Journal Article Abstracts and Radio Interview

Improving the Care and Management of Hispanics with Diabetes

Host Steven Edelman, MD and Guest Carlos Campos, MD, MPH
Posted June 2016

Overview: Healthcare professionals treating Hispanic patients with diabetes need to be rigorous in monitoring and treating this disease. Special considerations are required to address adherence issues and cultural norms. How can physicians learn to care and manage this growing population? Join host Dr. Steven Edelman and his guest, executive director for the Institute for Public Health & Education Research at the University of Texas Health Sciences, Dr. Carlos Campos, as they discuss the unique opportunities in managing and treating diabetes in the Hispanic population.
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Efficacy and safety of liraglutide, a once-daily human glucagon-like peptide-1 analogue, in Latino/Hispanic patients with type 2 diabetes: post hoc analysis of data from four phase III trials

J. A. Davidson, D. D. Ørsted & C. Campos
February 2016 and Posted June 2016

The aim of the present analysis was to evaluate the efficacy of the glucagon-like peptide-1 receptor agonist liraglutide in Latino/Hispanic individuals with type 2 diabetes, in addition to comparing its treatment effects with those observed in non-Latino/Hispanic individuals. Analyses were performed on patient-level data from a subset of individuals self-defined as Latino/Hispanic from four phase III studies, the LEAD-3, LEAD-4, LEAD-6 and 1860-LIRA-DPP-4 trials. Endpoints included change in glycated haemoglobin (HbA1c) and body weight from baseline. In Latino/Hispanic patients (n =505; 323 treated with liraglutide) after 26weeks, mean HbA1c reductions were significantly greater with both liraglutide 1.2 and 1.8mg versus comparator or placebo in the LEAD-3 and LEAD-4 studies, and with 1.8mg liraglutide in the 1860-LIRA-DPP-4 trial. In LEAD-3 both doses led to significant differences in body weight change among Latino/Hispanic patients versus the comparator. With 1.8 mg liraglutide, difference in weight change was significant only in the 1860-LIRA-DPP-4 trial versus sitagliptin. For both endpoints Latino/Hispanic and non-Latino/Hispanic patients responded to liraglutide similarly. In summary, liraglutide is efficacious for treatment of type 2 diabetes in Latino/Hispanic patients, with a similar efficacy to that seen in non-Latino/Hispanic patients.
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Tips for Communicating With Overweight and Obese Patients

Carlos Campos, MD, MPH, CDE
July 2014

Introduction: A chronic disease such as obesity is primarily managed by the patient who will make decisions on a daily basis that affect their health outcomes. To effectively self-manage their disease, overweight and obese patients must have the necessary knowledge, skills, and motivation to implement a treatment plan that should be developed in collaboration with their health care team. A 2013 survey of overweight patients and their physicians found that only half of these patients reported ever having discussed weight with their physicians. Yet, all physicians indicated they counsel their overweight and obese patients about diet and exercise. These findings, which are relatively unchanged from a 2008 survey, indicate a disconnect in the patient-provider relationship, and suggest an opportunity to improve patientprovider communication regarding excess weight.

The importance of good patient-provider communication cannot be overemphasized due to its significant impact on patient weight and attitudes related to weight management. Moreover, a study of 824 patients who completed a previsit and postvisit questionnaire pertaining to their physician’s consultation style showed that patients valued 3 elements of the office encounter: communication, partnership, and health promotion.

This article describes various communication techniques that can be implemented in the primary care setting to foster good patient-provider communication as part of a collaborative decision-making process. The goal is to improve patient self-management and motivation, and to achieve better health outcomes. Although patient-provider relationships in conjunction with their health system influence patient-centered communication, the empahsis in this article is on provider factors involving a patient’s weight management.
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Chronic Hyperglycemia and Glucose Toxicity:
Pathology and Clinical Sequelae

Carlos Campos, MD, MPH
November 2012

Abstract: Type 2 diabetes mellitus (DM) is a progressive disease characterized by elevated plasma glucose levels. Type 2 DM results from a combination of factors affecting both peripheral tissue insulin sensitivity and β-cell function. A survey of the scientific literature on DM, glucose toxicity, hyperglycemia, nephropathy, neuropathy, reactive oxygen species, and retinopathy cited on PubMed/Medline from January 1975 to May 2011 was conducted. The relevant publications, chosen at the author’s discretion, were used to synthesize this narrative review article. Chronic hyperglycemia imposes damage (glucose toxicity) on a number of cell types and is strongly correlated with the myriad of DM-related complications. Tissues most vulnerable to the effects of prolonged elevated plasma glucose levels include pancreatic β cells and vascular endothelial cells. The ensuing β-cell dysfunction promotes decreased insulin synthesis and secretion, further perpetuating the associated hyperglycemia. As for the vascular endothelium, chronic hyperglycemia is strongly correlated with many DM-related microvascular complications, including retinopathy, nephropathy, and neuropathy. The role of hyperglycemia in macrovascular complications is not well defined. Pathophysiologic modifications that arise in response to chronic hyperglycemia persist and may promote DM-related complications that manifest years later, even if plasma glucose levels have been brought under control. Increasing awareness of the mechanisms by which even modest hyperglycemia promotes long-lasting tissue damage highlights the need to achieve early tight glycemic control in patients with DM before substantial disease progression.
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Addressing Cultural Barriers to the Successful Use
of Insulin in Hispanics with Type 2 Diabetes

