Insurance Status and Biological and Psychosocial Determinants of Cardiometabolic Risk Among Mexican-Origin U.S. Hispanic/Latino Adults with Type 2 Diabetes

Namino M Glantz, Jessikah M Morales, Wendy C Bevier, Arianna Larez, Charis B Hoppe, Ian Duncan, Andrew Mackenzie, David Kerr, Namino M Glantz, Jessikah M Morales, Wendy C Bevier, Arianna Larez, Charis B Hoppe, Ian Duncan, Andrew Mackenzie, David Kerr

Abstract

Purpose: Hispanics/Latinos in the United States bear higher burden of type 2 diabetes (T2D) and associated complications compared with the general population. Health insurance coverage is also lower in this population. We examined the association of health insurance with biological and psychosocial determinants of cardiometabolic risk among U.S. Mexican-origin Hispanic/Latino adults with T2D. Methods: Participants were self-reported Hispanic/Latino adults with T2D diagnosis. Trained bilingual community health workers collected cross-sectional information on biological and psychosocial factors using clinical examinations, laboratory tests, validated questionnaires, and wearable activity monitors. Results: One hundred and seven Hispanic/Latino adults (54±12 years, 65% female, 36% prescribed insulin, 60% uninsured) with T2D were enrolled. While 93% had low language-based acculturation, 88% had high health literacy in Spanish. Forty percent were food insecure and 47% expressed at least one social need. Overall, 35% had an HbA1c <7.0% (indicating good control) and 31% had an HbA1c >9.0%. Sixty-three percent had blood pressure within target (<130/80 mmHg), and overall participants were moderately physically active. However, 53% were obese (body mass index ≥30 kg/m2) and 76% had a waist measurement defined as high risk (>88 cm for women and >102 cm for men). Participants without health insurance were younger (51.9±10.4 vs. 58.8±10.5 years mean±standard deviation, p=0.0008) but had higher HbA1c (8.4±2.2% vs. 7.6±1.6, p=0.031) and fasting glucose (184.9±86.5 vs. 148.6±61.2 mg/dl, p=0.008) levels. Conclusions: Health insurance status appears to influence achieved glycemic control for U.S. Hispanic/Latino adults with T2D. However, various psychosocial factors potentially influencing cardiometabolic risk independently of health insurance status may also be implicated in the inequitable burden of T2D. ClinicalTrials.gov Identifier: NCT03736486.

Keywords: Hispanic; Latino; cardiometabolic risk; diabetes; health insurance.

Conflict of interest statement

N.M.G., J.M.M., W.C.B., A.L., and D.K. are employees of SDRI. C.B.H. was an employee at SDRI at the time the study was being conducted. D.K. has received honoraria for participation in advisory boards for Novo Nordisk, Sanofi, and Ascensia and is a medical advisor to Glooko and Vicentra. A.M. and I.D. are employees of Santa Barbara Actuaries.

© Namino M. Glantz et al. 2020; Published by Mary Ann Liebert, Inc.

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