Diabetes mellitus type 2 among Hispanic and Latino Americans

T2DM, Risk Factors
Within the United States, obesity and T2DM are considered twin epidemics and have become widespread among the aging Hispanic/Latino population. According to National Alliance for Hispanic Health (2010), Hispanics/Latinos exercise less than both non-Hispanic whites and non-Hispanic blacks. Compounded with poor eating habits and lifestyle management nearly 80% of Hispanics/Latinos are considered overweight or obese. T2DM disproportionately affects the Hispanic/Latino population more severely, as they are nearly twice as likely to be diagnosed with T2DM as non-Hispanics Whites. Other risk factors associated with T2DM other than obesity are family history, race/ethnicity, and older age. According to the CDC (2013), approximately 90-95% of peoples diagnosed with diabetes have Type 2, which is often associated with the four main risk factors. The CDC (2012) also recognizes that the Hispanic/Latino ethnic group is at high risk of developing T2DM. Researchers believe that diabetes can be inherited, meaning that it “runs in families,” predisposing certain groups to receiving genes that affect their insulin function. Thereby, contributing to a higher risk of developing T2DM. Due to diabetes being an age related disease, it is affecting 26.9% (10.9 million) of Americans 65 years and older. And, with the aging of the baby boomer generation that number will only grow in the coming years.
The prevalence of T2DM and poor glycemic control is significantly higher in Hispanics/Latinos as compared to non-Hispanic whites. In 2010, Hispanics represented 16.7% of the population, 64.6% being of Mexican origin. Considered the largest ethnic minority group within the U.S., this number will nearly triple by 2050. Currently, the epidemic of Type 2 Diabetes Mellitus (T2DM) disproportionately afflicts Hispanics/Latinos, increasing their risk of being diagnosed by 66%. In addition, a report released in 2010 found that Hispanics/Latinos were 1.6 times more likely to die of T2DM related complications as compared to non-Hispanic Whites. Compounded by an aging America, we will soon see those numbers go up as Hispanics/Latinos will encompass 20% of baby-boomers, those of Mexican descent representing the majority. Overall, studies have shown that older Hispanics/Latinos with diabetes are more likely to seek care when symptoms are severe as evidenced by a higher prevalence of poor glycemic control, higher rates of health complications and an increased incidence of morbidity and mortality. According to the National Alliance for Hispanic Health (2010), “The hospitalization rate for diabetes-related amputations among Hispanics increased from 63 admissions per 100,000 people in 2001 to nearly 80 admissions per 100,000 people in 2004” (p. 19). It was also recently reported in the National Institute for Health (2014) that 1 in 3 Hispanic/Latinos had pre-diabetes and only 50% of those with diagnosed Type 2 Diabetes Mellitus had it under control. What makes the Hispanic/Latinos population especially vulnerable is the high incident of diabetes related complications due to uncontrolled or undermanaged diabetes. The National Alliance of Hispanic Health (2010) reported that in a study they conducted with Hispanic/Latino consumers around the U.S., “Almost 93% responded...that only the onset of symptoms, and possibly severe symptoms, would lead them to seek treatment for diabetes” (p. 40).
Latinas Especially Vulnerable to T2DM
Hispanic/Latina women are especially affected by diabetes. According to the National Alliance of Hispanic Health (2010), Hispanic/Latina women are at greater risk for T2DM and gestational diabetes. According to research conducted by NIH, the National Alliance for Hispanic Health (2010) reported that women who experienced gestational diabetes during their pregnancy have a 20-50% increase of developing T2DM later in life. Overall, Hispanic/Latina women have a higher prevalence of Type 2 Diabetes Mellitus as compared to their male counterparts. However, this is not the only major concern, it is the complications of the disease that lead to other comorbidities, such as heart disease that adversely affect women much more than men. Women with diabetes are 50% more likely to die of a myocardial infarction than men. Not only do they have lower survival rates post-myocardial infarction, their quality of life is also decreased much more when compared to men. Several studies have found that diabetes posses a much greater stroke risk to women than it does for men. In fact, Almdal et al. (2004) found, a significant difference in stroke risk in women aged 55-64 years, suggesting that diabetic women in the first decade after menopause may require more aggressive preventive care.
In addition, some researcher’s believe that within the Hispanic/Latino population the cultural value of “familia” or familism is a very important social construct that effects and influences the health and well-being of this demographic. Often loosely defined in the literature as, putting one’s familial needs before one’s individual needs. It signifies and encompasses the core cultural beliefs and normative values of what is considered important in life: loyalty to one’s family. Therefore, a variety of disciplines, particularly nursing, frequently study this concept. According to the American Diabetes Association (2013), Por Tu Familia, Hispanics/Latinos tend to feel a sense of guilt and selfishness when they put their personal healthcare needs before that of their family’s. Another social construct within the Hispanic culture that has an impact on women’s health is “marianismo”. Marianismo is a strong cultural belief that influences the gender role identity of Hispanic/Latina women. Generally marianistas exhibit Virgin Mary like characteristics, such as, family-centeredness and self-sacrifice. However, this family prioritization over self-care and health management can sometimes lead to neglect of their healthcare needs. According to D’Alonzo (2012), “Hispanic women with strong marianismo beliefs (marianistas) may be more likely to neglect their own health needs, particularly with regard to health promotion behaviors such as physical activity” (pp. 124). According to a recent report from NIH (2014), they found that Hispanic/Latina women consumed less fruits and vegetables than men. In addition, Márquez and McAuley (2006) found that Hispanic women/Latinas spent less time exercising or engaged in some form of physical activity as compared to Hispanic/Latino men. In comparison with other American women, Hispanic/Latina-American women are less likely to engage in physical activity, particularly formal exercise & planned vigorous physical activity. Two separate studies found that some Hispanic/Latina women, particularly those with low acculturation levels, feel that most types of physical activity and sports are unfeminine. According to the National Alliance of Hispanic Health (2010), “Only 1% of respondents recognized a sedentary lifestyle as a risk for diabetes” (p. 40). Due to diabetes being a self-managed disease. Individuals must be properly educated and monitored by their healthcare provider to achieve proper disease management and attain positive health outcomes and health promotion. The National Alliance of Hispanic Health (2010) states that Hispanic/Latinos, “need more help to easily identify their diabetes risk status, as well as access screening and early healthy lifestyle intervention services, if at risk for diabetes” (p. 3).
Programs and Initiatives
Examining the morbidity and mortality of T2DM within the Hispanic/Latino population, it is absolutely astounding considering that it is a preventable disease. The American Diabetes Association (ADA) recognizes Hispanic/Latinos as a vulnerable population and have three programs that address their healthcare needs: Por Tu Familia, Feria de Salud, and Conferencia. Port Tu Familia is a Latino Initiatives health campaign. According to the ADA (2013), “Feria de Salud is an outdoor community event reaching thousands of local Latinos/Hispanics”. In addition, the ADA has educational conferences or “Conferencias” in association with the Por Tu Familia Program to help educate and bring health opportunities to the community. In addition, in 2002 the Joslin Diabetes Center launched their Latino Diabetes Initiative, which focuses on providing culturally competent education, community outreach, patient care, and research. Unfortunately, after thoroughly researching no programs or policies that address the needs of the aging Hispanic/Latina woman with Type II Diabetes Mellitus were found. In fact, no websites, programs, initiatives, and/or policies were found that strictly serve the Hispanic/Latina woman and her T2DM healthcare needs/concerns.

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