Carlos Campos, MD, MPH
August 2007

Abstract: Hispanics experience a higher rate of diabetes than non- Hispanic whites and tend to have worse glycemic control and a greater risk of diabetes related complications. Once oral antidiabetic agents become insufficient, insulin plays an important role in achieving glycemic goals. However, many Hispanic patients are resistant to initiating insulin therapy or hesitant to increase doses, as neces- sary, to control their glucose levels. Barriers to insulin therapy include socioeconomic issues (eg, cost, insurance status), language difficulties, poor health literacy, and cultural beliefs that impact the patient-provider relationship and negatively affect patients’ perceptions of diabetes and insulin. Healthcare providers can help overcome these issues and improve patient-provider communication by practicing culturally competent care. Implementation of a simple titration regimen using once-daily basal insulin may enable Hispanic patients to maintain glycemic control and improve outcomes.
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Treating the Whole Patient for Optimal Management
of Type 2 Diabetes: Considerations for Insulin Therapy

Carlos Campos, MD, MPH
August 2007

Abstract: Primary care physicians are responsible for providing healthcare to most patients with type 2 diabetes. In this role, it is critical that physicians utilize a whole-patient treatment approach that includes lifestyle modifications and pharmacotherapy aimed to achieve glycemic control, in addition to the management of any comorbid conditions or risk factors for cardiovascular complications of diabetes. Due to the progressive nature of the disease, most patients with type 2 diabetes will eventually require insulin to achieve and maintain glycemic control, because of both increased insulin resistance and diminished secretory capacity of the pancreatic cells. Thus, physicians need to be knowledgeable about and com- fortable with the use of insulin, as well as with educating patients and discussing any potential barriers to insulin therapy. The use of a stepwise approach— beginning with basal insulin therapy and adding prandial insulin if necessary—is simple, effective, and appropriate for use in many patients.
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Narrowing the Cultural Divide in Diabetes Mellitus Care:
A Focus on Improving Cultural Competency
to Better Serve Hispanic/Latino Populations

Carlos Campos, MD, MPH, Executive Director
The Institute for Public Health and Education Research Inc., New Braunfels, Texa
April 2006 s


Background:

The number of people who belong to minority groups is increasing in the United States. Many of these groups are more prone to diabetes mellitus (DM), possibly due to a genetic predilection for DM and perhaps as a conse- quence of a disproportionate lack of access to adequate health care. Understanding different cultural perceptions is pivotal in providing health care (and DM care specifically) for people in the Hispanic/Latino community, currently the largest minority group in the United States.

Objective:

The objective of this article was to discuss how to improve health outcomes for patients in minority groups, with specific emphasis on Hispanic/Latino populations with DM.

Methods:

English-language articles were identified through an online search of MEDLINE/PubMed and Google (1990–2006) using the search terms prevalence, diabetes, Hispanic/Latino, and cultural barriers.

Results:

DM is a growing epidemic among the Hispanic/Latino population in the United States. Research has shown that genetically driven insulin resistance, high rates of abdominal obesity, increased visceral fat, and various lifestyle factors contribute to this epidemic. The fact that many Hispanic/Latino individuals lack access to adequate health care leads to health disparities.

Another reason for such discrepancies in DM care may be the way different cultures view DM. These differences may include a stronger emphasis on family support in DM management; a fatalistic view of life and a belief that DM is the result of divine intervention; the predominant use of Spanish, rather than English, as the primary language; and having fewer economic resources, including adequate health insurance.

These factors can lead to increased DM complications because health care providers are missing opportunities to enhance communication of health information to their patients from certain minority populations. Specific strategies to reduce racial and ethnic disparities include providing interpreters, hiring bilingual staff members, and becoming more familiar with the cultural factors that may impact on the delivery of health care services. Efforts to increase health literacy among patients also are important.

Conclusions:

Understanding and reducing disparities in health care can help improve health outcomes for patients who belong to minority groups. Effective communication by DM care providers and efforts to improve health literacy among patients can often lead to improvements in DM management, with an emphasis on achieving glycemic control and reducing the risk for DM-related complications. A better understanding of cultural differences and their impact on health care can influence how clinicians treat their minority patients with DM, leading to effective interventions that may help patients better manage their DM and narrow the cultural divide in DM care. (Insulin. 2006;1:70–76) Copyright © 2006 Excerpta Medica, Inc. 
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