Shireen Abdullah: 00:02 

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah: 00:36

Diabetes and heart disease do not affect every community equally. In this episode, our guest unpacks the forces that drive those gaps, structural barriers, clinical blind spots, and the mental health tool, and turns them into clear actions for clinicians, patients, and families. Stay to the end for practical ways your community can push for better screening, treatment, and outcomes. Diabetes health disparities and implementing and evaluating systems interventions to improve patient safety and quality of care in hospitalized patients with diabetes..

Shireen Abdullah: 01:10

Welcome, Dr. Golden. 

Dr. Sherita Golden: 01:10

Thank you for having me.

Shireen Abdullah: 01:12

Such a pleasure having you on. So first things first, we want to get to know you, Dr. Golden. Help us understand, you know, what led you or what inspired you to focus your career on diabetes, such a strong focus on diabetes, as well as cardiovascular disease. Where did that come from?

Dr. Sherita Golden: 01:28 

So when I was a medical student at the University of Virginia, the first patient I saw as a second-year medical student had type 1 diabetes. He was a young man, just 35 years old, and suffered from every complication of diabetes. He’d had a kidney transplant because he’d had end-stage renal disease. He had lost vision in one of his eyes because of retinopathy and eye damage, and even had a toe amputated because of nerve damage in his feet. And he had such severe low blood sugars that he’d had two car accidents and had his license revoked.

Dr. Sherita Golden: 02:02 

So he was quite disabled from the complications of diabetes. Then when I was a third year medical student, a year later, I did my rotation in internal medicine on the diabetes floor, happened to be randomly assigned there. Turns out it was providential. 

Dr. Sherita Golden: 02:15 

And I really loved caring for patients with diabetes and met a wonderful diabetes specialist, Dr. Eugene Barrett, who was an endocrinologist, had a wonderful bedside manner. And really, he taught us how you can partner with the patients in the management of diabetes. So that really inspired me. And despite the fact that patients were having all those complications back then, before I graduated, the results of the Diabetes Control and Complications trial was published.

Dr. Sherita Golden: 02:39

And that showed in September of 1993 that if you tightly control glucose, you could prevent the eye complications, the kidney complications, the nerve damage, all of those things. So I knew that moving forward as a future clinician, taking care of patients with diabetes, I’d have the tools in my armamentarium to prevent the complications I saw in that very first patient. So that is what inspired me. And plus, it was a growing public health epidemic.

Dr. Sherita Golden: 03:03

Now there are over 38 million people living with diabetes, and it also was impacting minoritized communities, communities who live in poverty. So all of that inspired me from the diabetes front. And then part of the reason I focused some of my career on cardiovascular complications of diabetes is that my father, even though he doesn’t have diabetes, almost died from a heart attack when I was an endocrine fellow. So when I was doing my training in endocrinology, and he was only 64 years old at the time. This was in 2000.

Dr. Sherita Golden: 03:33

But what really inspired me is that present day research that had advanced cardiovascular disease management, particularly in the setting of an acute heart attack, saved his life. So he had like a rescue angioplasty. And then after, even though he ended up having a five vessel bypass, ultimately, he implemented every preventive lifestyle change that the doctors and nutritionists recommended and lost 30 pounds of four inches off of his waist in his recovery. And he will celebrate his 90th birthday at the end of this month.

Dr. Sherita Golden: 04:01

So that is what has really inspired me to focus on cardiometabolic diseases as a whole, the patients I saw and my own family’s experience with heart disease. 

Shireen Abdullah: 04:10

Well, good for him. I just love hearing stories like that. That’s incredible. Thank you so much for sharing that as well. Speaking of which, you know, going back a second, you mentioned, you know, around communities of color as well. You mentioned, you know, the poverty level and how there’s a disproportionate impact.

Shireen Abdullah: 04:25

What are some of the most significant disparities we see today when it comes to diabetes and heart disease outcomes in these communities or just general population that you could share?

Dr. Sherita Golden: 04:38

Yeah, so diabetes and heart disease disproportionately impact minoritized communities. So if we talk about diabetes specifically, it’s African Americans, Native Americans, Native Hawaiians and Pacific Islanders, South Asians, Hispanic and Latino communities. They all experience a higher burden of diabetes and its complications. But similarly with heart disease, African Americans, American Indians,

Dr. Sherita Golden: 05:02

And also women surprisingly have a higher burden of heart disease and then also poor outcomes due to the higher rates of hypertension, diabetes and socioeconomic inequalities. But when we think about poverty, there are about 37 million Americans that are living in poverty. So individuals who live in poverty have higher rates of diabetes and heart disease regardless of their racial background.

