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. 2000 Aug;90(8):1288–1293. doi: 10.2105/ajph.90.8.1288

Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin.

K L Tucker 1, O I Bermudez 1, C Castaneda 1
PMCID: PMC1446320  PMID: 10937011

Abstract

OBJECTIVES: We estimated prevalence and control of type 2 diabetes in Puerto Rican, Dominican, and non-Hispanic White (NHW) elders and associated them with sociodemographic and health behavior variables and with body mass index (BMI) and waist circumference. METHODS: We used a cross-sectional analysis with a sample of Hispanic elders in Massachusetts and a comparison group of NHWs (1991-1997). The analysis included 379 Puerto Ricans, 113 Dominicans, and 164 NHWs, aged 60 to 96 years, with complete questionnaires and blood samples. RESULTS: Type 2 diabetes was significantly more prevalent among Puerto Ricans (38%) and Dominicans (35%) than among NHWs (23%). Differences remained after covariates were adjusted for. Hispanics with diabetes were approximately 3 times more likely to use insulin than NHWs. Puerto Ricans were 2 times, and Dominicans 3 times, more likely to have glycosylated hemoglobin concentrations of 7% or above than NHWs. BMI and waist circumference were individually associated with diabetes. When included in the model together, waist circumference, but not BMI, remained independently associated with diabetes. CONCLUSIONS: Ethnicity was more strongly associated with diabetes status and control than were socioeconomic or measured health behavior variables, suggesting that genetic or other culturally related factors may explain these differences.

