Skip to main content

Advertisement

SpringerLink
Log in

Diabetes in the hispanic or latino population: Genes, environment, culture, and more

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

The Hispanic or Latino population is the largest minority group in the United States, currently representing 13.7% of the total U.S. population. Hispanics or Latinos usually suffer from higher rates of type 2 diabetes, obesity, metabolic syndrome, and their multiple vascular complications. Inadequate nutrition and reduced physical activity in the setting of an increased genetic predisposition to type 2 diabetes have contributed to the inexorable rise in metabolic abnormalities in Hispanics in the United States, which now affect many children and adolescents. It is evident that multiple medical, cultural, and socioeconomic factors influence the development of diabetes, its course, and its consequences. Our health care system is barely prepared to face the challenge of managing diabetes in this high-risk group. Culturally oriented clinical care, education, outreach and research programs are needed to better identify the challenges to create opportunities to improve the lives of Hispanics or Latinos with diabetes or at risk for the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Hispanic and Asian Americans Increasing Faster Than Overall Population [press release]. US Census Bureau. Available at http://www.census.gov/Press-Release/www/releases/archives/race/001839.html. Accessed June 14, 2004.

  2. Ramirez RR, De la Cruz PG: The Hispanic Population in the United States: March 2002. Current Population Reports, P20-545. Washington, DC: U.S. Census Bureau; Available at http:// www.census.gov/prod/2003pubs/p20-545.pdf.2002.

    Google Scholar 

  3. Harris MI, Flegal KM, Cowie CC, et al.: Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the Third National Health and Nutrition Examination Survey (NHANES), 1988–1994. Diabetes Care 1998, 21:518–524.

    Article  PubMed  CAS  Google Scholar 

  4. Centers for Disease Control and Prevention: Prevalence of diabetes among Hispanics-selected areas, 1998–2002. MMWR Morb Mortal Wkly Rep 2004, 53:941–944.

    Google Scholar 

  5. Narayan KMV, Boyle JP, Thompson TJ, et al.: Lifetime risk for diabetes mellitus in the United States. JAMA 2003, 290:1884–1890.

    Article  PubMed  CAS  Google Scholar 

  6. Goran MI, Ball GD, Cruz ML: Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab 2003, 88:1417–1427. An updated review of the impact of obesity in the pediatric population and how it relates to the increasing number of children with type 2 diabetes.

    Article  PubMed  CAS  Google Scholar 

  7. Flegal KM, Ezzati TM, Harris MI, et al.: Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Examination Survey (HHANES), 1982–1984. Diabetes Care 1991, 14(suppl 3):628–638.

    Article  PubMed  CAS  Google Scholar 

  8. Swenson CJ, Trepka MJ, Rewers MJ, et al.: Cardiovascular disease mortality in Hispanics and non-Hispanic Whites. Am J Epidemiol 2002, 156:919–928.

    Article  PubMed  Google Scholar 

  9. Hanis CL, Chu HH, Lawson K, et al.: Mortality of Mexican Americans with NIDDM. Retinopathy and other predictors in Starr County, Texas. Diabetes Care 1993, 16:82–89.

    Article  PubMed  CAS  Google Scholar 

  10. Gilliland FD, Owen C, Gilliland SS, et al.: Temporal trends in diabetes mortality among American Indians and Hispanics in New Mexico: birth cohort and period effects. Am J Epidemiol 1997, 145:422–431.

    PubMed  CAS  Google Scholar 

  11. Hunt KJ, Williams K, Resendez RG, et al.: All-cause and cardiovascular mortality among diabetic participants in the San Antonio Heart Study: evidence against the "Hispanic Paradox." Diabetes Care 2002, 25:1557–1563.

    Article  PubMed  Google Scholar 

  12. Neel JV: Diabetes mellitus: a thrifty genotype rendered detrimental by progress? Am J Hum Genet 1962, 14:353–362.

    PubMed  CAS  Google Scholar 

  13. Lorenzo C, Serrano-Rios M, Martinez-Larrad MT, et al.: Was the historic contribution of Spain to the Mexican gene pool partially responsible for the higher prevalence of type 2 diabetes in Mexican-origin populations? The Spanish Insulin Resistance Study Group, the San Antonio Heart Study, and the Mexico City Diabetes Study. Diabetes Care 2001, 24:2059–2064.

    Article  PubMed  CAS  Google Scholar 

  14. Langefeld CD, Wagenknecht LE, Rotter JI, et al.: Linkage of the metabolic syndrome to 1q23-q31 in Hispanic families. The Insulin Resistance Atherosclerosis Study Family Study. Diabetes 2004, 53:1170–1174.

