Tag: type 2 diabetes

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.


The Impact of Major Depressive Disorder on Cardiometabolic Disease Risk

Driven by a widespread change in lifestyle factors, such as dietary patterns and physical activity levels, as well as heightened stress levels, the global prevalence of cardiometabolic disease continues to rise. A burgeoning body of evidence suggests the potential impact of mental health factors, specifically the presence of major depressive disorder (MDD) on the development of cardiometabolic conditions. Affecting an estimated 322 million people, MDD has a high comorbidity rate with other medical disorders and in particular, type 2 diabetes. Although the mechanisms underlying the potential causal associations between the two are unknown, both cardiometabolic disease and major depressive disorder place a significant burden on population health.

Past observational studies have reported an association between MDD and an increased risk for type 2 diabetes, caused by biological alterations – such as elevated counter-regulatory hormone release and activity – as well as poor lifestyle factors, including smoking and alcohol consumption. Research has shown that brain regions involved in mood regulation also control metabolism, hypothalamic-pituitary-adrenal (HPA) axis, inflammatory responses, and autonomic nervous system (ANS) thus, controlling heart rate and blood pressure. These factors may influence the relationship between MDD and certain cardiometabolic conditions, however, evidence remains limited.

Adding to the growing body of evidence, a recent bidirectional Mendelian randomization study published in Diabetologia aimed to assess the causal relationships between major depressive disorder, type 2 diabetes, coronary artery disease, and heart failure to further elucidate the connections.

MDD and Cardiometabolic Disease

A team of researchers utilized the Mendelian randomization method – used for assessing causal inference of exposures on outcomes based on genetic variants as instrumental variables for exposures – to diminish chances of residual confounding and eliminate reverse causality due to the fixed nature of genetic variants regardless of disease progression or development.

In conducting their investigation, researchers extracted summary-level data for MDD, T2D, CAD, and heart failure from corresponding large genome-wide association studies; they used 96 single-nucleotide polymorphisms (SNPs) for MDD, 202 SNPs for type 2 diabetes, 44 SNPs for CAD, and 12 SNPs for heart failure. To perform their main analyses, the random-effects inverse-variance weighted method used.

Impact of MDD on Cardiometabolic Risk

Overall, the study’s authors found that the genetic liability to MDD was significantly associated with type 2 diabetes and coronary artery disease; they also found a suggestive association between MDD and heart failure. In examining the causal relationship, the research team found limited evidence in support of the causal effects of cardiometabolic disease on MDD risk, indicating that the presence of these conditions may not increase the likelihood of major depressive disorder.

However, meta-analyses did prove that the presence of MDD had an impact on type 2 diabetes development with the potential to increase risk by up to 60%. Additionally, the team found evidence of MDD having a causal association with the risk of CAD and HF. As diabetes and CAD have been known risk factors for HF and CAD may explain over 60% of heart failure cases, the relationship between major depressive disorder and heart failure may possibly be mediated via type 2 diabetes and coronary artery disease.

The latest findings further validate previous evidence that MDD is a potential risk factor for both type 2 diabetes and CAD, however, additional research needs to be conducted to determine whether MDD is causally related to heart failure. Future studies are likely to continue investigating the correlation to determine the significance of the impact of MDD on cardiometabolic health as well as to assess potential therapeutic interventions.

Due to the high disease burden related to causal association, the study’s authors recommend “that MDD prevention, management, and treatment should be enhanced for type 2 diabetes prevention.” Implications for the clinical practice may include more targeted strategies for the prevention and treatment of cardiometabolic diseases in the future with an increased focus on the mental health of patients.