Macrovascular complications in Mexican Americans with type II diabetes

Mexican Americans have a threefold greater prevalence of non-insulin-dependent (type II) diabetes mellitus than non-Hispanic whites in the San Antonio Heart Study, a population-based study of diabetes. In addition, Mexican-American diabetic subjects (n = 365) have greater fasting glycemia than non-Hispanic white diabetic subjects (P less than 0.001). Despite these findings, and despite a higher prevalence of microvascular complications among Mexican Americans, there does not appear to be a marked difference in prevalence of macrovascular complications between Mexican-American and non-Hispanic white diabetic subjects. Mexican-American diabetic subjects have only a moderate excess of peripheral vascular disease (as judged by ankle-arm blood pressure ratios) relative to non-Hispanic white diabetic subjects (sex-adjusted Mantel-Haenszel odds ratio 1.84, 95% confidence interval 0.75-4.49). Mexican-American diabetic subjects actually reported fewer myocardial infarctions than non-Hispanic white diabetic subjects (sex-adjusted Mantel-Haenszel odds ratio 0.73, 95% confidence interval 0.31-1.71). Duration was not associated with either peripheral vascular disease or myocardial infarction. Severity of glycemia was only mildly associated with presence of peripheral vascular disease and negatively associated with self-reported myocardial infarction. This latter finding may represent a survival bias in that more severe diabetic subjects have already died and are not ascertained in a prevalence study. The absence of an ethnic difference in the prevalence of macrovascular disease contrasts with our previous reports from the San Antonio Heart Study, in which the prevalence of both retinopathy and proteinuria was observed to be higher in Mexican-American diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased incidence of type II diabetes mellitus in Mexican Americans

OBJECTIVE: To determine whether Mexican Americans have an increased incidence of non-insulin-dependent (type II) diabetes mellitus relative to non-Hispanic whites. Currently, no study has reported on the incidence of this disorder in Mexican Americans. RESEARCH DESIGN AND METHODS: We determined the 8-yr incidence of type II diabetes in 617 Mexican Americans and 306 non-Hispanic whites who participated in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Forty Mexican Americans (6.5%) and 6 non-Hispanic whites (2%) developed type II diabetes, as defined by World Health Organization criteria. The age-adjusted ethnic odds ratio (OR; Mexican Americans/non-Hispanic whites) for diabetes incidence was 8.13 (95% confidence interval [C1] 1.10-59.9) in men and 3.62 (95% CI 1.37-9.55) in women. We adjusted for age, sex, ethnicity, body mass index, and level of educational attainment with multiple logistic regression analyses. RESULTS: Mexican Americans continued to show a statistically significant increase in diabetes incidence (OR 2.72, 95% CI 1.02-7.28). Obesity and age were also positively related to diabetes incidence in this analysis (P less than 0.001). In addition, subjects with at least some college education had a lower incidence of diabetes than those with less than a high school education (OR 0.51, 95% CI 0.26-0.99). CONCLUSIONS: The incidence of type II diabetes in Mexican Americans is greater than in non-Hispanic whites, a difference that is not explained by ethnic differences in obesity, age, or level of educational attainment.     

Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes

Purpose: The purpose of this article is to report the results of a culturally tailored diabetes intervention for Mexican Americans on physical activity and to report the results of a focus group with intervention participants.
Data sources: Seventeen Mexican American subjects with type 2 diabetes participated in the study. The study used a pretest/posttest control group design with 10 subjects in each group ( N = 20). Outcome measures included the number of steps walked weekly, weight, and body mass index (BMI). Pedometers were used to measure the daily number of steps in the intervention group. A focus group provided data on participant satisfaction.
Conclusions: Results suggest a positive effect of the intervention on physical activity level, weight, and sense of control over diabetes self-management. Intervention participants had a statistically significant increase in the number of steps walked per day and a statistically significant mean weight loss of five pounds. Focus group results indicate that participants were satisfied with the culturally tailored intervention and that they and their families benefited from the intervention.
Implications for practice: A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.     

Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes

OBJECTIVE: To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. RESEARCH DESIGN AND METHODS: Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged >or=65 years. RESULTS: The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. CONCLUSIONS: Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.     

Measuring health beliefs in Spanish-speaking Mexican Americans with type 2 diabetes: adapting an existing instrument

Mexican Americans bear a disproportionate burden of type 2 diabetes, and although clinicians and researchers are beginning to develop culturally competent interventions, few instruments are available for measuring variables relevant to health outcomes. The purpose of this study was to determine the psychometric properties of a diabetes-related health belief instrument translated for use with Spanish-speaking Mexican Americans. Three hundred and twenty-six Spanish-speaking Mexican Americans from Starr County, a Texas-Mexico border community, diagnosed with type 2 diabetes participated in the study. Factor analysis was used to examine the factor structure of the instrument, and reliability testing was conducted to determine the internal consistency of the resulting factors. The final instrument had 25 items with four subscales-Barriers, Social Support for Diet, Impact of Job on Therapy, and Benefits of Therapy-and one item to measure, Control. Internal consistency coefficients for these subscales were .56, .62, .86, and .90, respectively. The translated instrument needs to be tested over time with other Hispanic populations.     

Family history of type 2 diabetes is associated with increased carotid artery intimal-medial thickness in Mexican Americans

OBJECTIVE: To evaluate whether the joint risk of diabetes and atherosclerosis tracked within families, we assessed the correlation between a family history of diabetes and intimal-medial thickness (IMT) of the common carotid artery (CCA). RESEARCH DESIGN AND METHODS: Study subjects included 620 nondiabetic individuals from 24 families enrolled in the San Antonio Family Heart Study. The thickness of the far walls of the CCA was measured by B-mode ultrasonography. Statistical analyses included familial correlations to account for the nonindependence of family data. RESULTS: After adjusting for sex, age, and IMT reader effects, the heritability of IMT in this population was 16% (P = 0.009). Using a more comprehensive family history score that accounted for diabetes status of the individual's parents and older siblings, we observed a significant correlation between family history score and increased CCA IMT (0.006 mm increase in CCA IMT for every point increase of diabetes family history score, P = 0.016). This association remained even after further adjustment for BMI, smoking, and fasting insulin and glucose levels. After adjusting for several cardiovascular risk factors, the mean CCA IMT in those with high family history scores for diabetes was still 0.037 mm thicker than those with low family history scores for diabetes (P = 0.040). CONCLUSIONS: These results suggest that the genetic contribution to CCA IMT variability is modest. Also, the small increase in subclinical atherosclerosis observed even among nondiabetic Mexican Americans with a positive family history of diabetes is probably transmitted along with the risk of diabetes through shared etiologic risk factors between diabetes and cardiovascular disease.     

U.S. army air ambulance operations in El Paso,Texas: A descriptive study and system review

Objectives. To analyze a high-volume military air ambulance unit and review the U.S. Army air medical transport system and Military Assistance to Safety and Traffic (MAST) program. Methods. The setting was a remote medical system with numerous ground emergency medical services. All patients transported between January 1, 1996, and February 28, 1998, were included. Patients who were dead on scene or for whom records were unavailable were excluded. A retrospective review of transport and available inpatient records was conducted. Results. Five hundred seventeen patients were transported during the study period; 461 patients met inclusion criteria (89%). Of these, 70% were classified as trauma; 30% possessed medical or other surgical diagnoses. Prehospital responses numbered 71.6%, while 28.4% were interhospital transfers. Missions averaged 23.4 minutes per flight, with no major aircraft mishaps. Prehospital utilization review showed appropriate use; 35% of interhospital trauma and 11% of interhospital nontrauma missions were staffed inadequately by these criteria. Time intervals, procedures, and program impact are discussed. Conclusion. This and similar units participating in the MAST program provide effective air transport in settings underserved by civilian programs. Quality and wartime readiness could be improved by centralized medical direction, treatment and transfer protocols, and enhanced training of medics. Further investigations of the clinical impact of advanced training and a two-medic aircrew model are warranted. PREHOSPITAL EMERGENCY CARE 2000;4:136-143     