    Article  PubMed  CAS  Google Scholar 

  15. Ferranini E, Gastaldelli A, Matsuda M, et al.: Influence of ethnicity and familial diabetes on glucose tolerance and insulin action: a physiological analysis. J Clin Endocrinol Metab 2003, 88:3251–3257. An updated review of the pathophysiology of type 2 diabetes, particularly in regard to the connection between ethnicity and insulin resistance.

    Article  CAS  Google Scholar 

  16. Haffner SM, D'Agostino R, Saad MF, et al.: Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with Non-Hispanic Whites. The Insulin Resistance Atherosclerosis Study. Diabetes 1996, 45:742–748.

    Article  PubMed  CAS  Google Scholar 

  17. Goran MI, Bergman RN, Cruz ML, Watanabe RM: Insulin resistance and associated compensatory responses in African-American and Hispanic children. Diabetes Care 2002, 25:2184–2190.

    Article  PubMed  CAS  Google Scholar 

  18. Chiu KC, Cohan P, Lee NP, Chuang LM: Insulin sensitivity differs among ethnic groups with a compensatory response in beta cell function. Diabetes Care 2000, 23:1353–1359.

    Article  PubMed  CAS  Google Scholar 

  19. Haffner SM, Mietinen H, Gaskill SP, et al.: Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of non-insulin dependent diabetes mellitus in Mexican Americans. Diabetes 1995, 44:1386–1391.

    Article  PubMed  CAS  Google Scholar 

  20. Cossrow N, Falkner B: Race/ethnic issues in obesity and obesity-related comorbidities. J Clin Endocrinol Metab 2004, 89:2590–2594.

    Article  PubMed  CAS  Google Scholar 

  21. Flegal KM, Carroll MD, Kuczmarski RJ, et al.: Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord 1998, 22:39–47.

    Article  PubMed  CAS  Google Scholar 

  22. Ogden CL, Flegal KM, Carroll MD, et al.: Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 2002, 288:1728–1732.

    Article  PubMed  Google Scholar 

  23. Caballero AE: Obesity, insulin resistance and endothelial dysfunction. The road to type 2 diabetes and cardiovascular disease. Obes Res 2003, 11:1278–1289.

    Article  PubMed  CAS  Google Scholar 

  24. Goel MS, McCarthy EP, Phillips RS, Wee CC: Obesity among US immigrant subgroups by duration of residence. JAMA 2004, 292:2860–2867.

    Article  PubMed  CAS  Google Scholar 

  25. Burke JP, Williams K, Haffner SM, et al.: Elevated incidence of type 2 diabetes in San Antonio, Texas, compared with that of Mexico City, Mexico. Diabetes Care 2001, 24:1573–1578.

    Article  PubMed  CAS  Google Scholar 

  26. US Interagency Committee on Nutrition Monitoring. U.S. Public Health Service and U.S. Department of Agriculture: Nutrition Monitoring in the United States: the Directory of Federal Nutrition Monitoring Activities. DHHS Publication no. (PHS) 89-1255. Hyattsville, MD: Department of Health and Human Service; 1989.

  27. Hollingsworth DR, Vaucher Y, Yamamoto TR: Diabetes in pregnancy in Mexican Americans. Diabetes Care 1991, 14:695–705.

    Article  PubMed  CAS  Google Scholar 

  28. Peters RK, Kjos SL, Xiang A, et al.: Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes. Lancet 1996, 347:227–230.

    Article  PubMed  CAS  Google Scholar 

  29. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.

    Article  PubMed  Google Scholar 

  30. Park YW, Zhu S, Palaniappan L, et al.: The metabolic syndrome: prevalence and associated risk factors findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 2003, 163:427–436.

    Article  PubMed  Google Scholar 

  31. Aguilar-Salinas CA, Olaiz G, Valles V, et al.: High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nationwide survey. J Lipid Res 2001, 42:1298–1307.

    PubMed  CAS  Google Scholar 

  32. Caballero AE: Diabetes in minority populations. In Joslin's Diabetes Mellitus, edn 14. Edited by Kahn RC, et al. Philadelphia: Lippincott Williams & Wilkins; 2005:505–524.

    Google Scholar 

  33. Harris MI, Eastman RC, Cowie CC, et al.: Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care 1999, 22:403–408.

    Article  PubMed  CAS  Google Scholar 

  34. Pugh JA, Tuley MR, Hazuda HP, et al.: The influence of outpatient insurance coverage on the microvascular complications of non-insulin-dependent diabetes in Mexican Americans. J Diabetes Complications 1992, 6:236–241.