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Selected References

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  1. Ashwell M., Cole T. J., Dixon A. K. Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J (Clin Res Ed) 1985 Jun 8;290(6483):1692–1694. doi: 10.1136/bmj.290.6483.1692. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bassford T. L. Health status of Hispanic elders. Clin Geriatr Med. 1995 Feb;11(1):25–38. [PubMed] [Google Scholar]
  3. Baxter J., Hamman R. F., Lopez T. K., Marshall J. A., Hoag S., Swenson C. J. Excess incidence of known non-insulin-dependent diabetes mellitus (NIDDM) in Hispanics compared with non-Hispanic whites in the San Luis Valley, Colorado. Ethn Dis. 1993 Winter;3(1):11–21. [PubMed] [Google Scholar]
  4. Bermúdez O. I., Becker E. K., Tucker K. L. Development of sex-specific equations for estimating stature of frail elderly Hispanics living in the northeastern United States. Am J Clin Nutr. 1999 May;69(5):992–998. doi: 10.1093/ajcn/69.5.992. [DOI] [PubMed] [Google Scholar]
  5. Black S. A., Ray L. A., Markides K. S. The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly. Am J Public Health. 1999 Apr;89(4):546–552. doi: 10.2105/ajph.89.4.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Blair S. N., Horton E., Leon A. S., Lee I. M., Drinkwater B. L., Dishman R. K., Mackey M., Kienholz M. L. Physical activity, nutrition, and chronic disease. Med Sci Sports Exerc. 1996 Mar;28(3):335–349. doi: 10.1097/00005768-199603000-00009. [DOI] [PubMed] [Google Scholar]
  7. Brunt M. J., Milbauer M. J., Ebner S. A., Levenson S. M., Millen B. E., Quatromoni P., Chipkin S. R. Health status and practices of urban Caribbean Latinos with diabetes mellitus. Ethn Dis. 1998;8(2):158–166. [PubMed] [Google Scholar]
  8. Carey V. J., Walters E. E., Colditz G. A., Solomon C. G., Willett W. C., Rosner B. A., Speizer F. E., Manson J. E. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study. Am J Epidemiol. 1997 Apr 1;145(7):614–619. doi: 10.1093/oxfordjournals.aje.a009158. [DOI] [PubMed] [Google Scholar]
  9. Chumlea W. C., Roche A. F., Steinbaugh M. L. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc. 1985 Feb;33(2):116–120. doi: 10.1111/j.1532-5415.1985.tb02276.x. [DOI] [PubMed] [Google Scholar]
  10. Clark L. T., Emerole O. Coronary heart disease in African Americans: primary and secondary prevention. Cleve Clin J Med. 1995 Sep-Oct;62(5):285–292. doi: 10.3949/ccjm.62.5.285. [DOI] [PubMed] [Google Scholar]
  11. Eriksson J., Taimela S., Koivisto V. A. Exercise and the metabolic syndrome. Diabetologia. 1997 Feb;40(2):125–135. doi: 10.1007/s001250050653. [DOI] [PubMed] [Google Scholar]
  12. Feskens E. J., Loeber J. G., Kromhout D. Diet and physical activity as determinants of hyperinsulinemia: the Zutphen Elderly Study. Am J Epidemiol. 1994 Aug 15;140(4):350–360. doi: 10.1093/oxfordjournals.aje.a117257. [DOI] [PubMed] [Google Scholar]
  13. Flegal K. M., Ezzati T. M., Harris M. I., Haynes S. G., Juarez R. Z., Knowler W. C., Perez-Stable E. J., Stern M. P. Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984. Diabetes Care. 1991 Jul;14(7):628–638. doi: 10.2337/diacare.14.7.628. [DOI] [PubMed] [Google Scholar]
  14. Haddock L., de Conty I. T. Prevalence rates for diabetes mellitus in Puerto Rico. Diabetes Care. 1991 Jul;14(7):676–684. doi: 10.2337/diacare.14.7.676. [DOI] [PubMed] [Google Scholar]
  15. Haffner S. M., Mitchell B. D., Hazuda H. P., Stern M. P. Greater influence of central distribution of adipose tissue on incidence of non-insulin-dependent diabetes in women than men. Am J Clin Nutr. 1991 May;53(5):1312–1317. doi: 10.1093/ajcn/53.5.1312. [DOI] [PubMed] [Google Scholar]
  16. Haffner S. M., Mitchell B. D., Stern M. P., Hazuda H. P., Patterson J. K. Public health significance of upper body adiposity for non-insulin dependent diabetes mellitus in Mexican Americans. Int J Obes Relat Metab Disord. 1992 Mar;16(3):177–184. [PubMed] [Google Scholar]
  17. Haffner S. M., Stern M. P., Hazuda H. P., Pugh J. A., Patterson J. K. Hyperinsulinemia in a population at high risk for non-insulin-dependent diabetes mellitus. N Engl J Med. 1986 Jul 24;315(4):220–224. doi: 10.1056/NEJM198607243150403. [DOI] [PubMed] [Google Scholar]