Dr. Sherita Golden: 05:24

Also, individuals living in rural areas. About 82 million Americans live in rural areas. So there are these geographic disparities, again, independent of race and ethnicity, where those individuals also have poorer outcomes around diabetes and cardiovascular disease.

Shireen Abdullah: 05:40

You know, when we hear that, Dr. Golden, help us understand the root cause of this. What are the drivers of these unequal health outcomes in these communities? Which drivers do you believe are most urgent to address? 

Dr. Sherita Golden: 05:52

The drivers overlap for both diabetes and cardiovascular disease. So in these communities, particularly in the rural communities and the impoverished communities, there’s a higher rate of smoking, a higher rate of overweight and people living with obesity.

Dr. Sherita Golden 06:06
So there are those factors, risk factors, but then there are also environmental factors, which I think are some of the most important. It is very difficult for people to implement healthy lifestyle if they don’t live in an environment that supports that. So a lot of these communities have difficulty accessing affordable, high-quality healthcare. They have difficulty accessing healthy foods easily and also having physical activity spaces. So you don’t even necessarily need a formal gym.

Dr. Sherita Golden: 06:33
But just having areas where you can safely you know, walk and engage in physical activity. So those are the environmental factors. And then there are the health system factors, which we talk about. So inadequate access to subspecialty care. So in many rural and impoverished areas, there are not a lot of endocrine specialists like myself. Diabetes education and clinician specialists are very difficult to access. They may be 50 or 60 miles away in some very isolated areas.

Dr. Sherita Golden: 07:02

So they just don’t have access to that subspecialty care. And many minoritized patients have less access to subspecialty care compared to those who aren’t. So part of it is several levels. So there’s these individual risk factors that individuals have, but then there are also environmental factors and then the health system factors.

Dr. Sherita Golden: 07:19

And if I were to think about what are the most important things that, you know, if I had like a magic wand that I could address, it would really be addressing those environmental and social structures that are contributing. So we know that things like air and water quality, housing, employment, having adequate insurance in our country – having adequate health insurance is very linked to employment, education, economics, all of those things, economic empowerment really need to be addressed. 

Dr. Sherita Golden 07:46

So I would really want to address the economic and environmental empowerment. And then also one of my pie in the sky ideas is that, you know, if we think out of a safety perspective, you have to have a fire hydrant, like every so many blocks from a safety standpoint. So in case there’s a fire, you can put it out pretty quickly.

Dr. Sherita Golden: 08:01

So I would love to see legislation where we could actually legislate healthy food options every so many blocks so people don’t have to take a lot of city buses to get to where there are fresh fruits and vegetables or, you know, have to drive 40 or 50 miles if they’re in a geographically isolated area. So I think we need to think about policies that really help to reinforce the environment that patients need to engage in their healthy lifestyle.

Shireen Abdullah: 08:25 

I absolutely love that. And also love the analogy around the fire hydrant. It makes it so real and so tangible to see, like if those security systems or the safety systems are in place, how it replicates to within a broader public health conversation here.

Dr. Sherita Golden: 08:39

And I thought about that because some of my patients over the years had to catch several city buses just to get to a full grocery store. But yet there would be corner stores that didn’t have healthy options, you know, very accessible. So if we could flip that script, that would be very beneficial. 

Shireen Abdullah: 08:53

Absolutely. You know, some of your research is also focused on mental health, and I know that there’s an overlap here. But your research that focuses on mental health and that aspect of living with chronic illness, is it like people’s misconception around it? What is it? 

Dr. Sherita Golden: 09:08

Well, I think there’s still a lot of stigma around mental health issues like depression and anxiety. So patients often feel uncomfortable admitting those symptoms or mentioning that they’re having those symptoms.

Dr. Sherita Golden: 09:20

And one of the things that we started doing in our diabetes center based on some of the research I had done is we just started screening everybody with just a screening question, like two questions. Have you lost interest or pleasure in activity? Do you have depressed mood? Because that answer, and it’s scored on a scale of zero to three, and if you have a score of three or above, there’s about a 70 or so percent chance that you likely have a depressive disorder that warrants additional follow-up. 

Dr. Sherita Golden: 09:46

And we incorporated them with the other questions – any problem with your eyes, any problems with numbness or tingling, and then you just go right in and ask those depression screening questions so you normalize it as a part of routine care. But I think that there’s still a lot of patients that don’t like to admit it. So the way that I address it is I would say, If your blood pressure isn’t adequate, we treat that. If your blood sugar is not controlled, we treat that.