    Article  PubMed  CAS  Google Scholar 

  35. Haffner SM, Fong D, Stern MP, et al.: Diabetic retinopathy in Mexican Americans and non-Hispanic Whites. Diabetes 1988, 37:878–884.

    Article  PubMed  CAS  Google Scholar 

  36. Harris MI, Klein R, Cowie CC, et al.: Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 1998, 21:1230–1235.

    Article  PubMed  CAS  Google Scholar 

  37. Hamman RF, Franklin GA, Mayer E, et al.: Microvascular complications of NIDDM in Hispanics and non-Hispanics Whites. San Luis Valley Diabetes Study. Diabetes Care 1991, 14:655–664.

    Article  PubMed  CAS  Google Scholar 

  38. Haffner SM, Mitchell BD, Pugh JA, et al.: Proteinuria in Mexican Americans and non Hispanic whites with NIDDM. Diabetes Care 1989, 12:530–536.

    Article  PubMed  CAS  Google Scholar 

  39. Harris MI: Racial and ethnic differences in health care access and health outcomes for adults with type 2 diabetes. Diabetes Care 2001, 24:454–459.

    Article  PubMed  CAS  Google Scholar 

  40. Pugh JA, Tuley MR, Basu S: Survival among Mexican-Americans, non-Hispanic Whites and African-Americans with endstage renal disease: the emergence of a minority pattern of increased incidence and prolonged survival. Am J Kidney Dis 1994, 23:803–807.

    PubMed  CAS  Google Scholar 

  41. Murthy BV, Molony DA, Stack AG: Survival advantage of Hispanic patients initiating dialysis in the Unites States is modified by race. J Am Soc Nephrol 2005, 16:782–790.

    Article  PubMed  Google Scholar 

  42. Sands ML, Shetterly SM, Franklin GM, Hamman RF: Incidence of distal symmetric (sensory) neuropathy in NIDDM. The San Luis Valley Diabetes Study. Diabetes Care 1997, 20:322–329.

    Article  PubMed  CAS  Google Scholar 

  43. Harris MI, Cowie CC, Eastman RC: Symptoms of sensory neuropathy in adults with diabetes in the U.S. population. Diabetes Care 1993, 16:1446–1452.

    Article  PubMed  CAS  Google Scholar 

  44. Lavery LA, van Houtum WH, Ashry HR, et al.: Diabetes-related lower-extremity amputations disproportionately affect Blacks and Mexican Americans. South Med J 1999, 92:593–599.

    PubMed  CAS  Google Scholar 

  45. Haffner SM, Mitchell BD, Stern MP, et al.: Macrovascular complications in Mexican Americans with type II diabetes. Diabetes Care 1991, 14:665–671.

    Article  PubMed  CAS  Google Scholar 

  46. Caballero AE, Habershaw GM, Pinzur MS: Preventing amputations in patients with diabetes. Caring for diverse populations. Patient Care 2000, 05:113–133.

    Google Scholar 

  47. Ford ES, Giles WH, Croft JB: Prevalence of nonfatal coronary heart disease among American adults. Am Heart J 2000, 139:371–377.

    Article  PubMed  CAS  Google Scholar 

  48. Stern M, Bradshaw B, Eifler C, et al.: Secular decline in death rates due to ischemic heart disease in Mexican Americans and non-Hispanic Whites in Texas, 1970–1980. Circulation 1987, 76:1245–1250.

    PubMed  CAS  Google Scholar 

  49. Lerman-Garber I, Villa AR, Caballero AE: Diabetes and Cardiovascular Disease. Is there a true Hispanic Paradox? Rev Invest Clinic 2004, 56:282–296. Available at http:// www.imbiomed.com.mx.

    Google Scholar 

  50. D'Agostino RB, Burke G, O'Leary D, et al.: Ethnic differences in carotid wall thickness. The Insulin Resistance and Atherosclerosis Study. Stroke 1996, 27:1744–1749.

    PubMed  Google Scholar 

  51. Sacco RL, RobertsKBoden, et al.: Race-ethnicity and determinants of carotid atherosclerosis in a multiethnic population. Stroke 1997, 28:929–935.

    PubMed  CAS  Google Scholar 

  52. Flores G: Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr 2000, 136:14–23.

    Article  PubMed  CAS  Google Scholar 

  53. Kimanyika S: Special issues regarding obesity in minority populations. Ann Intern Med 1993, 119:650–654.

    Google Scholar 

  54. Ho RC, Davy KP, Hickey MS, et al.: Behavioral, metabolic and molecular correlates of lower insulin sensitivity in Mexican-Americans. Am J Physiol Endocrinol Metab 2002, 283:E799-E808.

