Review article
Diabetes Prevention in U.S. Hispanic Adults: A Systematic Review of Culturally Tailored Interventions

https://doi.org/10.1016/j.amepre.2016.10.028Get rights and content

Context

Type 2 diabetes, prediabetes, and metabolic syndrome are highly prevalent in Hispanic individuals in the U.S. Cultural adaptations of traditional lifestyle interventions have been recommended to better reach this high-risk population. This systematic review examined the effectiveness of diabetes prevention programs for Hispanics in lowering risk for Type 2 diabetes, as evidenced by a reduction in weight or improvement in glucose regulation.

Evidence acquisition

PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO were searched from database inception to June 2016 for studies that evaluated diabetes prevention trials targeting U.S. Hispanic populations. Twelve publications met criteria for inclusion.

Evidence synthesis

Interventions varied substantially in length, rigor, and tailoring strategies. Five of 12 studies were RCTs. Eight studies included entirely or largely (>70%) female samples. All studies were delivered in Spanish and took place in community settings. Nine studies reported significant reductions in weight, and two in glucose regulation, post-intervention or when compared with controls. Effect sizes were small to moderate, study quality was moderate, and attrition was high in most trials. Interventions with the largest effect sizes included one or more of the following adaptations: literacy modification, Hispanic foods/recipes, cultural diabetes beliefs, family/friend participation, structured community input, and innovative experiential learning.

Conclusions

Culturally tailored lifestyle interventions for diabetes prevention appear to be modestly effective in reducing risk for diabetes in Hispanics in the U.S. More studies are needed that utilize randomized controlled designs, recruit Hispanic men, report intervention content and tailoring strategies systematically, and publish participant evaluation and feedback.

Section snippets

Context

Prevalence of Type 2 diabetes has risen markedly in recent decades. Hispanics/Latinos (hereafter referred to as “Hispanics”) and other racial/ethnic minorities in the U.S. exhibit higher prevalence of diabetes than their non-minority counterparts1, 2; have poorer glucose control once diagnosed; and experience disparities in quality of life, diabetes-related organ and vascular complications, depression, cardiovascular disease, and mortality once diagnosed.2, 3, 4 Though Hispanic and Hispanic

Literature Search

This systematic literature review was conducted and reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.12 Comprehensive search strategies were designed for electronic databases (PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials [CENTRAL], Web of Science, and PsycINFO) to capture all studies from database inception to June 2016. Searches incorporated medical subject heading (MeSH) and keyword terms in three

Study Characteristics

The literature search identified 215 unique publications, 12 of which were included in the final review (Figure 1). Characteristics of the 12 studies are presented in Table 2. Five studies were RCTs, six were single-group pre−post uncontrolled trials, and one study utilized a quasi-experimental community comparison group design. Studies were published between 2008 and 2016. One study included the school-aged children of participants15; only adult/parent data were included this review. Another

Discussion

Of the 12 interventions included in this review, nine resulted in significant reductions in weight and two in HbA1c, suggesting that adapted or culturally tailored diabetes prevention interventions for Hispanic individuals may be somewhat effective in reducing diabetes risk indicators. Although only five interventions (38%) were tested using a randomized controlled design, the gold standard methodology for evaluation of health behavior interventions and the strongest evidence for efficacy,19, 20

Conclusions

Culturally tailored diabetes prevention interventions for Hispanics appear to be modestly effective in reducing risk for Type 2 diabetes via reduction of weight and HbA1c. Evidence is weaker for the ability of these interventions to influence physical activity and dietary intake. A major limitation in this intervention literature, as a whole, is the exclusive use of self-report and the frequent use of study-specific, non-validated measures to assess behavior change. The completion of 12

Acknowledgments

Jessica L. McCurley was supported during the preparation of this article by research and training grants from the NIH/National Heart, Lung, and Blood Institute (5T32HL079891-06), the Fogarty International Center, the University of California Global Health Institute (R25 TW009343), and the University of California Health Initiative of the Americas. The remaining authors were supported by grants from the NIH/National Institute of Nursing Research (1 R01 NR014866-02, Gallo, Gutierrez; 1 R01

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