Dr. Sherita Golden: 10:12

So if the balance of chemicals in your brain is not adequate and is causing you to be depressed or anxious, we should treat that just like we do the blood pressure and the blood sugar and the cholesterol. So you can see a light bulb come on, you know, thinking about it as a part of the holistic treatment of their chronic illness.

Shireen Abdullah: 10:27 

You know, I love that you mentioned in the way the questions are even embedded. I’ll tell you from my own experience recently as part of the regular care, I guess my doctor’s office was doing a very similar screening for depression. But the way that screener was handed is like, oh, here’s all the documents you need to fill out. And also here’s the depression screener. And they handed me the separate sheet of paper and I’m looking at it going like, what? 

Shireen Abdullah: 10:49

There’s like, oh, this other thing that needs to be done. Anything on the top of it is that something like depression screen or something like that, too. And as I was responding to these questions, I was like, man, even if I wanted to respond a certain way, I’m still less likely to do it now. Right. In a truthful or honest way.

Dr. Sherita Golden: 11:06

Yes, because again, I think that’s why we have to embed it and normalize it into other aspects of routine care because, you know, in many cultures, you know, people are not comfortable admitting that they have those symptoms. And I also think some of it’s generational. The older generation is also not as likely to respond positively and admit that they’re having those feelings. So again, a reason to incorporate it into the routine questions that we ask.

Shireen Abdullah: 11:34 

How does psychological stress or depression influence diabetes management and cardiovascular outcomes, especially with this focus on underserved communities? 

Dr. Sherita Golden: 11:45

So you know, one of the challenges is that uncontrolled depression, anxiety, any kind of psychological stress, it can actually influence health behaviors that are needed to manage diabetes and cardiovascular disease. So think about the things we ask people to do.

Dr. Sherita Golden: 11:59 

You know, engage in regular exercise, eat a healthy diet. They are less likely to engage in physical activity. So in one of our studies, those who had symptoms of depression were less likely to engage in intentional physical activity as those who didn’t have those symptoms. They were also more likely to consume more calories.

Dr. Sherita Golden: 12:18

…during the day than those who did not have those symptoms. Those who engage, who had depressive symptoms also were more likely to smoke. And smoking is a risk factor for heart disease and also a risk factor for diabetes. So there’s that aspect of things. But then also, if you think about it, when people have depressive symptoms, they’re also less likely to adhere to their medication treatment recommendations. It’s just very hard to get motivated to do things. So those things impact the health behaviors needed to manage a chronic disease like diabetes or heart disease.

Dr. Sherita Golden: 12:48

And then there are also the stressors that we experience mentally and psychologically elevate the body’s stress hormones. And those stress hormones can trigger inflammation and all of those things can make your blood pressure go up, your cholesterol grow up, your blood pressure go up and your body weight rise.

Dr. Sherita Golden: 13:07
So again, like all of those things are working, you know, sort of against the person who is trying to manage the diabetes and cardiovascular disease, which is why it’s so important to get those mental health conditions treated as, again, as a part of a holistic treatment. And, you know, the underserved communities we talked about earlier, minoritized communities, those who live in rural, isolated areas, those living in poverty, they’re more likely to live under stressful conditions.

Dr. Sherita Golden: 13:31

So, you know, for example, even rural white Americans report more days of poor mental health than those who live in non-rural areas, Black and whites living in non-rural areas. So again, just thinking about, you know, that needs to be a really important part of holistic treatment of the chronic physical conditions.

Shireen Abdullah: 13:50 

Speaking of holistic treatment, from a clinical perspective, what are some of the biggest gaps in screening, diagnosis, or even care management among underserved populations? 

Dr. Sherita Golden: 14:00

I think one of the things is consistent access to primary care and subspecialty care, which is really dependent on having adequate health insurance. So many of us in the healthcare and public health space right now are very concerned about what is going to happen in January with the premiums going up on

Dr. Sherita Golden: 14:18 

…the insurance plans offered through the Affordable Care Act, because if individuals can’t afford those premiums, they may forgo their health insurance altogether, which then is going to limit their ability to access primary care, to access subspecialty care from an endocrinologist or a cardiologist, or even like a dietitian, for example. And what will end up happening is they will start seeking care in the emergency departments at local hospitals, which really is not an adequate

Dr. Sherita Golden: 14:46

…way to manage chronic health conditions. So either they will be seeking care for chronic health conditions, or because they’re not engaged with primary care, they will forgo treatment, maybe forgo medications, and then have to present to the emergency department because now, you know, they’re suffering an acute event, a heart attack, congestive heart failure, very high blood sugars needing to be admitted for IV insulin, those types of things. So it’s really the lack of consistent access to primary care and making sure that people have adequate

Dr. Sherita Golden: 15:16

…insurance, because you can also have insurance and be underinsured. You know, an insurance plan that has a high deductible and you have to pay $4,000 out of pocket, for example, before your insurance kicks in. There are many people that, again, may forgo certain treatments because they don’t want to have to have to pay that out of pocket. So that is the thing I think that is the biggest concern.