Familial aggregation of severity of diabetic retinopathy in Mexican Americans from Starr County, Texas

OBJECTIVE: Diabetic retinopathy is a major cause of blindness. To determine whether retinopathy itself or only its severity aggregates in families, we examined the occurrence and severity of diabetic retinopathy in Mexican-American siblings with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using stereoscopic fundus photography of seven standard fields, we measured retinopathy in 656 type 2 diabetic patients from 282 Mexican-American families from Starr County, Texas. Retinopathy severity was scored using the Early Treatment of Diabetic Retinopathy Study system and classified as no retinopathy, early nonproliferative diabetic retinopathy (NPDR-E), moderate-to-severe nonproliferative diabetic retinopathy (NPDR-S), or proliferative diabetic retinopathy (PDR). RESULTS: Of 249 siblings of randomly selected probands with retinopathy, 169 (67.9%) had retinopathy, compared with 95 of 125 siblings of unaffected probands (76.0%; P = 0.11). Proband retinopathy class was associated (P = 0.03) with sibling retinopathy class, with significant odds ratios (ORs) for NPDR-E versus no retinopathy (OR 0.57 [95% CI 0.35-0.93]) and PDR versus NPDR-E (2.02 [1.13-3.63]); the contrast of NPDR-S versus NPDR-E approached significance (1.78 [0.99-3.20]). With the more severe classes (PDR and NPDR-S) combined in one group and the less severe ones (none and NPDR-E) in another, more severe proband retinopathy was associated with more severe sibling retinopathy (1.72 [1.03-2.88]). CONCLUSIONS: More severe diabetic retinopathy showed evidence of familial aggregation, but the occurrence of diabetic retinopathy per se did not. The factors involved in the onset of diabetic retinopathy may differ from those involved in its progression to more severe forms.     

Mexican Americans' explanatory model of type 2 diabetes

The purpose of this study was to develop a culturally specific explanatory model (EM) of diabetes mellitus from the perspective of Mexican Americans living along the United States-Mexican bonier Kleinman's concept of EMs of illness was used as the theoretical orientation, and the grounded theory method was used to sample, collect, and analyze data. The Mexican Americans in this study described their perceptions of type 2 diabetes using the following constructs: causes, symptom, treatment, and social significance. Each of the components of Mexican Americans' EM contained elements of both the folk and the biomedical perspective. Susto (a fright or scare) was perceived to be the primary cause of diabetes, although participants also incorporated biomedical causes. Treatment included the use of both herbal and biomedical modalities. The use of herbal remedies was not well understood by the participants despite the fact that some used herbal therapies to control their diabetes.     

No Local Birth Sex Ratio Changes following the August 2019 Shootings in Montgomery County,Ohio, and in El Paso County,Texas

ObjectiveIn humans, males are born slightly in excess of females. Many factors have been shown to affect this ratio, including stressful events such as terrorist attacks. Two shootings occurred in early August 2019 in the Oregon District in Dayton, Montgomery County, Ohio, and in El Paso County, Texas, in the USA. This study was carried out in order to identify whether there were any effects on sex ratio at birth at the state or county level 3–5 months later.Subject and MethodsBirths by sex, month of birth (2015–2019), and county were obtained for Ohio and Texas from the website of the Centers for Disease Control and Prevention. Ordinary linear logistic regression was used to assess the time trend in the probability of boys and to investigate changes in the trend functions. Poisson regression (SAS GENMOD) and linear logistic regression using SAS procedure LOGISTIC was applied.ResultsThis study analyzed 2,623,714 live births, 1,939,938 in Texas (sex odds [SO] 1.044) and 683,776 in Ohio (SO 1.045). The only significant effect noted was seasonality (month) at the state level.ConclusionIt has been postulated that male fetal loss in pregnant women during stressful periods may occur in accordance with the Trivers-Willard hypothesis. Several studies have found significant effects after terrorist attacks in the USA (as well as in other countries), but this study did not reveal such effects. This may be due to several reasons including underpowered datasets and the possibility that populations may be becoming relatively immured to these events.     

