Diabetes is a scourge for many Americans — including Somali Minnesotans.
For many immigrants, treating diabetes requires navigating a multifaceted mix of cultural traditions, dietary restrictions and systemic barriers to health care.
Omar Nur, executive director of the Somali American Social Service Association in Rochester, said diabetes is one of the most pressing health issues facing Somali families.
Many aren’t aware of their hereditary risk or the chronic nature of the disease, he said, and they often lack preventative education or guidance on exercise and diet.
Axis Medical Clinic in Minneapolis, a nonprofit primary care community health center aimed at serving Minneapolis’ refugee and immigrant community, has seen an influx of patients with diabetes since opening in 2008.
Dr. Juan Lewis, a family practice physician at Axis, attributed the high prevalence of diabetes among Somali patients to dietary habits, adding that many members of ethnic minority groups in America are at higher risk for developing diabetes.
The challenge of an American diet
Somali immigrants in the United States find themselves dealing with food and ingredients very different from those in their native countries, Lewis said. In America, it’s easy to access highly processed foods loaded with carbohydrates and sugar, and more difficult to find fresh fruits and vegetables.
That greatly increases the risk of diabetes, said Rageh Abdullah, 45, a Minnesota Somali immigrant.
Abdullah came to Minnesota at the age of 15. As his dietary habits changed — he made frequent runs to McDonald’s and KFC because it was so convenient — so did his health.
In 2018, he was diagnosed as pre-diabetic and prescribed a preventative medication. He thanked the doctor and left, not returning for two years.
During those two years, Abdullah never took the recommended medication, instead adopting a holistic healing approach. He spent six months in Kenya, following a strict diet of no sugar, carbohydrates, pasta, tea or coffee, and prioritized his water intake.
When he returned to the clinic two years later, doctors found that he was no longer pre-diabetic nor at risk for developing Type 2 diabetes as a result of his dietary changes.
Axis Medical Clinic employs a Somali diabetic educator to help patients adapt their traditional cuisine to a diabetic-friendly diet, Lewis said. It’s just one of several resources offered to the Somali community to combat diabetes.
Twice a month, the Brian Coyle Neighborhood Center in Minneapolis’ Cedar-Riverside neighborhood offers free fruits and vegetables. It also employs a community health director, according to Ferdowza Ali, the technology and education coordinator at the center.
Individuals and families can also receive halal food staples though Isuroon’s Halal Food Assistance, a food shelf supporting the East African community in Minneapolis. It has several locations throughout the Twin Cities and is available to anyone in need, regardless of income or immigration status.
Managing religious obligations
For some in the Somali immigrant population, dietary habits are influenced by cultural and religious factors, such as fasting during Ramadan, a holy month in Islam that involves fasting between sunrise and sunset, prayer, reflection and community involvement.
Ramadan’s irregular meal schedule conflicts with the structured eating important for effective diabetes management, Lewis said.
He advises his patients with diabetes to maintain a strict diet throughout the year to help reduce the potential health impacts of fasting during Ramadan. However, he does not discourage his patients from observing their religious or cultural practices, instead providing guidance on how to balance those commitments with effective diabetes management, such as portion control, structured eating schedules and carbohydrate reduction.
Patients’ needs are not all the same and providers’ approaches also differ, according to Edie Berggren, a scribe at Axis Medical Clinic. Some providers recommend patients engage in intermittent fasting to help with weight loss.
Abdullah said fasting during Ramadan helped lower his blood sugar levels, and he continues to fast on Mondays and Thursdays, a practice recommended in Islam.
Other religious practices can influence the community’s willingness to partake in certain medications. For example, preventative medicine is not always accepted because of the Muslim belief that one’s time of death is decided by God, according to Lewis.
“A lot of them have a hard time understanding doing something to prevent bad things from happening,” Lewis said. “So that belief system is not working in their favor. That’s why a lot of times they don’t come in at all, or they don’t come in as frequently.”