  18. Haffner S. M., Stern M. P., Mitchell B. D., Hazuda H. P., Patterson J. K. Incidence of type II diabetes in Mexican Americans predicted by fasting insulin and glucose levels, obesity, and body-fat distribution. Diabetes. 1990 Mar;39(3):283–288. doi: 10.2337/diab.39.3.283. [DOI] [PubMed] [Google Scholar]
  19. Haffner S. M., Stern M. P., Mitchell B. D., Hazuda H. P. Predictors of obesity in Mexican Americans. Am J Clin Nutr. 1991 Jun;53(6 Suppl):1571S–1576S. doi: 10.1093/ajcn/53.6.1571S. [DOI] [PubMed] [Google Scholar]
  20. Hamman R. F., Marshall J. A., Baxter J., Kahn L. B., Mayer E. J., Orleans M., Murphy J. R., Lezotte D. C. Methods and prevalence of non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. Am J Epidemiol. 1989 Feb;129(2):295–311. doi: 10.1093/oxfordjournals.aje.a115134. [DOI] [PubMed] [Google Scholar]
  21. Harris M. I., Eastman R. C., Cowie C. C., Flegal K. M., Eberhardt M. S. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999 Mar;22(3):403–408. doi: 10.2337/diacare.22.3.403. [DOI] [PubMed] [Google Scholar]
  22. Harris M. I. Epidemiological correlates of NIDDM in Hispanics, whites, and blacks in the U.S. population. Diabetes Care. 1991 Jul;14(7):639–648. doi: 10.2337/diacare.14.7.639. [DOI] [PubMed] [Google Scholar]
  23. Hazuda H. P., Haffner S. M., Stern M. P., Eifler C. W. Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol. 1988 Dec;128(6):1289–1301. doi: 10.1093/oxfordjournals.aje.a115082. [DOI] [PubMed] [Google Scholar]
  24. Helmrich S. P., Ragland D. R., Paffenbarger R. S., Jr Prevention of non-insulin-dependent diabetes mellitus with physical activity. Med Sci Sports Exerc. 1994 Jul;26(7):824–830. [PubMed] [Google Scholar]
  25. Horton E. S. NIDDM--the devastating disease. Diabetes Res Clin Pract. 1995 Aug;28 (Suppl):S3–11. doi: 10.1016/0168-8227(95)01087-t. [DOI] [PubMed] [Google Scholar]
  26. Kannel W. B., Sorlie P. Some health benefits of physical activity. The Framingham Study. Arch Intern Med. 1979 Aug;139(8):857–861. [PubMed] [Google Scholar]
  27. Kaye S. A., Folsom A. R., Sprafka J. M., Prineas R. J., Wallace R. B. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991;44(3):329–334. doi: 10.1016/0895-4356(91)90044-a. [DOI] [PubMed] [Google Scholar]
  28. LaPorte R. E., Montoye H. J., Caspersen C. J. Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Rep. 1985 Mar-Apr;100(2):131–146. [PMC free article] [PubMed] [Google Scholar]
  29. Manson J. E., Rimm E. B., Stampfer M. J., Colditz G. A., Willett W. C., Krolewski A. S., Rosner B., Hennekens C. H., Speizer F. E. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet. 1991 Sep 28;338(8770):774–778. doi: 10.1016/0140-6736(91)90664-b. [DOI] [PubMed] [Google Scholar]
  30. Manson J. E., Spelsberg A. Primary prevention of non-insulin-dependent diabetes mellitus. Am J Prev Med. 1994 May-Jun;10(3):172–184. [PubMed] [Google Scholar]
  31. Marshall J. A., Hamman R. F., Baxter J., Mayer E. J., Fulton D. L., Orleans M., Rewers M., Jones R. H. Ethnic differences in risk factors associated with the prevalence of non-insulin-dependent diabetes mellitus. The San Luis Valley Diabetes Study. Am J Epidemiol. 1993 Apr 1;137(7):706–718. doi: 10.1093/oxfordjournals.aje.a116731. [DOI] [PubMed] [Google Scholar]
  32. Muller D. C., Elahi D., Tobin J. D., Andres R. The effect of age on insulin resistance and secretion: a review. Semin Nephrol. 1996 Jul;16(4):289–298. [PubMed] [Google Scholar]
  33. Paffenbarger R. S., Jr, Wing A. L., Hyde R. T. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol. 1978 Sep;108(3):161–175. doi: 10.1093/oxfordjournals.aje.a112608. [DOI] [PubMed] [Google Scholar]
  34. Samet J. M., Coultas D. B., Howard C. A., Skipper B. J., Hanis C. L. Diabetes, gallbladder disease, obesity, and hypertension among Hispanics in New Mexico. Am J Epidemiol. 1988 Dec;128(6):1302–1311. doi: 10.1093/oxfordjournals.aje.a115083. [DOI] [PubMed] [Google Scholar]
  35. Wei M., Gaskill S. P., Haffner S. M., Stern M. P. Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans--a 7-year prospective study. Obes Res. 1997 Jan;5(1):16–23. doi: 10.1002/j.1550-8528.1997.tb00278.x. [DOI] [PubMed] [Google Scholar]

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