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Miller De Rutté AM, Barrie A. A Systematic Review Exploring Acculturation and Type 2 Diabetes in Spanish-Speaking Populations. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:133-146. [PMID: 34493108 DOI: 10.1177/15404153211037022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acculturation to the United States has been previously studied in Spanish-speaking populations, but little is known about the potential relationship between acculturation and type 2 diabetes mellitus (T2DM). OBJECTIVE The purpose of this systematic review was to explore the relationship between acculturation and T2DM in Spanish-speaking populations in the United States. METHODS Selected studies collected from a review of literature were analyzed by population, ethnicity, acculturation scale, and significance. RESULTS Thirty-two eligible articles showed conflicting data between the effects of acculturation on T2DM. CONCLUSION Overall, studies yielded inconclusive results on the significance of the relationship between acculturation and diabetes in Spanish-speaking populations, which merit further investigation.
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Affiliation(s)
| | - Amanda Barrie
- Department of Biology, The University of Tampa, Tampa, FL, USA
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Marquez I, Calman N, Crump C. A Framework for Addressing Diabetes-Related Disparities in US Latino Populations. J Community Health 2020; 44:412-422. [PMID: 30264184 DOI: 10.1007/s10900-018-0574-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems.
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Affiliation(s)
- Ivan Marquez
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Suite L5-40, New York, NY, 10029, USA.
| | - Neil Calman
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Institute for Family Health, New York, NY, USA
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
BACKGROUND Although there is increasing knowledge regarding the association between generational status on diabetes risk, less is known about the effects of generational status on diabetes management among Mexicans. OBJECTIVES We test whether generational status is associated with variations in diabetes processes of care among Mexican adults to optimize disease management. RESEARCH DESIGN Weighted multivariate logistic regression was used to test the association between generational status on the quality of diabetes care processes and health care utilization adjusting for socioeconomic/demographic factors. Four generational cohorts were constructed: first generation immigrant; second generation; generation 2.5; and third generation. SUBJECTS We conducted analyses of 3072 self-identified foreign and US-born Mexican adults with diabetes who participated in the 2005, 2007, 2009, and 2011/2012 California Health Interview Surveys. MEASURES Three diabetes process outcomes were measured, including receipt of at least 1 eye examination, 1 foot examination, or 1 hemoglobin A1C test (HbA1c) in the past year. One secondary prevention outcome was measured, receipt of an annual influenza vaccine. Finally, we measured whether an individual with diabetes received an annual doctor visit. RESULTS A gradient of progressively decreased odds of receiving an eye examination and HbA1c test were observed and significant for most of the higher generations. Higher generations also had significantly decreased odds of receiving an annual flu vaccine. CONCLUSIONS Data collection on generational granularity and a specific focus on mixed acculturation status can vitally inform health system improvements in diabetes care among Mexicans in the United States.
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Chang A, Kenya S, Ilangovan K, Li H, Koru-Sengul T, Alonzo Y, Carrasquillo O. Is greater acculturation associated with an increased prevalence of cardiovascular risk factors among Latinos in South Florida? Med Care 2015; 53:417-22. [PMID: 25793266 PMCID: PMC7945007 DOI: 10.1097/mlr.0000000000000337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine the association of acculturation with various cardiovascular risk factors (CRFs) among Latinos with diabetes in South Florida. METHODS In a cross-sectional analysis of data collected from 300 Latinos with poorly controlled diabetes we measured acculturation using the Marin Short Acculturation Scale. We examined correlations between acculturation and the following 7 CRFs: hemoglobin A1C, low-density lipoprotein, systolic blood pressure, body mass index, smoking status, physical activity, and fruit and vegetable intake. RESULTS Cubans made up 38% of our population; no other Latino subgroup represented over 17% of the sample. Of the 8 outcomes examined, only smoking was associated with increased acculturation; 12% of Latinos in the 2 lowest acculturation groups were current smokers versus 25% in the highest acculturation group (P=0.02). Furthermore, Cuban Americans from our sample had over double the prevalence of smoking compared with non-Cubans in both the lowest and highest acculturation groups. CONCLUSIONS With the exception of smoking, our data does not support a link between increased acculturation and higher prevalence of CRFs in Latinos with diabetes. Smoking prevention and cessation programs targeting Latinos and particularly among Cubans are needed.
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Affiliation(s)
- Aileen Chang
- Department of General Internal Medicine, Division of Biostatistics, University of Miami, Miami, FL
| | - Sonjia Kenya
- Department of General Internal Medicine, Division of Biostatistics, University of Miami, Miami, FL
| | - Kumar Ilangovan
- Department of General Internal Medicine, Division of Biostatistics, University of Miami, Miami, FL
| | - Hua Li
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Miami, FL
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Miami, FL
| | - Yisel Alonzo
- Department of General Internal Medicine, Division of Biostatistics, University of Miami, Miami, FL
| | - Olveen Carrasquillo
- Department of General Internal Medicine, Division of Biostatistics, University of Miami, Miami, FL
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Zallman L, Himmelstein DH, Woolhandler S, Bor DH, Ayanian JZ, Wilper AP, McCormick D. Undiagnosed and uncontrolled hypertension and hyperlipidemia among immigrants in the US. J Immigr Minor Health 2014; 15:858-65. [PMID: 22915055 DOI: 10.1007/s10903-012-9695-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cardiovascular disease is a major cause of mortality and disability. We analyzed the National Health and Nutrition Examination Survey (1998-2008). We used logistic regression analysis to compare the odds of having undiagnosed and uncontrolled hypertension and hyperlipidemia among FB and US born adults sequentially adjusting for (1) age and gender, (2) income and education, and (3) insurance status. Among FB individuals, we identified factors independently associated with having each outcome using logistic regression analyses. Of 27,596 US adults, 22.6 % were foreign-born. In age- and -gender adjusted analyses, FB were more likely to have undiagnosed hypertension (OR 1.35, 95 % CI 1.13-1.63, p < 0.001), uncontrolled hypertension (OR 1.37, 95 % CI 1.15-1.64, p < 0.001), and uncontrolled hyperlipidemia (OR 1.35, 95 % CI 1.11-1.63, p = 0.002), while undiagnosed hyperlipidemia approached significance (OR 1.24, 95 % CI 0.99-1.56, p = 0.057). Having insurance was associated with a 5-15 % decrease in FB-US born disparities. Immigrants are at increased risk of undiagnosed and uncontrolled hypertension and hyperlipidemia.
