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Cardio Metabolic Health Congress – Official Blog

Hispanic Heritage Month: Managing Type 2 Diabetes in Hispanic/Latino Patients

September 15th marks the beginning of Hispanic Heritage Month  – a national observance celebrating the vast historic and cultural contributions of Hispanic/Latino Americans. During this time, healthcare organizations spotlight some of the medical conditions affecting this community and emphasize the urgency of problems resulting from pervasive racial health disparities.

As part of a new campaign, the American Heart Association and American Diabetes Association introduced a Spanish-language effort to address the disproportionate rates of cardiometabolic conditions affecting this group and raise awareness among Hispanic/Latino individuals. By underscoring the link between type 2 diabetes (T2D) and detrimental cardiovascular complications, the organizations aim to inspire action among these at-risk patients to improve prevention and management.

Type 2 Diabetes in Hispanic/Latino Populations

Hispanic and Latino Americans – which include those of Cuban, Mexican, Puerto Rican, South and Central American, and other Spanish descent – experience a heightened risk for developing prediabetes and type 2 diabetes. The average risk for type 2 diabetes in patients of Hispanic heritage is 17% compared with 8% for non-Hispanic white patients. This risk is also closely tied to patient background; for example, Mexican and Puerto Rican patients are twice as likely to develop type 2 diabetes as South American individuals, per data from the CDC.

Overall, Hispanic/Latino American adults have a 50% chance of developing the type 2 diabetes, are more likely to develop it at a younger age and more likely to experience worse outcomes. At the same time, this population is 3 times more likely to be uninsured than non-Hispanic whites, a factor that consistently impedes access to necessary healthcare and contributes to racial health disparities.

Causes of the Disparities

Underlying the disproportions in type 2 diabetes prevalence are several, multifactorial and multilevel factors including environmental differences, which range from a limited access to healthy food to differential access and quality of medical care. A lack of awareness alongside health insurance disparities contribute to decreased rates of patients seeking medical care. Further complicating the issue are low socioeconomic status, poor health literacy, language barriers, and prominent cultural values and belief systems that influence diabetes perception, management, and outcomes in Hispanic/Latino patients.

Cultural and Genetic Risk Factors

Several important risk factors which can significantly impact the level of risk for type 2 diabetes and its complications in this group of patients need to be considered in the clinical setting. Both genetic and cultural variables found in patients of Hispanic origin exacerbate the likelihood of adverse health outcomes. In particular, cultural behaviors – such as a prevalence of high fat foods and food-centered celebrations – can have a profound impact of health status as this demographic. In addition, this demographic has higher rates of obesity, tending to be less physically active than non-Hispanic whites.

Management of T2D in Hispanic/Latino Patients

Managing type 2 diabetes in this group of patients requires careful consideration of the multilevel factors influencing the condition and requires the clinician’s cultural awareness. This does not have to mean speaking the same language as the patient, although interacting in the same language is helpful and strengthens the patient-provider relationship. Cultural awareness implies a deeper understanding of the patient’s health beliefs, attitudes, and habits that ultimately affect their willingness to undergo and adhere to treatment.

Diabetes management is challenging in all patients; however, Hispanic/Latino patients face additional barriers to successful treatment. Communication is essential to ensuring patient adherence to therapeutic strategies; in such cases it is important to consider language barriers when matching patients and providers. Patients who can communicate their concerns directly and be understood tend to exhibit greater adherence, improved diabetes self-care behaviors, and better clinical outcomes.

Targeting cultural factors, such as traditions and beliefs, is also important as Hispanic cultures tend to consume high-fat diets and some view being overweight as a sign of health. Improved educational efforts are needed to raise awareness of the detrimental effects of obesity, need for effective weight management, and the multifaceted benefits of a healthy diet and regular physical exercise among this population.

Improving outcomes requires tailoring diabetes education and treatment strategies to specific populations. Educational efforts aimed at Hispanic/Latino patients must consider racial, ethnic, social, cognitive, and cultural factors to improve health literacy and with it, health outcomes for this group.

