Skip to main content

Diabetes in Culturally Diverse Populations: From Biology to Culture

  • Chapter
  • First Online:

Abstract

The constantly evolving nature of modern societies has made many health-care professionals around the world face the challenge of providing optimal health care to people from various racial, ethnic, and cultural backgrounds. In the area of diabetes care, this is of particular relevance due to multiple reasons. First of all, racial and ethnic minorities continue to grow in many countries around the globe. In addition, diabetes affects populations at different rates. Furthermore, the quality of diabetes care provided to minority groups often lags behind that provided to the mainstream group.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   199.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Merriam-Webster OnLine Dictionary. Available at http://www.m-w.com. Accessed February 13, 2008.

  2. US Census Bureau, 2004. US Interim Projections by Age, Sex, Race, and Hispanic Origin. Available at: http://www.census.gov/ipc/www/usinterimproj/. Accessed January 18, 2005.

  3. Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. Available at: http://www.iom.edu; 2002; Washington, DC: The National Academies Press.

  4. National Diabetes Statistics. National Diabetes Information Clearing House; 2005, http://diabetes.niddk.nih.gov/dm/pubs/statistics. Accessed April 15, 2008.

  5. National Health and Nutrition Examination Survey (NHANES), 1999–2002. National Center for Health Statistics, Center for Disease Control and Prevention. Available at: http://www.cdc.gov/nhcs/nhanes.htm. Accessed April 15, 2008.

  6. McBean AM, Li S, Gilbertson DT, Collins AJ. Differences in diabetes prevalence, incidence and mortality among the elderly of four racial/ethnic groups: whites, blacks. Hispanics and Asians. Diabetes Care. 2004;27:2317–2324.

    Article  PubMed  Google Scholar 

  7. Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the US: 1990–1998. Diabetes Care. 2000;23:1278–1283.

    Article  PubMed  CAS  Google Scholar 

  8. Shai I, Jiang R, Manson JE, et al. Ethnicity, obesity and the risk of type 2 diabetes in women: a 20 year follow-up study. Diabetes Care. 2006;29:1585–1590.

    Article  PubMed  Google Scholar 

  9. Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”?. Am J Hum Genet. 1962;14:353–362.

    PubMed  CAS  Google Scholar 

  10. Joffe B, Zimmet P. The thrifty genotype in type 2 diabetes: an unfinished symphony moving to its finale?. Endocrine. 1998;9(2):139–141.

    Article  PubMed  CAS  Google Scholar 

  11. 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;23:1353–1358.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  13. Caballero AE. Diabetes in minority populations. In: Kahn CR, Weir G, King GL, et al., eds. Joslin’s Diabetes Mellitus. 14th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:505–524.

    Google Scholar 

  14. Weiss R, Dziura JD, Burgert TS, Taksali SE, Tamborlane WV, Caprio S. Ethnic differences in beta cell adaptation to insulin resistance in obese children and adolescents. Diabetologia. 2006;49(3):571–579.

    Article  PubMed  CAS  Google Scholar 

  15. Osei K, Rhinesmith S, Gaillard T, Schuster D. Impaired insulin sensitivity, insulin secretion, and glucose effectiveness predict future development of impaired glucose tolerance and type 2 diabetes in pre-diabetic African-Americans: implications for primary prevention. Diabetes Care. 2004;27:1439–1446.

    Article  PubMed  CAS  Google Scholar 

  16. Rosouli N, Spencer HJ, Rashidi AA, Elbein SC. Impact of family history of diabetes and ethnicity on beta cell function in obese, glucose-tolerant individuals. J Clin Endocrinol Metab. 2007;92(12):4656–4663.

    Article  Google Scholar 

  17. Banerji MA. Diabetes in African Americans: unique pathophysiologic features. Curr Diabetes Rep. 2004;4(3):219–223.

    Article  Google Scholar 

  18. Snehalatha C, Ramachandran A, Sivassankari S, Satyavani K, Vijay V. Insulin secretion and action show differences in impaired fasting glucose and in impaired glucose tolerance in Asian Indians. Diabetes Metab Res Rev. 2003;19(4):329–332.

    Article  PubMed  CAS  Google Scholar 

  19. Caballero AE. Endothelial dysfunction, inflammation, and insulin resistance: a focus on subjects at risk for type 2 diabetes. Curr Diabetes Rep. 2004;4:237–246.

    Article  Google Scholar 

  20. Hamdy O, Porramatikul S, Al-Ozairi E. Metabolic obesity: the paradox between visceral and subcutaneous fat. Curr Diabetes Rev. 2006;2(4):367–373.