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Affiliation(s)
- Leah Zallman
- Department of Medicine, Cambridge Health Alliance, and Harvard Medical School, Cambridge, MA 02139, USA.
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Ismail-Beigi F, Lombardero MS, Escobedo J, Genuth S, Green J, Massaro E, Mooradian AD, Ovalle F, Whitehouse F, Zonszein J. Determinants of successful glycemic control among participants in the BARI 2D trial: a post-hoc analysis. J Diabetes Complications 2014; 28:101-9. [PMID: 23478173 PMCID: PMC4156479 DOI: 10.1016/j.jdiacomp.2013.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/25/2013] [Accepted: 01/30/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. RESEARCH DESIGN AND METHODS In a 2×2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of <7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during >80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. RESULTS 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p<0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. CONCLUSION Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.
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Affiliation(s)
- Faramarz Ismail-Beigi
- Department of Medicine, Case Western Reserve University and Cleveland VA Medical Center, Cleveland, OH, USA.
| | | | - Jorge Escobedo
- Clinical Research Center. Regional Hospital No. 1. Mexican Institute of Social Security. Gabriel Mancera 222, Col. del Valle. 03100 Benito Juarez, DF. Mexico
| | - Saul Genuth
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jennifer Green
- Department of Medicine, Division of Endocrinology, Duke University Medical Center and Durham VA Medical Center, Durham, NC, USA
| | - Elaine Massaro
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando Ovalle
- Department of Medicine, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL, USA
| | - Fred Whitehouse
- Division of Endocrinology, Diabetes and Bone and Mineral Diseases, Henry Ford Health System, Detroit, MI, USA
| | - Joel Zonszein
- Albert Einstein College of Medicine, Montefiore Clinical Diabetes Center, Bronx, NY, USA
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White RO, Osborn CY, Gebretsadik T, Kripalani S, Rothman RL. Health literacy, physician trust, and diabetes-related self-care activities in Hispanics with limited resources. J Health Care Poor Underserved 2013; 24:1756-68. [PMID: 24185168 PMCID: PMC3916094 DOI: 10.1353/hpu.2013.0177] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hispanics with diabetes often have deficits in health literacy (HL). We examined the association among HL, psychosocial factors, and diabetes-related self-care activities. METHODS Cross-sectional analysis of 149 patients. Data included patient demographics and validated measures of HL, physician trust, self-efficacy, acculturation, self-care behaviors, and A1c. RESULTS Participants (N=60) with limited HL were older and less educated, and had more years with diabetes compared with adequate HL participants (N=89). Limited HL participants reported greater trust in their physician, greater self-efficacy, and better diet, foot care, and medication adherence. Health literacy status was not associated with acculturation or A1c. In adjusted analyses, HL status remained associated with physician trust, and we observed a notable but nonsignificant trend between HL status and medication adherence. DISCUSSION Lower HL was associated with greater physician trust and better medication adherence. Further research is warranted to clarify the role of HL and physician trust in optimizing self-care for Hispanics.
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Otiniano ME, Al Snih S, Goodwin JS, Ray L, Al Ghatrif M, Markides KS. Factors associated with poor glycemic control in older Mexican American diabetics aged 75 years and older. J Diabetes Complications 2012; 26:181-6. [PMID: 22520403 PMCID: PMC3521032 DOI: 10.1016/j.jdiacomp.2012.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 10/11/2011] [Accepted: 03/12/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study examines the prevalence and correlates of poor glycemic control in Mexican Americans aged 75 years and older with diabetes. METHODS Data are from the 5(th) wave (2004-05) of the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE). A total of 2,069 Mexican Americans aged 75 and over were interviewed. Six hundred eighty nine subjects (33.5%) reported having been diagnosed with diabetes and 209 (30.3%) subjects agreed to a blood test of their HbA(1)c level. RESULTS Of the 209 diabetic subjects with an HbA(1)c test, 73 (34.9%) had good glycemic control (HbA(1)c <7%) and 136 (65.1%) had poor glycemic control (HbA(1)c >7%). Bivariate analysis revealed that subjects with poor control had longer disease duration, had lower education, used the glucometer more frequently, and had more diabetes-complications when compared to those in the good glycemic control group. Multivariable logistic regression analysis found the following factors associated with poor glycemic control: <8 years of education, foreign-born, smoking, obesity, longer disease duration, daily glucometer use, and having macro-complications. DISCUSSION Prevalence of poor glycemic control is very high in this population with very high and rising prevalence of diabetes. Further studies are needed to explore the effect of these and other characteristics on glycemic control among older Mexican Americans and to develop appropriate interventions to improve diabetes outcomes and increase life-expectancy.
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Affiliation(s)
- Max E. Otiniano
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, University of Texas Medical Branch
- Sealy Center on Aging, University of Texas Medical Branch
| | | | - Laura Ray
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
| | | | - Kyriakos S. Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
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