Clinical Challenges

Clinicians face the challenging task of diminishing prevailing racial disparities in type 2 diabetes care among a culturally diverse patient population. While there may be many ways to address differences in health outcomes, community-driven strategies that engage community members and address socioeconomic and cultural factors have proven most successful at improving health outcomes. To optimize their efficacy, these programs needs to be based in cultural practices that influence the development and progression of type 2 diabetes in this population.

Targeted, community-driven interventions specific to Hispanic populations should place an emphasis on prevention tactics and highlight medication adherence, lifestyle changes, and educational programs to improve the standard of diabetes self-care. Research has found that live and technology-based interventions largely improve behavioral and clinical outcomes in T2D patients of Hispanic descent. Innovative, culturally aware interventions have the potential to improve quality of life and offer promising results while highlighting areas for future research.

In light of the COVID-19 public health crisis, improved type 2 diabetes management techniques are particularly important. The virus poses a significant threat to Hispanic and Latino patients with type 2 diabetes while also highlighting the overall need for an increased emphasis on cardiometabolic health in this subgroup to reduce type 2 diabetes incidence, morbidity, and mortality.

 

Disparities in Obesity Management in Primary Care

Currently, around 90 million U.S. adults are classified as obese with a disproportionate amount of socioeconomically disadvantaged individuals affected. As recently proven, obesity can worsen COVID-19 outcomes alongside increasing the risk of cardiometabolic conditions, cardiovascular disease, type 2 diabetes, and other health conditions. Despite the significant disease burden placed on population health and the public health system, the management of obesity in primary care settings continues to lag behind that of other chronic conditions. Only recently has obesity become formally recognized as a disease, highlighting the need for improved prevention and treatment protocols across demographics and increased accessibility.

Obesity Management in Primary Care Clinics

Recently published in the New England Journal of Medicine, results of the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) trial advance the current knowledge regarding obesity management in primary care settings. The findings elucidate both the scope and intensity of interventions with a focus on underserved demographics.

The cluster-randomized trial examined data from 803 adults (67% black, 84% women) recruited from 18 primary care clinics across Louisiana. Participants were assigned to two groups, usual care and intensive-lifestyle intervention. Patients in the usual care cohort received routine medical care and health education materials throughout the course of the 24-month trial. Meanwhile, participants designated part of the intensive-lifestyle group received weekly counseling, personalized care, and tailored recommendations. This cohort received weekly counseling with 16 sessions conducted in person and 6 over telephone during the first 6 months of the trial. Afterward, they had monthly sessions through month 24.

Health coaches were trained by the research team and embedded in the primary care setting to deliver care and give patients personalized food-intake and calorie-intake targets. Patients were to weigh themselves daily using digitally connected scales and their nutritional and physical patterns were adjusted to help them meet their weight goals.

Intensive Lifestyle Interventions Show Real Results 

The study’s author noted a significant improvement in meeting weight loss targets when combined with strategic expert care. At the 12-month benchmark point, participants in the intensive-lifestyle group lost a mean of 6.75% of their baseline weight while those in the usual-care group only lost an average of 0.59%. In addition, participants within the intensive-lifestyle cohort reported significant improvements in multiple components of quality of life, including physical function and work.

Overall, the researchers’ findings revealed black patients lost approximately 2% less weight than patients of other races and ethnic groups at the 12-month mark. For the time being, the reasons for this disparity are unknown but experts believe they may include a lower resting energy expenditure in black women compared with that of their non-Hispanic white counterparts.

Out of the 803 total participants, 50.7% reduced their baseline weight by at least 5% – the best categorical weight losses observed in primary care studies, especially those involving socioeconomically disadvantaged patients. “Although patients in the intensive-lifestyle group in the PROPEL trial, on average, regained weight from month 12 to month 24, most likely because of the reduced frequency of counseling visits, they nevertheless maintained a mean 5% reduction at month 24,” the study’s authors noted.

The findings from the latest PROPEL trial reveal that it is possible for socioeconomically disadvantaged persons to lose clinically substantial amounts of weight when provided the intensive behavioral therapy and professional support necessary in primary care settings. The issue of how to ensure that all Americans, including those in underserved areas, receive the same reimbursed care for weight management that they have for other chronic conditions that stem from obesity – the root of the problem. The current lack of such targeted, accessible care contributes to the growing burden of widening health disparities in the nation which are only becoming more apparent in the face of a public health crisis.