    PubMed  Google Scholar 

  21. Kahn BB, Flier JS. Obesity and Insulin resistance. J Clin Invest. 2000;106(4):81.

    Article  Google Scholar 

  22. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–1727.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Bacha F, Saad R, Gungor N, Janosky J, Arslanian SA. Obesity, regional fat distribution and syndrome X in obese black versus white adolescents: race differential in diabetogenic and atherogenic risk factors. J Clin Endocrinol Metab. 2003;88:2534–2540.

    Article  PubMed  CAS  Google Scholar 

  25. Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab. 2001;86:5366–5371.

    Article  PubMed  CAS  Google Scholar 

  26. ww.idf.org. Ethnic specific values for waist circumference. Accessed June 17, 2007.

    Google Scholar 

  27. Caballero AE, Bousquet-Santos K, Robles-Osorio L, et al. Overweight Latino children and adolescents have marked endothelial dysfunction and subclinical vascular inflammation in association with excess body fat and insulin resistance. Diabetes Care. 2008;31(3):576–582.

    Article  PubMed  CAS  Google Scholar 

  28. Sing GK, Hiatt RA. Trends and disparities in socio-economic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979–2003. Int J Epideimol. 2006;35(4):903–919.

    Article  Google Scholar 

  29. Misra A, Ganda OP. Migration and its impact on adiposity and type 2 diabetes. Nutrition. 2007;23(9):696–708.

    Article  PubMed  Google Scholar 

  30. Candid LM. Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes. Ann Fam Med. 2007;5(6):547–556.

    Article  Google Scholar 

  31. Caballero AE. Diabetes in the Hispanic or Latino population: genes, environment, culture and more. Curr Diabetes Rep. 2005;5:217–225.

    Article  Google Scholar 

  32. Boltri JM, Okosun IS, Davis-Smith M, Vogel RL. Hemoglobin A1c levels in diagnosed and undiagnosed black, Hispanic, and white persons with diabetes: results from NHANES 1999–2000. Ethn Dis. 2005;15(4):562–567.

    PubMed  Google Scholar 

  33. Lara M, Gamboa C, Kahramanian MI, Morales L, Hayes Bautista DE. Acculturation and Health in the Unites States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–397.

    Article  PubMed  Google Scholar 

  34. Mainous AG 3rd, Majeed A, Kooopman RJ, et al. Acculturation and diabetes among Hispanics: evidence from the 1999–2002. National Health and Nutrition Examination Survey. Public Health Rep. 2006;121(1):60–66.

    PubMed  Google Scholar 

  35. Kandula NR, Diez-Roux AV, Chan C, et al. Association of acculturation levels and prevalence of diabetes mellitus in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care. 2008;31(8):1621–1628.

    Article  PubMed  Google Scholar 

  36. Cortes DE, Deres S, Andia J, Colon H, Robles R, Kang SY. Biculturality among Puerto Rican adults in the United States. Am J Commun Psychol. 1994 Oct;22(5):707–721.

    Article  CAS  Google Scholar 

  37. Arcia E, Skinner M, Bailey D, Correa V. Models of acculturation and health behaviors among Latino immigrants to the US. Soc Sci Med. 2001;53:41–53.

    Article  PubMed  CAS  Google Scholar 

  38. Liburd LC, Anderson LA, Edgar T, Jack L Jr. Body size and body shape: perceptions of black women with diabetes. Diabetes Educ. 1999;25(3):382–388.

    Article  PubMed  CAS  Google Scholar 

  39. Boyington JE, Carter-Edwards L, Piehl M, Hutson J, Langdon D, McManus S. Cultural attitudes toward weight, diet and physical activity among overweight African American girls. Prev Chronic Dis. 2008;5(2):A36.

    PubMed  Google Scholar 

  40. Betancourt JR. Cultural competence – marginal or mainstream movement?. N Engl J Med. 2004;351(10):953–955.

    Article  PubMed  CAS  Google Scholar 

  41. Reimann JO, Talavera GA, Salmon M, Nunez JA, Velasquez RJ. Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model. Soc Sci Med. 2004;59(11):2195–2205.

    Article  PubMed  Google Scholar 

  42. Caballero AE. Cultural competence in diabetes care: an urgent need. Insulin. 2007;2:81–90.

    Article  Google Scholar 

  43. Black S, Markides K, Ray L. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;10:2822–2828.

    Article  Google Scholar 

  44. 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 

  45. Tucker KL. Stress and nutrition in relation to excess development of chronic disease in Puerto Rican adults living in the Northeast USA. J Med Invest. 2005;52(Suppl):252–258.

    Article  PubMed  Google Scholar 

  46. Saver BG, Van-Nguyen V, Keppel G, Doescher MP. A qualitative study of depression in primary care: missed opportunities for diagnosis and education. J Am Board Fam Med. 2007;20:28–35.

