Diabetes and Hispanic-Americans

Mexican American children in Colorado had lower rates of type 1 diabetes than non-Hispanic white children. However, the incidence of type 1 diabetes in Puerto Rican children in Philadelphia was similar to that of white children.Genetic, immunologic, and environmental factors are thought to be involved in the development of type 1 diabetes. Recent reports indicate an increase in the prevalence of type 2 diabetes among Mexican American youth, especially among those who are overweight.

Gestational diabetes, in which blood glucose levels are elevated above normal during pregnancy, occurs in about two to five percent of all pregnant women. Perinatal problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar) are higher in these pregnancies. The women generally return to normal glucose levels after childbirth. Mexican American women, especially when they are overweight, have higher rates of gestational diabetes than non-Hispanic white women.

Once a woman has had gestational diabetes, she has an increased risk of developing gestational diabetes in future pregnancies. In addition, experts estimate that about half of women with gestational diabetes develop type 2 diabetes within 20 years of the pregnancy. For Mexican American women, this may be as great as 12 percent per year.

Diabetic retinopathy is a deterioration of the blood vessels in the eye that is caused by high blood glucose. It can lead to impaired vision and, ultimately, to blindness. In the San Antonio Heart Study, the rate of diabetic retinopathy among Mexican Americans was more than twice that of non-Hispanic white Americans. NHANES III also found that Mexican Americans had a twofold higher rate of diabetic retinopathy.However, the San Luis Valley Diabetes Study found lower rates of retinopathy in Hispanics than in non-Hispanic whites. The results of all three studies showed that the severity of the diabetes--as indicated by insulin use, higher glucose levels, and more years since diagnosis--was significantly associated with retinopathy.

Diabetes is the leading cause of kidney failure (nephropathy) in the United States. The San Antonio Heart Study showed that the prevalence of clinical evidence of kidney damage (proteinuria) was more frequent in Mexican Americans with diabetes than in non-Hispanic whites.

A higher incidence of protein in the urine (microalbuminuria), an early indicator of diabetic nephropathy, was also seen in the San Antonio Heart Study comparing Mexican Americans with non-Hispanic whites. However, the San Luis Valley Diabetes Study showed no difference between Hispanics and non-Hispanic whites in the incidence of diabetic nephropathy.

Mexican Americans who develop kidney failure fare better than many others on dialysis. According to a report from Texas, Mexican Americans survived longer on renal dialysis than non-Hispanic white Americans.

In the San Luis Valley Diabetes Study, there was no significant difference in the prevalence of diabetic neuropathy between Hispanics and non-Hispanic whites. However, in the 1989 National Health Interview Survey, symptoms of sensory neuropathy were reported more frequently by Mexican Americans than by whites or African Americans.

Peripheral Vascular Disease

In the San Antonio Heart Study, Mexican Americans with type 2 diabetes had a higher rate of peripheral vascular disease than non-Hispanic whites; however, this increased incidence was not statistically significant.

Heart disease is the most common cause of death in people with both type 1 and type 2 diabetes. However, in the Texas and Colorado studies, Mexican Americans had lower rates of myocardial infarctions than non-Hispanic white Americans.

• In 1998, about 1.2 million Hispanic Americans were known to have diabetes.

• About 675,000 Hispanic Americans have diabetes but do not know it.

• One in every four Mexican Americans and Puerto Ricans age 45 or older has diabetes. One in every six Cuban Americans in this age group has diabetes.

• Being overweight or physically inactive is a major risk factor for developing diabetes. Hispanic Americans have high rates of both of these risk factors.

• Healthy lifestyles, such as eating healthy foods and getting regular exercise, are particularly important for people who are at increased risk of diabetes. Some diabetes may be prevented with weight control and regular physical activity.

• Hispanic Americans with diabetes have a higher incidence of diabetes complications such as eye and kidney disease than non-Hispanic whites. However, they may have lower rates of heart disease.

• If Hispanics can prevent or control their diabetes, their risk of complications will decrease.

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Reprinted with permission from the National Diabetes Information Clearinghouse

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