Why Are Hispanic People at High Risk for Type 2 Diabetes?
By April Hopcroft
Over half of Hispanic adults are predicted to develop diabetes in their lifetime. Genetics, diet, and culture play a role – see how you can lower your risk.
While diabetes affects over 1 in 10 people in the U.S., Hispanic people are at an especially high risk. Over half of Hispanic adults are predicted to develop type 2 diabetes during their lives, according to the Centers for Disease Control (CDC).
Hispanic people with diabetes are also reported to have worse glycemic control and higher rates of diabetes-related complications, such as kidney disease and vision loss.
It’s important to consider how diet, culture, and education affect diabetes among Hispanic people. With the right knowledge, people can act early to prevent diabetes and improve health by getting necessary screenings, making lifestyle changes, and more.
Why does type 2 diabetes affect Hispanic people more?
There are different biological, social, and cultural factors that explain the higher rates of type 2 diabetes among Hispanic people, said Dr. A. Enrique Caballero, director of Latino Diabetes Health at Brigham and Women’s Hospital and Associate Professor of Medicine at Harvard Medical School.
Genetics
There is no single gene that causes type 2 diabetes in Hispanic people, Caballero said. Researchers have found certain genes that are more common in Hispanic people that are related to type 2 diabetes. For instance, the SLC16A11 gene is linked to a greater risk of developing diabetes and explains about 20 percent of the increased prevalence of type 2 diabetes in Mexico.
It’s important to note that there is a lot of variation among Hispanic people – not all subgroups are the same. For instance, researchers found that the SLC16A11 gene was linked to a higher risk of type 2 diabetes among people of Mexican ancestry, but not those of South and Central American, Dominican, Puerto Rican, or Cuban descent.
In general, Caballero said that Hispanic people who have more Indigenous or African ancestry also tend to have a higher prevalence of type 2 diabetes.
At the biological level, Caballero said that insulin resistance – when insulin the body produces doesn’t work very well – is more common among Hispanic people. Beta cells may tire more rapidly and frequently in Hispanic people.
Obesity is also more prevalent in Hispanic people, likely due to a combination of genetic, environmental, and social factors. In the future, genetic risk scores may be able to better identify Hispanic people at the highest risk of developing type 2 diabetes based on changes in parts of their DNA.
Social determinants of health
It’s important to consider how social determinants of health – the conditions in which people are born, live, work, and play – contribute to diabetes in Hispanic people.
These factors can affect access to medication, nutritious foods, and physical activity. For instance, people with a lower income may not be able to afford medication copays, buy fresh produce, or purchase a gym membership.
Hispanic people are more likely to have a lower average household income, live in poverty, and lack health insurance compared to non-Hispanic white people, according to the U.S. Census. In the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), having an income less than $20,000 was linked with a higher prevalence of diabetes compared to incomes higher than $75,000 per year.
Education and health literacy also play a role; the more you understand about diet, technology, and medications, the easier it is to take care of your diabetes. Graduating from high school is also associated with a lower risk of developing diabetes. According to 2017 U.S. Census data, 72 percent of Hispanic people had earned a high school degree or higher education, compared to 93 percent of non-Hispanic white people.
Language and cultural factors
Barriers around language can make diabetes prevention and care more challenging for Hispanic people. If you can’t communicate with your healthcare provider, it’s harder to ask questions, get the advice you need, and follow treatment plans.
Spanish-language resources are a key part of successful diabetes prevention and care among Hispanic people. For example, research found that the OneTouch Verio Flex meter used with the Spanish-language OneTouch Reveal app in an underserved Hispanic population led to sustained improvements in diabetes management. The ADA, CDC, and Association of Diabetes Care & Education Specialists (ADCES) offer Spanish language resources, too.
Beyond translating information from English to Spanish, Caballero said resources must be translated “culturally” and adapted to be appropriate for specific communities. This is especially important for meal plans, as words for specific foods can vary substantially by Spanish-speaking country.
Certain beliefs among Hispanic people may also complicate diabetes care. Some Hispanic people view being overweight as a sign of good health, rather than a health condition. This can lead to higher rates of obesity and prediabetes, which are risk factors for type 2 diabetes.
Some Hispanic people view insulin as a last resort rather than preventive medicine, and others may prefer holistic or natural treatments over commercial drugs.
How can Hispanic people prevent type 2 diabetes?
Preventing diabetes begins with preventing prediabetes and obesity. Taking the risk calculator for prediabetes is a good first step to understanding your risk level (it’s available in both Spanish and English).
If you already have prediabetes, don’t despair.
“Prediabetes doesn’t mean you’re destined to develop disease – you can reduce your risk primarily by implementing lifestyle changes,” Caballero said.
Diet
Some traditional Hispanic foods are rich in carbohydrates and saturated fats. While some people suggest that these foods are unhealthy by nature, Caballero said that it’s actually the way in which traditional foods are prepared that can make them unhealthy.
Specifically, incorporating more processed items into meals makes them less nutritious. When possible, choose lighter options, such as salads and soups, and be mindful of portion sizes.
That said, there are many ways you can still enjoy traditional foods:
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Choose lean protein fillings, such as chicken or fish, instead of beef, refried beans, and fatty cheeses.
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To reduce carbohydrate counts, replace tortillas with lettuce or opt for a taco salad. Whole wheat or low-carb tortillas are another good option.
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For toppings, choose guacamole (which is full of healthy fats) over sour cream, which is high in saturated fats. With just 1 gram of carbs per tablespoon, salsa is another great choice to spice up your meal.
The following dishes are also healthy alternatives:
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Fajitas made with grilled vegetables or chicken
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Tacos with vegetables, grilled chicken, fish, or turkey
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Burrito bowls
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Salad with grilled chicken
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Brown rice in small portions (or substitute cauliflower rice)
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Tortilla soup or any chicken-based soup
Physical activity
U.S. guidelines recommend that adults get 150-300 minutes each week of moderate-intensity aerobic activity (like walking), 75-150 minutes each week of vigorous aerobic exercise (like running), or some combination of the two types of exercise.
Caballero said it’s important to adapt these recommendations to your preferences and traditions. For instance, Caballero incorporated a salsa dancing program into the Latino Diabetes Initiative, since dancing plays a key role in many Hispanic cultures.
Walking is another great form of physical activity that can be social, low-cost, and be done anywhere. As with any lifestyle change, it’s a good idea to try habit stacking to start small and incorporate changes into your daily routine.
Education and screening
Access to culturally appropriate diabetes care and education is important to address the high burden of diabetes among Hispanic people. While telehealth can be a helpful tool for diabetes education, research suggests that in-person or phone-based programs are most effective in Hispanic populations.
One example of an in-person program is the CDC’s National Diabetes Prevention Program (DPP), which focuses on healthy eating and physical activity to reduce the risk of transitioning from prediabetes to type 2 diabetes. Participants with prediabetes reduced their risk of developing type 2 diabetes by 58 percent by making certain lifestyle changes.
Caballero noted that the National DPP included people from the Hispanic community, showing that type 2 diabetes can be prevented among Hispanic people by introducing a healthier lifestyle. Find a program near you by entering your zip code or location, and see the list of programs offered in Spanish.
Most importantly, Caballero said you shouldn’t wait until you have symptoms of type 2 diabetes to see a doctor. He encouraged anyone in the Hispanic community to be proactive in asking their doctor about diabetes screening, prevention, and lifestyle changes.