Shireen Abdullah: 15:37

Help us understand the ripple effect of it. You know, you mentioned someone who has a diagnosed diabetes and perhaps having an acute event and then showing up to the emergency room. How does that, I mean, if we’re thinking about screening and testing, are there implications of, again, forgoing that care that shows up in the emergency room or elsewhere that you can point to if we’re not seeking care appropriately and not on time?

Dr. Sherita Golden: 15:58 

Yeah, so if you’re not seeking care appropriately at one time, so for example, you know, for those of us of a certain age, we get screened for diabetes each year. You know, we get our blood drawn. We have a fast and glucose checked. We have our hemoglobin A1C checked, for example.

Dr. Sherita Golden: 16:14

And you’re showing signs of prediabetes or you’re diagnosed with diabetes at that early stage. You can start treatment early, prevent the complications. Well, imagine if you don’t have the resources to have that screening done. Your first manifestation of diabetes may be that you suddenly are having excessive thirst, excessive urination because your glucose is so high that you’re spilling it in your urine.

Dr. Sherita Golden: 16:36 

And you end up showing up to the emergency room because you’re dehydrated. You have blurred vision because that is another sign, not necessarily because you already have eye damage from the diabetes, but because when your sugar is high, it distorts the lens of the eye. And so you actually have blurred vision.

Dr. Sherita Golden: 16:51 

up in the emergency room because you have blurred vision, you’re losing weight, you’re having excessive thirst and urination, they draw your blood and your blood sugar may be 400 or 500, for example. So now it’s an acute situation. Depending upon how ill you are, you may end up having to be admitted to the hospital and have that treated, wherein that could have all been prevented had, you know, the person had the resources earlier to engage in the lifestyle intervention or medication therapy to prevent the acute complications.

Shireen Abdullah: 17:17 

Which takes me to my next question. How can patients or families or communities really advocate for better diabetes and heart health outcomes in their communities? What can they do? 

Dr. Sherita Golden: 17:28

You know, I think one thing is that we need to be delivering more of our care and screening practices in the community. So partnering

Dr. Sherita Golden: 17:34 

…with the local health department or the local health care organizations in the community to actually do community-based screening in local community centers, in religious and spiritual care organizations. Screening, in other words, happening in the communities where people are living so that they can actually get the screening they need for diabetes, for heart disease. Personal anecdote, like I was diagnosed, even though I was getting annual health physicals, I was diagnosed with hypertension at a screening health fair at my parents’ church. I just went to get it checked and its like 150 over 90 and she kept checking and she kept checking, and then I went to my primary care physician, and lo and behold it was elevated, consistently.

Dr. Sherita Golden 18:15

So but I would have found that out when I went to my annual visit – but imagine if I was someone who was not linked into healthcare, having that information would have inspired me to go to healthcare. So I think that people should advocate to have those kind of health screening programs in their communities. And then the other thing is to really ask when you do go into care, ask your doctor, what are my numbers? What is my hemoglobin A1C? What is my glucose? What is my cholesterol? And what is my blood pressure?

Dr. Sherita Golden: 18:40 

And because they may tell you, oh, I did your screenings, everything looks fine. So again, I’ll use my father as an example. For years, his primary care doctor told him that his blood pressure was fine. So he didn’t think to ask what the number was. So after his heart attack, you know, they put him on medication. The goal was to be 120 over 80. And he went and got his old records from his primary care doctor to take to his cardiologist.

Dr. Sherita Golden: 19:02 

And my dad looks at it and said, my blood pressure has been 140 over 95 for years. That wasn’t fine. But he never asked because if he had asked and then he had told me his blood pressure was 140 over 95, I would have said, you need another blood pressure medicine. So he was on blood pressure medicine.

Dr. Sherita Golden: 19:17 

…but it needed to be a higher dose or he needed an additional agent. That’s an example where you ask what the number is. And if you’re talking to a clinician who’s annoyed that you’re asking those questions, then it’s time to find another doctor because, you know, no doctor who’s really wanting to partner with you should be bothered that you want to know those numbers.