    Article  PubMed  Google Scholar 

  47. Williams JW, Mulrow CD, Kroenke K, et al. Case-finding for depression in primary care: a randomized trial. Am J Med. 1999 Jan;106(1):36–43.

    Article  PubMed  Google Scholar 

  48. Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28(3):626–631.

    Article  PubMed  Google Scholar 

  49. Leonetti DL, Tsunehara CH, Wahl PW, Fujimoto WY. Educational attainment and the risk of non-insulin-dependent diabetes or coronary heart disease in Japanese-American men. Ethn Dis. 1992;2(4):326–336.

    PubMed  CAS  Google Scholar 

  50. Maty SC, Everson-Rose SA, Haan MN, Raghunathan TE, Kaplan GA. Education, income, occupation and the 34-year incidence (1965–99) of type 2 diabetes in the Alameda County study. Int J Epidemiol. 2005;34(6):1274–1281.

    Article  PubMed  Google Scholar 

  51. Gurka MJ, Wolf AM, Conaway MR, et al. Lifestyle intervention in obese patients with type 2 diabetes: impact of the patient’s educational background. Obesity (Silver Spring). 2006;14:1085–1092.

    Article  Google Scholar 

  52. Glasgow RE, Hampson SE, Strycker LA, Ruggiero L. Personal-model beliefs and social–environmental barriers related to diabetes self-management. Diabetes Care. 1997;20:556–561.

    Article  PubMed  CAS  Google Scholar 

  53. Hunt LM, Valenzuela MA, Pugh JA. NIDDM patients’ fears and hopes about insulin therapy. The basis of patient reluctance. Diabetes Care. 1997;20:292–298.

    Article  PubMed  CAS  Google Scholar 

  54. Caballero AE, Montagnani V, Ward MA, et al. The assessment of diabetes knowledge, socio-economic and cultural factors for the development of an appropriate education program for Latinos with diabetes. Diabetes. 2004;53(Suppl 2):A514.

    Google Scholar 

  55. Caballero AE. Building cultural bridges: understanding ethnicity to improve acceptance of insulin therapy in patients with type 2 diabetes. Ethn Dis. 2006;16:559–568.

    PubMed  Google Scholar 

  56. Caballero AE. For the patient. Overcoming barriers to using insulin for better diabetes control among Latinos. Ethn Dis. 2006;16:591.

    PubMed  Google Scholar 

  57. Wen LK, Parchman ML, Shepherd MD. Family support and diet barriers among older Hispanic adults with type 2 diabetes. Fam Med. 2004;36:423–430.

    PubMed  Google Scholar 

  58. Fisher L, Chesla C, Skaff MM, et al. The family and disease management in Hispanic and European-American patients with type 2 diabetes. Diabetes Care. 2000;23:267–272.

    Article  PubMed  CAS  Google Scholar 

  59. Chesla CA, Fisher L, Mullan JT, et al. Family and disease management in African American patients with type 2 diabetes. Diabetes Care. 2004;27:2850–2855.

    Article  PubMed  Google Scholar 

  60. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288:475–482.

    Article  PubMed  Google Scholar 

  61. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24:561–587.

    Article  PubMed  CAS  Google Scholar 

  62. Kim S, Love F, Quistberg DA, Shea JA. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care. 2004;27:2980–2982.

    Article  PubMed  Google Scholar 

  63. Sarkar U, Fisher L, Schillinger D. Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?. Diabetes Care. 2006;29:823–829.

    Article  PubMed  Google Scholar 

  64. Rosal MC, Goins KV, Carbone ET, Cortes DE. Views and preferences of low-literate Hispanics regarding diabetes education: results of formative research. Health Educ Behav. 2004;31:388–405.

    Article  PubMed  Google Scholar 

  65. Millan-Ferro A, Cortes D, Weinger K, Caballero AE. Development of a culturally oriented educational tool for low health literacy Latino/Hispanic patients with type 2 diabetes and their families. Presented at: The American Diabetes Association Meeting; June 2007; Chicago, IL.

    Google Scholar 

  66. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients literacy skills. J Gen Intern Med. 1995;10:537–541.

    Article  PubMed  CAS  Google Scholar 

  67. Caballero AE. Diabetes in Hispanics/Latinos: challenges and opportunities. Curr Opin Endocrinol Diabetes Obes. 2007;14:151–157.

    Article  PubMed  Google Scholar 

  68. Devlin H, Roberts M, Okaya A, Xiong YM. Our lives were healthier before: focus groups with African American, American Indian, Hispanic/Latino, and Hmong people with diabetes. Health Promot Pract. 2006;7:47–55.

