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Hispanics with diabetes are a heterogenous group, should be treated individually
LAS VEGAS — An expert here cautioned practitioners against the tendency to generalize care recommendations based on ethnicity: care of one Hispanic patient with diabetes should not equate care for all Hispanic patients.
“It has been assumed for a long time that Hispanics are homogenous, one unique group, that we all behave the same, we eat the same, we dance the same, we speak the same language, we were born in the same country. And that is not the case. Although we have similarities – cultural, historical, religious similarities – we also have differences. Assuming homogeneity is not the way to address clinical care with Hispanics. It’s better to ask questions, to get to know the patient, where the patient is coming from and then go from there,” Larissa Aviles-Santa, MPH, FACP, FACE, medical officer with the NHLBI’s Division of Cardiovascular Sciences, said during a press briefing at the AACE 23rd Annual Scientific & Clinical Congress.
Larissa Aviles-Santa
Aviles-Santa presented the Hispanic Community Health Study/Study of Latinos, an observational study of 16,415 self-identified Hispanics aged 18 to 74 years evaluated over a 3-year period to determine the risk factors that contributed to the development of diabetes and cardiovascular disease. The self-identification categories were as follows: 39% Mexican, 17% Puerto Rican, 14% Cuban, 9% Dominican, 11% Central American, and 7% South American.
In this group, Aviles-Santa and colleagues found that metabolic syndrome is higher in the Hispanic population than in the non-Hispanic white population (36% in Hispanic women and 34% in Hispanic men vs. 22.5% in non-white Hispanics from NHANES). Abdominal obesity, HDL-C, triglycerides, blood pressure and fasting glucose were all present in both Hispanic men and women.
“Overall, as a group, we have a higher prevalence of diabetes than previously reported,” Aviles-Santa said, but she showed diabetes was least prevalent among those from Cuba and South America as compared with those of Dominican, Mexican and Puerto-Rican descent, but that prediabetes was similar among all backgrounds. Interestingly, Hispanics living in the United States for more than 16 years had a rate of diabetes of 18.75% while those who lived in the United States for less than 5 years had a rate of 12.29%.
“The national data are very useful and give us an overview of the nation, but when we look individually, we see differences that may be a reflection of where we live, the environment in which we live, health policy (Do we have good access to medical care? Do we have good awareness of prevention of diabetes?), genetics, nutrition. All of that leads to the development of diabetes and all of that is very different in different parts of the country.”
Similarly, hypertension showed differences among the Hispanic backgrounds; it was more prevalent in those of Caribbean ancestry while those of Mexican ancestry had lower prevalence.
“It’s telling you that we probably don’t share the same risk factors or we should be looking at other mechanisms of disease or other factors that we have not identified,” Aviles-Santa said.
In addition, Aviles-Santa showed that there is a gap in awareness, treatment and control of diabetes when comparing Hispanic patients with non-Hispanic whites. She suggested these differences could be due to geographic differences in the four field sites of the study as well as access to care or sociocultural factors such as language barriers, faith, beliefs about medications, beliefs about disease, trust in the physician and more.
“All of that taken into consideration are important because all of these may be playing a big role in the differences that we are observing among Hispanic groups,” Aviles-Santa said. “It takes time. It’s a challenge because many of our patients have lived through a lot of adversity, and changing the paradigm about self-management and engagement is a challenge.”
The study will conduct another evaluation of these patients this October and continue through 2019, according to Aviles-Santa.
For more information: Aviles-Santa L. T33. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosures: Aviles-Santa reports no relevant financial relationships.