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The interaction between genetics, sociodemographic
factors and culture play a decisive
role in the presentation of specific risk
factors. These risk factors, such as poverty,
obesity, metabolic syndrome and cardiovascular
disease, lead the patient to poor selfmanagement,
emotional barriers, lack of
motivation and ultimately to serious and
negative outcomes—poorly
controlled diabetes and the
presence of macro-vascular
complications.
The levels of obesity and overweight in the U.S.
between 1994 and 2004 showed a negative trend
in the age-adjusted rate of diabetes and obesity.
 The integrated impact of the combination of diet,
physical activity and genetics over body weight
during the life time is known as energy balance.
This energy balance has been seriously affected in
regards to body weight in Latinos. According to a study of the prevalence of obesity in the U.S.
between 1999 and 2002, more than 72% of all
Latino Mexican-Americans were either overweight
or obese, and 30% were obese. The highest rate of
overweight was among Mexican-American women
40-60 years of age.
Very often reports show that Latinos consume
fewer fruits and vegetables in comparison with
other groups, and eat more fat, sugar and fast
food. This is important because one of the serious
factors that determines the prevalence of diabetes is the link between obesity and hyperglycemia.
Proper diet is a crucial aspect of managing diabetes, and the importance of patient education cannot be
overemphasized. There is often the perception among Hispanic patients that they will have to give
up their traditional diet. That is not true. The National Diabetes Education Program (NDEP) recently
updated their nutritional campaign, Más que comida, es vida (It’s more than food. It’s Life.). Created to
clear up misunderstandings about how to follow a healthy diet, it provides information to help
Hispanics incorporate their traditional dishes into an appropriate food program. It includes a recipe booklet, Ricas recetas para personas con diabetes y sus familiares (Tasty Recipes for People with Diabetes
and Their Families) that is available in both the Spanish and English languages. All materials are available
free on their website and a link is provided in the Resources section of this monograph. All recipes
are geared toward the Latino palate.
The NDEP also offers a variety of patient education materials for teens and children, all of which are
available in both English and Spanish. A link to the website for information about these materials is also
provided in the Resources section.
An increase in obesity has also contributed to the growing prevalence of type 2 diabetes in Hispanic children
and adolescents. Latino children have a 2-3 times higher rate of obesity compared to other groups.
They also have a 2-3 times higher rate of Metabolic Syndrome in comparison to other children.
Metabolic Syndrome has been defined as a “cluster of the most dangerous heart attack risk factors.”
These factors include:
- diabetes and prediabetes
- abdominal obesity
- high cholesterol
- high blood pressure
According to the International Diabetes Federation (IDF), people with Metabolic Syndrome are:
- Twice as likely to die from, and three times as likely to have a heart attack
or stroke compared with people without the syndrome
- Have a five-fold greater risk of developing type 2 diabetes
Latinos consistently report adverse socio-economic conditions that affect their diabetes care. Studies
have consistently shown that Latinos are more likely to be living in poverty compared to non-Hispanic
White people.
 The Urban Institute and Kaiser Commission on
Medicaid and the Uninsured reviewed the
Current Population Survey (CPS) for March 2007
through 2008 . The following chart shows their
estimates of poverty rates by race/ethnicity.
Poverty creates a very serious barrier to the management
of diabetes because it makes it very difficult
for people to afford health insurance.
Almost 30% of Latinos 18 years and older don’t have regular health insurance. Nearly 22% of Latino
women, who are at greatest risk of developing type 2 diabetes, are unable to meet their medical needs
because of the cost of treatment.
A study published in PubMed in October 2008 examined health insurance data from 1983-2003 which
showed that health insurance rates for Hispanics actually declined, while the rates for non-Hispanics
remained fairly steady. They reported the following key findings:
- The largest increase of uninsured people was found among Hispanic noncitizens,
but U.S.-born Hispanics also had significant increases in rates of uninsurance.
This change was driven largely by changes in private insurance. Public insurance
rates did not change significantly.
- The widening disparity in health insurance rates between non-Hispanics and
Hispanics was a more important contributor to the increasing rates of uninsurance
among Hispanics than the increase in the Hispanic adult population.
The following chart from the US Census Bureau confirms those findings. It shows health insurance coverage of people by race and Hispanic origin using 2-and 3-year averages for the period 2002-2004.
Health Insurance Coverage of People by Race and Hispanic Origin Using 2- and
3-year Averages: 2002 to 2004
(Numbers in thousands, confidence intervals (C.I.) in thousands or percentage points as appropriate. People as of March of the following year)
*Statistically different from zero at the 90-percent confidence level.
1 Federal surveys now give respondents the option of reporting more than one race. Therefore, two basic ways of defining a race group are possible.
A group such as Asian may be defined as those who reported Asian and no other race (the race-alone or single-race concept) or as those who
reported Asian regardless of whether they also reported another race (the race-alone-or-in-combination concept). This table shows data using the first
approach (race alone). The use of the single-race population does not imply that it is the preferred method of presenting or analyzing data. The
Census Bureau uses a variety of approaches. Information on people who reported more than one race, such as White and American Indian and
Alaska Native or Asian and Black or African American, is available from Census 2000 through American FactFinder. About 2.6 percent of people
reported more than one race in Census 2000.
2 Details may not sum to totals because of rounding.
3 A 90-percent confidence interval is a measure of an estimate’s variability. The larger the confidence interval in relation to the size of the estimate,
the less reliable the estimate. For more information, see ‘‘Standard Errors and Their Use’’ at <www.census.gov/hhes/www/p60_229sa.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2003 to 2005 Annual Social and Economic Supplements.
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