Innovative Diabetes Interventions in the U.S. Hispanic Population

Abstract

IN BRIEF In the United States, Hispanics have a 66% greater risk of developing type 2 diabetes and, once diagnosed, exhibit worse outcomes than non-Hispanic whites. It is therefore imperative to ensure that interventions meet the specific needs of this at-risk group. This article provides a selective review of the evidence on innovative, real-world approaches (both live and technology-based) to improving behavioral, psychosocial, and clinical outcomes in underserved Hispanics with type 2 diabetes. Key aspects of successful live interventions have included multimodal delivery, greater dosage/attendance, and at least some in-person delivery; effective technology-based approaches involved frequent but intermittent communication, bi-directional messaging, tailored feedback, multimodal delivery, and some human interaction. Across modalities, cultural tailoring also improved outcomes. Additional research is needed to address methodological limitations of studies to date and pinpoint the most efficacious components and optimal duration of interventions. Future efforts should also attend to variability within the U.S. Hispanic population to ensure acceptability and sustainability of interventions in this diverse group.

Delivering the Same Intervention to Hispanic/Latinos With Pre-diabetes and Diabetes. Early Evidence of Success in a Longitudinal Mixed Method Study

“…Trust has been cited as the most important factor in enrollment and we believe that recruitment by a trusted physician and/or community health worker in this study was a key factor. 51 According to our findings, H/L of low to medium educational level could indeed benefit from a "joint" program, regardless of their location on the dysglycemic spectrum, especially if attending with family or friends and when there is physician engagement. Overall, our study sample benefited from the intervention in that participants lost weight, increased their diabetes knowledge, had a trend towards A1C improvement, and adopted healthy behaviors.…”

“…Trust has been cited as the most important factor in enrollment and we believe that recruitment by a trusted physician and/or community health worker in this study was a key factor. 51 …”

Patient Decision-Making About Self-Disclosure of a Type 2 Diabetes Diagnosis: A Qualitative Study

“…Although culture influenced perceptions of disease, it did not do so uniformly. Rather than make generic recommendations, we suggest that clinicians tailor their communication to individual patients (43).…”

Digital health tools to promote diabetes education and management of cardiovascular risk factors among under-resourced populations

“…5 A subsequent study, Dulce Digital-Me, is underway and will evaluate an adaptive approach to personalize text exchanges with patients based on wirelessly transmitted glucose values, pill box use, and ecological momentary assessments of physical activity, diet, and stress. 8,9 A recent extension of these projects was born of the dire need for addressing the major healthcare barriers that have arisen owing to the ongoing COVID-19 pandemic. The Dulce Digital-COVID Aware (DD-CA) trial was launched amid the pandemic with the aim of reducing these barriers in diverse, underserved Hispanic communities, improving glucose control, and lowering transmission of COVID-19 after hospital discharge.…”

“… 5 A subsequent study, Dulce Digital-Me , is underway and will evaluate an adaptive approach to personalize text exchanges with patients based on wirelessly transmitted glucose values, pill box use, and ecological momentary assessments of physical activity, diet, and stress. 8 , 9 …”