    PubMed  CAS  Google Scholar 

  55. Haffner SM, Knapp JA, Hazuda HP, et al.: Dietary intakes of macronutrients among Mexican Americans and Anglo Americans. The San Antonio Heart Study. Am J Clin Nutr 1985, 42:1266–1275.

    PubMed  CAS  Google Scholar 

  56. Frati AC, Gordillo BE, Altamriano P, et al.: Acute hypoglycemic effect of Opuntia streptacantha Lemaire in NIDDM [letter]. Diabetes Care 1990, 13:455–456.

    PubMed  CAS  Google Scholar 

  57. Crespo CJ, Keteyian SJ, Heath GW, et al.: Leisure-time physical activity among U.S. adults. Arch Intern Med 1996, 156:93–98.

    Article  PubMed  CAS  Google Scholar 

  58. Monterrosa AE, Haffner SM, Stern MP, et al.: Sex difference in lifestyle factors predictive of diabetes in Mexican Americans. Diabetes Care 1995, 18:448–456.

    Article  PubMed  CAS  Google Scholar 

  59. Stern MP, Knapp JA, Hazuda HP, et al.: Genetic and environmental determinants of type II diabetes in Mexican Americans. Is there a descending limb to the modernization/ diabetes relationship? Diabetes Care 1991, 14:649–654.

    Article  PubMed  CAS  Google Scholar 

  60. Hazuda HP, Haffner SM, Stern MP, et al.: Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol 1988, 128:1289–1301.

    PubMed  CAS  Google Scholar 

  61. Hazuda HP, Monterrosa A: Social class predicts 8-year incidence of diabetes in Mexican Americans and non-Hispanic whites. Diabetes 1992, 41:179A.

    Google Scholar 

  62. Black SA, Markides KS, Ray LA: Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003, 26:2822–2828.

    Article  PubMed  Google Scholar 

  63. Lerman I, Lozano L, Villa AR, et al.: Psychosocial factors associated with poor diabetes self-care management in a specialized Center in Mexico City. Biomed Pharmacother 2004, 58:566–570.

    Article  PubMed  Google Scholar 

  64. Solis JM, Marks G, Garcia M, Shelton D: Acculturation, access to care and use of preventive services by Hispanics: findings from HHANES 1982–1984. Am J Public Health 1990, 80(suppl):11–19.

    Article  PubMed  Google Scholar 

  65. Fernandez A, Schillinger D, Grumback K, et al.: Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med 2004, 19:167–174. An interesting article in regard to the growing area of cultural competence and its influence on physician-patient interaction.

    Article  PubMed  Google Scholar 

  66. Brown SA, Garcia AA, Kouzekanani K, Hanis CL: Culturally competent diabetes self-management education for Mexican Americans. The Starr County Border Health Initiative. Diabetes Care 2002, 25:259–268.

    Article  PubMed  Google Scholar 

  67. Caballero AE, Ward K, Hill J, Abeln C: The Latino Diabetes Initiative: a comprehensive clinical care, education and research program to improve the lives of Latinos with diabetes and at risk for the disease. Diabetes 2004, 53(suppl 2):A552-A553.

    Google Scholar 

  68. Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.

    Article  Google Scholar 

  69. Caballero AE, Delgado A, Naranjo A, et al.: Metformin improves markers of endothelial activiation but not markers of inflammation in subjects with impaired glucose tolerance. J Clin Endocrinol Metab 2004, 89:3943–3948.

    Article  PubMed  CAS  Google Scholar 

  70. Buchanan TA, Xiang AH, Peters RK, et al.: Preservation of pancreatic B-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Diabetes 2002, 51:2796–2803.

    Article  PubMed  CAS  Google Scholar 

  71. Caballero AE: Endothelial dysfunction, inflammation and insulin resistance: a focus on subjects at risk for type 2 diabetes. Curr Diab Rep 2004, 4:237–246. An updated review of the metabolic and vascular abnormalities in individuals at risk for type 2 diabetes.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Latino Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, 02215, Boston, MA, USA

    A. Enrique Caballero MD

Authors
  1. A. Enrique Caballero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Caballero, A.E. Diabetes in the hispanic or latino population: Genes, environment, culture, and more. Curr Diab Rep 5, 217–225 (2005). https://doi.org/10.1007/s11892-005-0012-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-005-0012-5

Keywords

Search

Navigation