According to the 1988-1994 National Health and Nutrition Examination Survey III (NHANES III), the prevalence of diabetes is 1.8 times higher in Mexican Americans than in whites (20.3% vs. 11.2%) (Harris et al. 1998a).
The influence of indigenous and African admixture has been hypothesized as accounting for the disproportionate rate of diabetes among Latinos. Rates of diabetes in Mexican Americans have increased 17% since the 1982-1984 Hispanic Health and Nutrition Examination Survey (HHANES) (Harris et al. 1998a). These findings are consistent with data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1990-1998, which reflect a 38% increase in the prevalence of diabetes among Latinos (Mokdad et al. 2000). The age-and sex-standardized prevalence of undiagnosed diabetes also was higher in Mexican Americans than in whites (4.2% vs. 2.5%) (Harris et al. 1998a).
A major problem that contributes to excess morbidity and secondary complications due to diabetes in Latinos is their greater likelihood of receiving a diagnosis and treatment when the disease is more advanced. In fact, compared with whites, Latinos with diabetes were less likely to report preventive care to detect diabetes-related complications. For example, Latinos were less likely to have documented dilated eye examinations (59.6% vs. 54.1%), foot examinations (56.2% vs. 46.8%), self-monitoring of blood glucose (48.1% vs. 34.8%), and glycosylated hemoglobin tests (26.5% vs. 17.6%) (Centers for Disease Control and Prevention 2000a). Prevalence of diabetic retinopathy was 84% higher in Mexican Americans than in whites in those previously diagnosed with diabetes (Harris et al. 1998b). A study of hospitalizations for lower-extremity amputations in south Texas found that diabetes caused a higher proportion of amputations among Mexican Americans than among whites (85.9% vs. 56.3%) (Lavery et al. 1999). Additionally, Mexican Americans are at higher risk for developing proteinuria and end-stage renal disease (Pugh 1996). The severity of these problems points to the importance of encouraging health care access and care seeking among Latinos, as well as preventive measures that may reduce their risk of developing diabetes, such as engaging in physical activity, maintaining ideal body weight, and developing healthy nutritional habits. The HHANES study showed that 24% of the Mexican Americans, 40% of the Puerto Ricans, and 58% of the Cubans who had diabetes were unaware that they had the disease (Flegal et al. 1991).
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