Diabetes Prevention in U.S. Hispanic Adults: A Systematic Review of Culturally Tailored Interventions

Abstract

Context Type 2 diabetes, prediabetes, and metabolic syndrome are highly prevalent in Hispanic individuals in the U.S. Cultural adaptations of traditional lifestyle interventions have been recommended to better reach this high-risk population. This systematic review examined the effectiveness of diabetes prevention programs for Hispanics in lowering risk for Type 2 diabetes, as evidenced by a reduction in weight or improvement in glucose regulation. Evidence acquisition PubMed/MEDLINE, CENTRAL, Web of Science, and PsycINFO were searched from database inception to June 2016 for studies that evaluated diabetes prevention trials targeting U.S. Hispanic populations. Twelve publications met criteria for inclusion. Evidence synthesis Interventions varied substantially in length, rigor, and tailoring strategies. Five of 12 studies were RCTs. Eight studies included entirely or largely (>70%) female samples. All studies were delivered in Spanish and took place in community settings. Nine studies reported significant reductions in weight, and two in glucose regulation, post-intervention or when compared with controls. Effect sizes were small to moderate, study quality was moderate, and attrition was high in most trials. Interventions with the largest effect sizes included one or more of the following adaptations: literacy modification, Hispanic foods/recipes, cultural diabetes beliefs, family/friend participation, structured community input, and innovative experiential learning. Conclusions Culturally tailored lifestyle interventions for diabetes prevention appear to be modestly effective in reducing risk for diabetes in Hispanics in the U.S. More studies are needed that utilize randomized controlled designs, recruit Hispanic men, report intervention content and tailoring strategies systematically, and publish participant evaluation and feedback.

A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention

“…The adaptations identified through this process have also been recommended in previous cultural adaptations of behavioral lifestyle interventions. 7 For example, offering traditional foods and recipes and including family members has been used in previous cultural adaptations. 7 Other common adaptations, such as modifying materials for low literacy level, offering the intervention in a community setting, and using community health workers, have been used in the past but did not emerge in this study.…”

“…7 Primary care is an ideal setting for implementing behavioral lifestyle interventions for all patients, including Latinos. Latinos increasingly have access to primary care 23 , and primary care leverages the weight of providers' recommendations, provides opportunities for ongoing support for maintaining behavior change, and can be integrated with management of comorbid conditions.…”

“…6 Given that Latinos currently represent 17% of the US population and are expected to grow to 29% by 2060, culturally tailored interventions to address obesity and promote healthy lifestyles are urgently needed. 7 We and others have published robust evidence from randomized controlled trials (RCTs) for the effectiveness of practical lifestyle interventions for weight management and cardiometabolic risk reduction in primary care. 8 -10 Initially, the landmark Diabetes Prevention Program (DPP) efficacy trial demonstrated that an intensive one-on-one behavioral lifestyle intervention targeting moderate weight loss and increased physical activity conferred 58% lower incidence of diabetes than placebo in high-risk patients.…”

“…20,21 Furthermore, no DPP translation studies, especially technology-supported DPP, with this priority population have been conducted in primary care, leaving a critical evidence gap for Latinos. 7,22 Latinos have increasing access to primary care 23 , which can be an effective context to promote sustainable chronic disease prevention. Thus, cultural adaptation of evidence-based technologysupported DPP translations is needed to effectively address obesity and its related clinical sequelae among Latinos in primary care.…”

“…7,24 The Patient-Centered Outcomes Research Institute's (PCORI) Patient Engagement Rubric calls for research that involves patients and their stakeholders in all phases of the research process, including in formative research aimed at adapting interventions for specific settings and populations. 25 Such stakeholder-engaged approaches are likely to become increasingly important given the diversification of the US population; by 2055 the US will not have a single racial or ethnic majority.…”