A profile of Latinos with poorly controlled diabetes in South Florida

Abstract

IntroductionLatinos are the largest minority group in the United States and diabetes or pre-diabetes affects more than 70% of Latinos aged 45 years and older. Miami-Dade County is home to one of the highest populations of diverse Latinos. In this descriptive manuscript, we present baseline characteristics of participants enrolled in the Miami Healthy Heart Initiative (MHHI). This was a study conducted to determine the effects of a community health worker (CHW) intervention among Latinos with poorly controlled diabetes in South Florida.MethodsWe recruited 300 diverse Latino adults with suboptimal diabetes outcomes (HbA1c≥8) into MHHI. This randomized control trial examined the impact of a 1-year CHW-led intervention on glycemic control, blood pressure, and cholesterol levels. At baseline, physiologic measures, including HbA1c, LDL, blood pressure, and BMI, were assessed. Data on socio-demographic characteristics and additional determinants of health such as depression status, provider communication, diet, exercise, cigarette smoking, readiness to change diabetes management behaviors (stages of change), and confidence in ability to improve diabetes self-care (self-efficacy) were collected.ResultsParticipants came from 20 different countries, with Cuban Americans representing 38% of the sample. Most had lived in the US for more than 10 years, had completed at least 12 years of school, and had high levels of health literacy, yet 48% had very low acculturation. Nearly 80% had poor self-efficacy, 80% met the criteria for depression, and 83% were not adherent to their medications. More than half the population was not at their target for blood pressure, 50% were above the recommended LDL goal, and most were obese.ConclusionIn a diverse population of Latinos with poorly controlled diabetes in Miami, we found high rates of depression, obesity, medication non-adherence, poor self-efficacy, and provider communication. These may contribute to poor diabetes control, high blood pressure, and elevated cholesterol.

Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes

“…Baseline characteristics of participants are provided in Table 1. Additional characteristics have been previously published . With respect to Latino ancestry, 115 (38.3%) were born in Cuba; the rest were from more than a dozen different Latin American countries.…”

“…In addition, 212 participants, or 70.7% of our population, had positive findings on screening for depression. Helping a predominantly uninsured population find high-quality culturally acceptable behavioral and mental health services was a major challenge . The CHWs were trained to screen for depression by using standardized instruments and on the processes and procedures to link patients with the mental health resources that exist in the community.…”

Development of a computerized intervention to improve health literacy in older Hispanics with type 2 diabetes using a pharmacist supervised comprehensive medication management

“…Rates of depression in Hispanics with T2D are even higher. A recent study in Hispanics in South Florida showed 80% of participants met criteria for depression, while 80% and 83% of participants reported poor self-efficacy and non-adherence, respectively [ 60 ]. In other Hispanic populations, patients with depression were more likely to be non-adherent [ 61 ].…”

Editor's notes

“…A survey of residents showed they were less likely than primary care practitioners to be in concordance with guidelines published by the American Thyroid Association ( 1 ). A profile of Latino patients in Dade County, Florida, demonstrated that poorly controlled diabetes was very common and associated with depression and medication non-adherence ( 2 ). There are two medical education quality improvement papers: the Modified Early Warning System (MEWS) ( 3 ) and an accompanying editorial ( 4 ), and the Transitions of Care Rotation (TRACER) outcomes paper ( 5 ).…”