Table 2.
Literature on Diabetes Health Disparities Among Native Hawaiians and Other Pacific Islanders, January 1998–December 2008
| Study Authors and Year (Ref. No.) |
Sample and No. of Subjects |
% of Total Sample Who Were NHOPI |
Age, years |
Study Design | Main Goal and Outcomes/Findings |
Limitations |
|---|---|---|---|---|---|---|
| Grandinetti et al., 1998 (5) |
574 Native Hawaiians from 2 rural communities in Hawai‘i; nonpregnant |
100 | ≥30 | Observational, retrospective cohort, population-based sample |
To estimate prevalences of type 2 diabetes and impaired glucose tolerance. |
Cross-sectional; self-reported ancestry, contributing to possible misclassification. |
| Prevalence of impaired glucose tolerance was 16%; diabetes, 20%. Prevalence of impaired glucose tolerance was significantly higher in women and significantly associated with body mass index, waist circumference, and waist-to-hip ratio. Age-adjusted prevalence of diabetes was 4 times higher than in the Second National Health and Nutrition Examination Survey population. | ||||||
| Grandinetti et al., 2000 (26) |
581 Native Hawaiians from 2 rural communities in Hawai‘i; nonpregnant |
100 | ≥30 | Observational, retrospective cohort, population-based ample |
To examine the association between diabetes and CES-D depressive symptoms. |
Cross-sectional design; thus, the temporal relation between glycemic control and CES-D depressive symptoms could not be determined. |
| Among participants reporting a prior history of diabetes, both mean CES-D score and depressive symptom prevalence were significantly higher than in participants with no prior history of chronic illness, after adjustment for age and social support. High hemoglobin A1c level (≥7%) was also associated with higher prevalence of CES-D-assessed depressive symptoms. Results suggest that hyperglycemia may explain the high prevalence of depressive symptoms among participants with known and newly identified diabetes. | ||||||
| Mau et al., 2001 (29) |
147 Native Hawaiians with diabetes or metabolic syndrome and their ‘ohana (family) support person |
100 | ≥30 | Quasi-experimental, nonrandomized, controlled trial; subjects recruited from population-based sample |
To examine association of stage of change with diet and exercise in response to lifestyle intervention. |
Nonrandomized intervention; lack of true control group. |
| Stage of change was significantly associated with positive dietary and exercise behaviors. Participants in the family support intervention group were more likely to advance from pre-action to action/maintenance regarding fat intake and physical activity than the standard intervention group. | ||||||
| Grandinetti et al., 2002 (18) |
578 Native Hawaiians from 2 rural communities in Hawai‘i; nonpregnant |
100 | ≥30 | Observational, retrospective cohort, population-based sample |
To investigate the relation between glucose and percentage of Hawaiian blood quantum. |
Cross-sectional survey; self- reported ancestry, contributing to possible misclassification; self- reported lifestyle behaviours |
| Increased Hawaiian blood quantum was significantly associated with increased fasting glucose level, body mass index, waist-to-hip ratio, and age. Full Hawaiians had higher glucose concentrations than part-Hawaiians after adjustment for age, sex, body mass index, and waist-to-hip ratio. | ||||||
| Kaholokula et al., 2003 (27) |
59 Native Hawaiians out of a total multiethnic sample of 141; nonpregnant |
41 | ≥30 | Observational, nested case study from a population- based sample |
To examine correlations between glycemic status and health-related quality of life and depressive symptoms. |
Limited generalizability; little variability in body mass index and waist-to-hip ratio. |
| No correlation between depressive symptoms and glycemic status was observed. Health-related quality of life had the greatest magnitude of effect on depressive symptoms in people with diabetes compared with glycemic status and knowledge of diabetes diagnosis. Relation between depressive symptoms and health- related quality of life was influenced by glycemic status, sex, education, marital status, and social support. | ||||||
| Grandinetti et al., 2005 (48) |
510 Native Hawaiians out of a total multiethnic sample of 1,447; nonpregnant |
35 | ≥30 | Observational, retrospective cohort, population-based sample |
To estimate the prevalence of metabolic syndrome. |
Cross-sectional |
| Prevalence of metabolic syndrome was significantly higher among Native Hawaiians and all other minority ethnic groups than among Caucasians. Prevalences were similar in all non- Caucasian groups. Prevalence of abdominal obesity and low high density lipoprotein cholesterol was highest in Native Hawaiians. | ||||||
| Wu et al., 2005 (49) |
228 Chamorros in San Diego, California |
100 | ≥18 | Observational, cross- sectional telephone survey, administrative database |
To assess diabetes risk status, incidence, and morbidity. |
Data were population- and geography-specific and may not be generalizable. Self-reported data. |