A feasibility study of a culturally tailored diabetes intervention for Mexican Americans

Latinos, the fastest growing minority group in the United States, are among the hardest hit by diabetes. Among Latinos, Mexican Americans have the highest rate (23.9%) of diabetes. Good self-management can improve glycemic control and decrease diabetes complications but can be challenging to achieve. The purpose of this study was to test the feasibility and examine the effects of a culturally tailored intervention for Mexican Americans with type 2 diabetes on outcomes of self-management. The study used a pretest/posttest control group design with 10 participants in each group (N = 17). Feasibility and acceptability of the tailored diabetes self-management program was assessed by examining ease of recruitment and retention rates. The behavioral outcomes of self-efficacy, diabetes knowledge and self-care measures, and the biologic outcomes of weight, body mass index, HbA1C, and blood glucose were used to examine intervention effectiveness. Successful recruitment of participants came from personal referrals from providers or the promotora. Retention rates were 100% for the intervention group and 80% for the control group. Findings suggest that the intervention had a positive clinical and statistical effect on diabetes knowledge, weight, and body mass index. Improvements were also noted in self-efficacy scores, blood glucose, and HbA1C, but these changes did not reach statistical significance. A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.     

Early detection of type 2 diabetes among older African Americans

The purpose of this research was to determine whether a group of African Americans who had no diagnosis of type 2 diabetes had elevated blood glucose levels and other risk factors indicative of type 2 diabetes. A convenience sample of 20 African American adults 50 years and older participated in the pilot study. Participants were screened for elevated fasting capillary blood glucose levels and related risk factors such as hypertension, high cholesterol levels, and high body mass index. Frequency data indicated that at least 50% of participants had capillary glucose levels greater than 110 mg/dL. An overwhelming majority of the participants with elevated glucose levels had one or more other risk factors for type 2 diabetes. Evidence-based practice clearly indicates that an early detection and control of type 2 diabetes can prevent complications and also help prevent coronary artery disease.     

Self‐management practices of Chinese Americans with type 2 diabetes

The purpose of this study was to examine the level of diabetes self‐management and its association with demographic and diabetes‐related characteristics in Chinese Americans with type 2 diabetes. A questionnaire that measured diabetes self‐management and diabetes‐related characteristics was administered to a sample of 211 Chinese Americans with type 2 diabetes living in America. The results indicated that the participants were likely to take medications but less likely to carry out diet, physical activity, self‐monitoring of blood glucose, and foot care behaviors. Associations between diabetes self‐management and demographic and diabetes‐related characteristics were observed. For example, individuals who had less education and were employed were less likely to engage in diabetes self‐management than those with higher education and who were retired, while individuals who had a longer duration of diabetes and used insulin as a treatment more frequently carried out self‐monitoring than those who had a shorter duration of diabetes and used oral hypoglycemic agents. These findings indicate that the self‐management practices among the participants are suboptimal. Research on developing culturally and linguistically appropriate interventions to promote diabetes self‐management for Chinese Americans is warranted.     

Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative

OBJECTIVE: To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. A total of 256 randomly selected individuals with type 2 diabetes between 35 and 70 years of age, diagnosed with type 2 diabetes after 35 years of age, and accompanied by a family member or friend were included. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Outcomes included indicators of metabolic control (HbA(1c) and fasting blood glucose), diabetes knowledge, and diabetes-related health beliefs. RESULTS: Experimental groups showed significantly lower levels of HbA(1c) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA(1c) of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (>10%). CONCLUSIONS: This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA(1c) levels >10%.