be using. How do they plan a meal if you have not spoken to them about the other 60 percent of foods they’re eating?”
Lorena is also the author of “Beyond Rice and Beans: The Caribbean Latino Guide to Eating Healthy with Diabetes,” published by the American Diabetes Association. “The book addresses the food in Caribbean communities: Puerto Rico, the Dominican Republic, and Cuba,” she said. “When I was working with people from the Caribbean, I couldn’t find any relevant information, so I wanted to address how to tackle meal planning, food shopping, and religious and other celebrations. The book is written in English and Spanish, in the same book. I wanted it to be bilingual, to meet the needs of both the English and Spanish dominant person.”
Learn as much as you can about diabetes management, says Lorena. “Know that it’s a long journey,” she said. “There are going to be good days and not so good days, but it’s what you do most of the days that matters. It’s about consistency. Understand, learn, apply and repeat often. Diabetes education, cultural competency and health literacy – I think the three are intertwined. I’m always trying to find what works best, and how can I teach this so that it becomes an ‘a-ha’ moment.”
I am so impressed with Lorena’s wide breadth of knowledge of different cultures and how willing she is to share her insight to the benefit of others. I know I had several “a-ha” moments during our conversation. Many thanks to her for sharing her experiences.
All the best,
Disclosure: Lorena Drago received no compensation for this post. All opinions contained in this post reflect those of the interviewee, and not of Sanofi US, its employees, agencies or affiliates.
*“Certified Diabetes Educator” and “CDE” are certification marks owned and registered by the National Certification Board for Diabetes Educators (NCBDE). NCBDE is not affiliated in any way with Sanofi US. NCBDE does not sponsor or endorse any diabetes-related products or services.
Nutriportion is a registered trademark of Lorena Drago.