| Diabetes prevalence was 16.2%; 60% of respondents with diabetes were obese as compared with 21% of those without diabetes. Respondents without diabetes reported more days of moderate physical activity than those with diabetes. More than half of all men and women reported consuming less than the recommended 5 or more fruits and vegetables per day. Prevalence of high blood pressure was 42.5%, higher than the nationwide 2003 Behavioral Risk Factor Surveillance System prevalence of 24.8%. | ||||||
| Kaholokula et al., 2006 (25) |
80 Native Hawaiians out of a multiethnic total sample of 190; nonpregnant, with diabetes |
50 | ≥30 | Observational, nested case study from population- based sample |
To examine relation between depressive symptoms and aspects of health-related quality of life in type 2 diabetes. |
Cross-sectional survey, small sample sizes. |
| Ethnicity moderated the relation between depressive symptoms and quality-of-life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health. | ||||||
| Silva et al., 2006 (31) |
614 NHOPI women out of a multiethnic total sample of 2,155 women |
28 | ≥18 | Observational, retrospective cohort, medical-right- based sample |
To examine ethnic differences in perinatal outcomes among women with gestational diabetes. |
Retrospective study; ethnicity was self-reported. |
| Being NHOPI was a significant predictor of fetal macrosomia. Higher percentage of NHOPI women required insulin during pregnancy and before 20 weeks’ gestation, suggesting that there may be a larger subset of NHOPI women with preexisting undiagnosed diabetes. | ||||||
| Grandinetti et al., 2007 (13) |
510 Native Hawaiians out of a total multiethnic sample of 1,452; nonpregnant |
35 | ≥30 | Observational, retrospective cohort, population-based sample |
To assess prevalences of diabetes and glucose intolerance. |
Cross-sectional; self-reported lifestyle behaviors. |
| Threefold higher prevalence of diabetes among Asian and Native Hawaiian groups than among Caucasians; diabetes prevalences were similar across non-Caucasian ethnic groups despite differences in body mass index. | ||||||
| Mau et al., 2007 (32) |
196 Native Hawaiians out of a total multiethnic sample of 793 |
25 | ≥18 | Observational, cross- sectional, community clustered sample |
To examine associations between factors associated with chronic kidney disease. |
Cross-sectional; community sample may have been biased. |
| Chronic kidney disease was highest among Native Hawaiians. Diabetes, hypertension, and lower education were significantly associated with increased chronic kidney disease in Native Hawaiians. | ||||||
| Beckham et al., 2008 (50) |
78 Native Hawaiians, Samoans, and Tongans out of a total sample of 116 diabetes clinic patients |
67 | ≥18 | Quasi-experimental, refusal control group, pre-post intervention with lack of control for number of visits, clinic sample |
To examine the effectiveness of a culturally tailored diabetes management program delivered by community health workers, using intervention refusers as the comparison group. |
Small sample size, pre-post study design, biased sample without true control group. 42% of the control group vs. 10% of the intervention group was lost to follow-up. Intervention group received more visits than controls. |
| 72 of 80 participants in the community- health-worker-delivered intervention had a postintervention decrease in hemoglobin A1c level of 2.2% (SD, 1.8), as compared with 21 of 36 participants who declined community health worker intervention, who had a 0.2% (SD, 1.5) decrease in hemoglobin A1c. | ||||||
| Elstad et al., 2008 (38) |
64 Samoans (35 with diabetes and 29 caregivers) |
100 | ≥18 | Focus groups, community sample |
To study perceptions of diabetes to design a culturally appropriate program. |
Small sample size; focus groups were mixed with persons with diabetes and caregivers, which may have biased responses. |
| American Samoans with type 2 diabetes experienced multiple types of stress. Environmental and familial stress worsened their glucose levels. Despite the effects of family stress on diabetes, family members were often the primary caregivers. | ||||||
| Kaholokula et al., 2008 (51) |
495 Native Hawaiians from 2 rural communities in Hawai‘i; nonpregnant |
100 | ≥30 | Observational, retrospective cohort, population-based sample |
To examine associations between modes of acculturation and diabetes prevalence. |
Cross-sectional survey. Modes of acculturation included only Native Hawaiian vs. American; other ethnic cultures were not included. |
| Native Hawaiians with a traditional mode of acculturation were more likely to have diabetes (27.9%) than persons with integrated (15.4%), assimilated (12.5%), or marginalized (10.5%) modes. | ||||||
| Kim et al., 2008 (28) |
434 Native Hawaiians out of a multiethnic total sample of 1,257; nonpregnant |
35 | ≥30 | Observational, retrospective cohort, population-based sample |
To examine associations of diabetes with dietary pattern and ethnicity. |
Cross-sectional; possible recall bias on food frequency questionnaire; measurement error in estimation of food portions. |
| Consumption of local ethnic foods was correlated with body mass index, smoking, waist-to-hip ratio, and glucose. Consumption of these foods was higher for Native Hawaiians than for other ethnic groups. Native Hawaiians had the highest total energy intake. |
Abbreviations: CES-D, Right for Epidemiologic Studies Depression Scale; NHOPI, Native Hawaiians and other Pacific Islanders; SD, standard deviation.