    Article  PubMed  Google Scholar 

  69. Millan-Ferro A, Caballero AE. Cultural approaches to diabetes self-management programs for the Latino community. Curr Diabetes Rep. 2007;7(5):391–397.

    Article  Google Scholar 

  70. Thackeray R, Merrill RM, Neiger BL. Disparities in diabetes management practice between racial and ethnic groups in the United States. Diabetes Educ. 2004;30:665–675.

    Article  PubMed  Google Scholar 

  71. Brown SA, Blozis SA, Kouzekanani K, et al. Dosage effects of diabetes self-management education for Mexican Americans: the Starr county border health initiative. Diabetes Care. 2005;28:527–532.

    Article  PubMed  Google Scholar 

  72. Hornberger JC, Gibson CD Jr, Wood W, et al. Eliminating language barriers for non-English-speaking patients. Med Care. 1996;34:845–856.

    Article  PubMed  CAS  Google Scholar 

  73. Huerta EE, Macario E. Communicating health risk to ethnic groups: reaching Hispanics as a case study. J Natl Cancer Inst Monogr. 1999;25:23–26.

    PubMed  Google Scholar 

  74. McCabe M, Gohdes D, Morgan F, Eakin J, Schmitt C. Training effective interpreters for diabetes care and education: a new challenge. Diabetes Educ. 2006;32(5):714–720.

    Article  PubMed  Google Scholar 

  75. Meece J. Dispelling myths and removing barriers about insulin in type 2 diabetes. Diabetes Educ. 2006;32(Suppl 1):9S–18S.

    Article  PubMed  Google Scholar 

  76. Garrow D, Egede LE. Association between complementary and alternative medicine use, preventive care practices, and use of conventional medical services among adults with diabetes. Diabetes Care. 2006;29:15–19.

    Article  PubMed  Google Scholar 

  77. Dham S, Shah V, Hirsch S, Banerji MA. The role of complementary and alternative medicine in diabetes. Curr Diab Rep. 2006;6:251–258.

    Article  PubMed  Google Scholar 

  78. Shane-McWhorter L. Botanical dietary supplements and the treatment of diabetes: what is the evidence?. Curr Diab Rep. 2005;5:391–398.

    Article  PubMed  Google Scholar 

  79. Bijlani RL, Vempati RP, Yadav RK, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med. 2005;11:267–274.

    Article  PubMed  Google Scholar 

  80. Centers for Disease Control and Prevention (CDC). Trends in leisure-time physical inactivity by age, sex, and race/ethnicity – United States, 1994–2004. MMWR Morb Mortal Wkly Rep. 2005;54:991–994.

    Google Scholar 

  81. Wood FG. Leisure time activity of Mexican Americans with diabetes. J Adv Nurs. 2004;45:190–196.

    Article  PubMed  Google Scholar 

  82. Clark DO. Physical activity efficacy and effectiveness among older adults and minorities. Diabetes Care. 1997;20:1176–1182.

    Article  PubMed  CAS  Google Scholar 

  83. Luscombe FA. Health-related quality of life measurement in type 2 diabetes. Value Health. 2000;3(Suppl 1):15–28.

    Article  PubMed  Google Scholar 

  84. Wee HL, Cheung YB, Li SC, et al. The impact of diabetes mellitus and other chronic medical conditions on health related quality of life: is the whole greater than the sum of its parts?. Health Qual Life Outcomes. 2005;3:2.

    Article  PubMed  Google Scholar 

  85. Hall DE. Medicine and religion. N Engl J Med. 2000;343:1340–1341 author reply 1341–1342.

    Article  PubMed  CAS  Google Scholar 

  86. Al-Arouj M, Bouguerra R, Buse J, et al. Recommendations for management of diabetes during Ramadan. Diabetes Care. 2005;28:2305–2311.

    Article  PubMed  Google Scholar 

  87. Robbins JM, Vaccarino V, Zhang H, Kasl SV. Socioeconomic status and diagnosed diabetes incidence. Diabetes Res Clin Pract. 2005;68:230–236.

    Article  PubMed  Google Scholar 

  88. Wachtel MS. Family poverty accounts for differences in lower-extremity amputation rates of minorities 50 years old or more with diabetes. J Natl Med Assoc. 2005;97:334–338.

    PubMed  Google Scholar 

  89. Diez Roux AV, Detrano R, Jackson S, et al. Acculturation and socioeconomic position as predictors of coronary calcification in a multiethnic sample. Circulation. 2005;112:1557–1565.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Enrique Caballero .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Caballero, A.E. (2010). Diabetes in Culturally Diverse Populations: From Biology to Culture. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-09841-8_9

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-09841-8_9

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-09840-1

  • Online ISBN: 978-0-387-09841-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics