Understanding the impact of five major determinants of health (genetics, biology, behavior, psychology, society/environment) on type 2 diabetes in U.S. Hispanic/Latino families: Mil Familias - a cohort study

Abstract

Background: In the United States (U.S.), the prevalence of both diagnosed and undiagnosed type 2 diabetes (T2D) is nearly twice as high among Mexican-origin Hispanic/Latino adults compared to non-Hispanic Whites. Rates of diabetes-related complications, e.g., acute stroke and end-stage renal disease, are also higher among Hispanic/Latino adults compared to their non-Hispanic/Latino White counterparts. Beyond genetic and biological factors, it is now recognized that sociocultural influences are also important factors in determining risk for T2D and the associated complications. These influences include ethnicity, acculturation, residence, education, and economic status. The primary objective of this study is to determine the influence of the 5 major determinants of human health (genetics, biology, behavior, psychology, society/environment) on the burden of T2D for Latino families. To achieve this objective, Mil Familias (www.milfamilias.sansum.org/) is establishing an observational cohort of 1000 Latino families, with at least one family member living with T2D.

Methods: Specially trained, bilingual Latino/a community health workers (Especialistas) recruit participant families and conduct research activities. Each individual family member will contribute data annually on over 100 different variables relating to their genetics, biology, psychology, behavior, and society/environment, creating a Latino-focused biobank ("Living Information Bank"). This observational cohort study is cross-sectional and longitudinal. Participants are divided into 4 groups: adults age ≥ 18 years with and without T2D, and children age ≥ 7 and < 18 years with and without T2D. Study activities take place through encounters between families and their Especialista. Encounters include screening/enrollment, informed consent, health promotion assessment, laboratory tests, questionnaires, physical activity monitoring, and reflection.

Discussion: By creating and providing the framework for the Cohort Establishment study, we intend to inform new approaches regarding equity and excellence in diabetes research and care. We will examine the complex set of factors that contribute to the burden of diabetes in Latino families and assess if cardio-metabolic disease risks go beyond the traditional biological and genetic factors. Breaking the code on the interplay of cardio-metabolic risk factors may help not only this fast growing segment of the U.S. population, but also other high-risk populations.

Trial registration: Study retrospectively registered at ClinicalTrials.gov (NCT03830840), 2/5/2019 (enrollment began 2/1/2019).

Keywords: Hispanic Americans; Latino; Social determinants of health; Type 2 diabetes.

Conflict of interest statement

Jessikah Morales, Namino Glantz, Arianna Larez, Wendy Bevier, Mary Conneely, and David Kerr are employees of Sansum Diabetes Research Institute. David Kerr is medical advisor to Glooko, Vicentra and Hi.Health. He has received remuneration for participation in advisory boards for Sanofi, Ascensia, NovoNordisk and Abbott Diabetes Care and is in receipt of research funding from Lilly, NovoNordisk and Sanofi.

Ludi Fan, Beverly Reed, Carlos Alatorre, and Rosirene Paczkowski are employees and stockholders of Eli Lilly and Company.

Tamim Ahmed, Andrew Mackenzie, and Ian Duncan declare that they have no competing interest.

This study is partially funded by Eli Lilly and Company, and the study protocol has undergone peer-review by Eli Lilly and Company.

Figures

Fig. 1

Study design. Encounters may be split or combined as long as the Reflection encounter occurs at least 3 months after the HPA encounter