Abstract
Background: Hispanics/Latinos in the US are at high risk of type 2 diabetes mellitus (T2D). The American Diabetes Association (ADA) consensus statement recommends prediabetes screening in persons with body mass index (BMI) ≥ 25 kg/m 2 from at-risk racial/ethnic groups and/or with additional T2D risk factors to identify those who may benefit from lifestyle and/or pharmacological (metformin) therapy to prevent T2D. Little is known about the proportion of diverse Hispanics/Latinos who have prediabetes and may benefit from such preventive measures. Objectives: This study examined prediabetes prevalence in Hispanics/Latinos by BMI categories to estimate the proportion eligible for preventive therapy per ADA guidelines. Methods: The HCHS/SOL is a prospective, multi-center, population-based study that enrolled 16,415 diverse Hispanic/Latino adults aged 18-74 years from four US communities in 2008 – 2011. Prediabetes was defined per ADA criteria as any of the following: fasting plasma glucose 100-125 mg/dL, oral glucose tolerance test 140-199 mg/dL, or hemoglobin A1C 5.7%-6.4%. Prevalence of prediabetes age-standardized to the 2010 US population was examined in persons aged 18-74 years with BMI ≥ 25 kg/m 2 who were free of diabetes and not taking anti-glycemic medication (n=9393) and a sub-sample of those aged 18-60 with BMI ≥ 35 kg/m 2 (n=1528) to determine eligibility for preventive lifestyle and pharmacological therapy, respectively. Overall and heritage specific prevalence estimates (95% confidence intervals) were computed. Analyses were weighted for sampling probability and non-response. Results: Among individuals with BMI ≥ 25 kg/m 2 , 50.9% (49.6 - 52.3) had prediabetes, i.e., could benefit from preventive lifestyle measures. Prevalence was highest in those of Mexican heritage (53.1%; 50.8 – 55.4), followed by Puerto Rican (49.8%; 46.2 – 53.4) and Central American (49.8%; 45.5 – 54.1) heritage. Persons of South American heritage had the lowest prevalence (45.6%; 41.4 – 49.6) (p=0.29 for overall differences across groups). Among persons with BMI ≥ 35 kg/m 2 , 55.7% (52.2 – 59.2) had prediabetes, i.e., could benefit from metformin therapy; prevalence was highest in persons of South American heritage (62.2%; 48.3 – 76.1). Of those who met the criteria for lifestyle measures, about 64% were age 18-44, 69% had at least a high school education, 41% had income <$20,000, and 40% had family history of diabetes. Over 60% of those eligible for preventive metformin therapy were women. Conclusions: Among Hispanics/Latinos who are overweight/obese, over half of those of Mexican heritage and almost half of those of Puerto Rican and Central American heritage need intensive lifestyle measures to prevent progression to diabetes. Among those who are obese, six out of ten individuals of South American heritage met criteria for preventive metformin therapy.