Shireen Abdullah: 19:33 

And I absolutely love that approach. Thank you so much, Dr. Golden for even mentioning that, because I find that repeatedly, again and again, even the folks that we work with, and we do a lot of work within communities where, you know, they’re at high risk for diabetes, and we do our diabetes prevention programs. And within that time and again, we ask participants coming through, what are your diabetes numbers? How’s your hypertension or blood pressure, if you will. Normally, like 95% of the

Shireen Abdullah: 20:00

…time we’ll get the response I don’t know I’m not sure it’s like oh the next time you go to your doctor get to know your numbers and it’s a simple tell me more it’s a very simple I want to understand this better tell me more and I feel like or what we hear is like oh yeah you know they did my blood work and everything was fine fine compared to what? Like so what? 

Dr. Sherita Golden: 20:23 

Right because fine for one person is not fine for someone else so for example you know the the targets for your blood pressure and cholesterol if you have diabetes or you have had like a heart attack or stroke in the past your targets are different than someone who just as a younger person who just has high blood pressure doesn’t have any other risk factors right? So fine like you said it’s different for different people you need to know what it is for you.

Dr. Sherita Golden: 20:46

And I would also say, ask your doctor, what medications do you have me on to prevent heart disease? Like which of these medications that I’m taking, what are they for? What is this one for? Am I on a cholesterol, I mean, a medicine for cholesterol or blood pressure? If not, do I need to be? Why am I on it or am I not on it? So that kind of partnership with your physician is really important and helpful.

Shireen Abdullah: 21:05 

I absolutely love that. And it’s all about speaking up and speaking out, right? Like not being afraid to ask your numbers, even if you feel like you just don’t completely understand it, that’s fine. Come home, do your research, ask someone who understands this better, but definitely know this information for yourself so you can understand what it means for you. As you can tell, I’m very passionate about this one because I feel like there’s so much that we can do differently if we just know more about our health.

Dr. Sherita Golden: 21:32 

No, I agree. Like you, I am equally passionate about this. And particularly in communities of color and impoverished communities, you know, those who people make assumptions about what you do and don’t know. So in order to advocate for yourself, it’s really important to ask those questions like you have a right to do so. And then also even taking someone with you to your appointment to make sure you’re all hearing the same thing.

Dr. Sherita Golden: 21:58 

I mean, I’m a physician and I will tell, you know, any doctor that I go to, I know diabetes and heart disease very well. For anything outside of that, you need to treat me like I don’t know. And I often will take someone with me. So I’m like, did you hear the same thing I heard, you know, about what the next step is in this process or what I need to do? So, you know, I also encourage people to take advocates with them, just even just to have another set of listening ears.

Shireen Abdullah: 22:20 

With that are toward the end of the episode. Dr. Golden, I feel like this in itself, what we touched on right here could be an episode on its own, but we are toward the end of this one. How can our listeners just connect with you and learn more about your work and what you’re doing? 

Dr. Sherita Golden: 22:33

Well, I am on LinkedIn. So that’s a place to find me and then have a website at Johns Hopkins Medicine where I work. So that’s another place to find information. But probably my LinkedIn profile has all of my information, work I’ve worked on over the years, work I do in the community.

Dr. Sherita Golden: 22:49 

So that’s probably the easiest way to reach me.

Shireen Abdullah: 22:53

Perfect. Thank you so much, Dr. Golden for joining us on this episode of the Yumlish podcast. To our listeners, thank you so much for tuning into another episode of this podcast. You know what time it is. Head over to our social media and answer this quick question: What changes would you like to see in your community to make it easier for people to prevent or manage diabetes and heart disease? So Dr. Golden already talked about a couple – what are the types of things that you like to see in your community, again, to prevent diabetes and heart disease?

Shireen Abdullah: 23:19

So thank you so much, Dr. Golden truly appreciate your time. It’s such a pleasure having you on. 

Dr. Sherita Golden: 23:24

Yes, my pleasure as well. 

Shireen Abdullah: 23:26

Until next time. Thank you.

Shireen Abdullah: 23:30 

Thank you for listening to the Yumlish podcast. Make sure to follow us on social media at Yumlish_ on Instagram and Twitter and at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective.

Shireen Abdullah: 23:50 

You can also visit our website, yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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John Hopkins Profile Page: https://profiles.hopkinsmedicine.org/provider/sherita-hill-golden/2704881