Social status and misinformation
Somali immigrants, as newcomers in the United States, often face language barriers, cultural differences and limited access to culturally competent care, Lewis said.
Ali said some Somali immigrants are hesitant to follow medical advice, often placing more trust in community members, even if they lack professional expertise. The reluctance stems from a cultural tendency to rely on familiar, trusted voices within their own community.
Even when resources are translated, communication between the patient and provider can fall short, according to Lewis, the family practice physician at Axis.
“They speak Somali, but they don’t write Somali,” said Lewis. “So even when you try to translate words to them, they don’t understand. And that’s not everybody, but that’s a significant portion of people.”
A 2015 Mayo Clinic study found that Somali patients scored low on diabetes literacy, averaging 42% on a standard knowledge test. However, researchers discovered that low literacy wasn’t the main driver of poor diabetes outcomes, suggesting that larger structural and social barriers play a bigger role.
“Health literacy scores are lower in Somali patients compared to non-Somali patients, but it doesn’t mediate the disparity in diabetes,” Dr. Mark L. Wieland, a researcher involved in the study, told Sahan Journal earlier this year. “That implies structural barriers that are not unique to Somali populations are kind of driving that.”
To address diabetes disparities among immigrants and refugees, researchers from the Rochester Healthy Community Partnership, a collaboration among the Mayo Clinic, community organizations and local leaders, developed a digital storytelling intervention for Somali and Latino adults with Type II diabetes.
The digital storytelling program is free to access on the App Store and YouTube, removing potential financial barriers, according to Wieland.
Economic barriers also play a role
Health illiteracy challenges among Somali immigrants are compounded by economic barriers and misunderstandings about insurance coverage and medication access.
While many Somali patients qualify for free or subsidized health care through Medicaid, a government program offering health insurance to low-income individuals and families, Lewis said the program has limitations. It often does not cover certain essential medications, such as Metformin, which controls the amount of glucose in the body. Additionally, he said, patients frequently assume their prescriptions were not sent when in reality, the medications are denied by their insurance companies.
Without a clear understanding of the system or someone to advocate on their behalf, patients are often left without the medications they need to manage conditions like diabetes effectively or don’t know how to access those medications without insurance, according to Lewis.
Somali Minnesotans facing challenges with health or prescription coverage can receive free, culturally and linguistically tailored support through various community organizations. MNsure, Minnesota’s official program helping people find and sign up for affordable health coverage, offers free assistance through certified navigators who can explain coverage and guide individuals in their preferred language, including Somali.
Another option is Project Care, an initiative run by Mid‑Minnesota Legal Aid, which provides multilingual enrollment help and support in identifying insulin assistance programs.
Still, structural barriers persist, such as lack of affordable gym options and transportation, according to Nur. He noted that gym memberships can cost families over $150 per month.
“It’s America. You can get that nice food, but you don’t get exercise,” said Nur. “Control your food, get to the gym. If you don’t have enough money, try to move around your house in summertime. It’s free.”
As part of its work to reduce health care disparities and economic barriers, the University of Minnesota’s Mobile Health Initiative partners with community-based organizations like the Islamic Association of North America to provide free primary care and screenings to underserved communities across Minnesota, said Jonathan Kirsch, clinical director of the Mobile Health Initiative. It delivers health care directly into community spaces such as mosques.
The mobile health vehicle functions as a fully equipped clinic on wheels, allowing screening for diabetes, hypertension, cholesterol and other conditions in places people already live, work and worship. The initiative currently serves more than 6,000 people annually, with events at Somali community sites often seeing 40 to 80 attendees in a single day.
“It was really a turning point for a good number of our community members who did not even know that they had this chronic disease until they came to those events,” IANA Executive Director Yusuf Abdulle said.
But challenges remain.
“Funding cuts from the federal government have limited us in doing as many things as we want to do, especially for this underserved community,” Abdulle said. “Having said that, we will definitely continue working together and depending on the limited resources we do have.”
