AUSTIN, Texas — Mexican Americans in one of the poorest counties in Texas will soon have new culturally tailored tools to better understand the relationship between weight loss and the onset of diabetes. The effort is aimed at dramatically reducing the number of individuals who eventually develop the disease and suffer its devastating effects.
Researchers at The University of Texas at Austin and The University of Texas Health Science Center at Houston (UTHealth) School of Public Health have received a $2.9 million, five-year award from the National Institute of Diabetes and Digestive and Kidney Diseases to prevent diabetes in Hispanics who are at risk of developing the disease.
For more than 25 years, Sharon Brown, a professor at the UT Austin School of Nursing, in collaboration with Craig Hanis at the Human Genetics Center at UTHealth School of Public Health, has led the Starr County Border Health Initiative, a series of research studies conducted in an impoverished Texas-Mexico border community. During this time, Brown has developed and tested culturally tailored, community-based methods designed to help Mexican Americans take control of their diabetes and improve their health.
“We were always aimed at diabetes self-management so individuals could learn how to keep their blood glucoses under control,” she said. “Clearly it would be so much better if we could get to people earlier before they have diabetes and try to prevent or, at least, delay it.”
The major precursor to Type 2 diabetes is abdominal obesity, which is associated with the most dangerous risk factors for serious diabetes-related complications. The researchers say they are confident that a culturally sensitive intervention can slow or perhaps even halt the progression of prediabetes to diabetes.
A number of factors may influence the high rates of Type 2 diabetes in Hispanics, including Native American genetic admixture combined with environmental risk factors such as low socioeconomic status, barriers to accessing health care, underutilization of health care resources, lower rates of insurance coverage and lack of health education.
Brown’s current research study, “Diabetes Prevention Culturally Tailored for Mexican Americans,” uses self-management education, but instead of working with people who already have diabetes, she is recruiting 300 individuals from Starr County who are diagnosed with prediabetes, that is, they haven’t yet developed the disease but they are on the path to developing it in the next few years.
Specifically, there is no carb-counting; just practical dietary guidance on portion control, food preparation demonstrations, and supervised trips to the grocery stores to learn how to read food labels and locate healthier food choices.
“We provide general principles and knowledge about food preparation and eating the foods they like, such as lowering fat and sodium content and portion control,” Brown said.
She and co-principal investigator Hanis have based their new intervention on a large nationwide study on diabetes prevention initially published in 2002 that found that lifestyle change was the most effective strategy in preventing diabetes in persons already diagnosed with prediabetes.
The new study will also look at whether these individuals have any genes that predict how well they respond to the lifestyle intervention.
“Are there genetic differences in people who respond to this intervention and those who don’t? Because some people have such a severe form of diabetes, lifestyle changes may not work as well for them,” Brown said. “The genetic aspect is very exploratory and will be directed by Dr. Hanis. If it turns out that cases in which people experience a more severe, downhill disease process are linked to a genetic profile, then that will need further, more in-depth investigation.”
Brown’s team is also integrating motivational interviewing, a new communication tool she anticipates will prompt a desire to make health-related lifestyle changes.