title: Undiagnosed Diabetes and Pre-Diabetes in Health Disparities.
abstract: Globally half of all diabetes mellitus is undiagnosed. We sought to determine the extent and characteristics of undiagnosed type 2 diabetes mellitus and pre-diabetes in Mexican Americans residing in the United States. This disadvantaged population with 50% lifetime risk of diabetes is a microcosm of the current pandemic. We accessed baseline data between 2004 and 2014 from 2,838 adults recruited to our Cameron County Hispanic Cohort (CCHC); a two-stage randomly selected 'Framingham-like' cohort of Mexican Americans on the US Mexico border with severe health disparities. We examined prevalence, risk factors and metabolic health in diagnosed and undiagnosed diabetes and pre-diabetes. Two thirds of this Mexican American population has diabetes or pre-diabetes. Diabetes prevalence was 28.0%, nearly half undiagnosed, and pre-diabetes 31.6%. Mean BMI among those with diabetes was 33.5 kg/m2 compared with 29.0 kg/m2 for those without diabetes. Significant risk factors were low income and educational levels. Most with diabetes had increased waist/hip ratio. Lack of insurance and access to health services played a decisive role in failure to have diabetes diagnosed. Participants with undiagnosed diabetes and pre-diabetes had similar measures of poor metabolic health similar but generally not as severe as those with diagnosed diabetes. More than 50% of a minority Mexican American population in South Texas has diabetes or pre-diabetes and is metabolically unhealthy. Only a third of diabetes cases were diagnosed. Sustained efforts are imperative to identify, diagnose and treat individuals in underserved communities.
authors.affiliation: Division of Epidemiology, University of Texas Health Science Center, Houston, School of Public Health, Brownsville Campus, Brownsville, Texas, United States of America.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Fisher-Hoch
authors.affiliation: Division of Epidemiology, University of Texas Health Science Center, Houston, School of Public Health, Brownsville Campus, Brownsville, Texas, United States of America.
authors.forename: Kristina P
authors.initials: KP
authors.lastname: Vatcheva
authors.affiliation: Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, and Center for Clinical and Translational Sciences at The University of Texas Health Science Center at Houston, Room 1100.05 UT Professional Building, Houston, Texas, United States of America.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rahbar
authors.affiliation: Division of Epidemiology, University of Texas Health Science Center, Houston, School of Public Health, Brownsville Campus, Brownsville, Texas, United States of America.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: McCormick
mesh_terms: D000328:Adult; D015415:Biomarkers; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State; D012307:Risk Factors
chemical_list: D015415:Biomarkers