Mil Familias: Diabetes in Latino Families
Mil Familias is an innovative ten-year initiative to improve the lives of Latino families affected by type 2 diabetes (T2D) through research, education and care. The Mil Familias strategy is to understand why diabetes is so common among Latino families and then establish education, prevention and treatment interventions to reverse the upward trend of this disease. Beyond Type 2 talked to Namino Glantz, associate director of Mil Familias, to get details on what makes the program so important.
BT2: What is Mil Familias?
NG: Mil Familias is based in a California Central Coast county in which Latinos comprise 43 percent of the population, and ~17 percent of the Latino population has uncontrolled diabetes. Incited by the disparate burden of diabetes on Latinos, and recognizing that effective prevention and treatment rest on understanding diabetes determinants as well as accurate risk calculation, Sansum Diabetes Research Institute launched the Mil Familias research initiative (milfamilias.com) in 2017 with a successful operational pilot and, in 2018, transitioned to a full-scale program.
Mil Familias is a unique program, enrolling 1000 U.S. Latino families with at least one member living with T2D. From each participant, data is collected on over 100 variables covering all five determinants of health (genetics, biology, behavior, psychology, environment). Information is compiled in a Living Information Bank of Latino-focused big data and biosamples. Data is analyzed and interpreted to inform novel environmental, behavioral, pharmaceutical, technological and policy interventions aimed at reducing the inequitable burden of diabetes and cardio-metabolic disease in Latinos.
Why work with Latino families? What is needed in this population?
Diabetes disproportionately impacts certain people and communities. Recent data from the Centers for Disease Control and Prevention (CDC) shows that diabetes rates are twice as high for Latinos of Mexican heritage compared to white people. Type 2 diabetes disproportionately and unjustly impacts those who can least afford it, including older adults, racial/ethnic minorities and those who are uninsured.
Our local community outreach program found that, among Latino adults in Santa Barbara, CA:
- Almost one in two Latino adults are at risk for type 2 diabetes.
- A significant number of Latino adults have diabetes but were not aware.
This puts them at risk for serious complications such as heart attack, stroke and kidney failure. For many local families, it can be challenging to achieve optimal diabetes control.
Care, education and research are needed, and it is best if this is conducted among, by and for Latinos.
How does type 2 diabetes impact Latino populations in the US, specifically in California?
Latino families of Mexican heritage are facing diabetes at rates twice as high as the national average—9 percent (white) vs 18 percent (Mexican Latino). Further, Latino families also have much higher rates of diabetes-related complications and are more likely than non-Latino whites to be hospitalized for uncontrolled diabetes. Additionally, communities facing the highest burden of diabetes are rarely participants in new medical discoveries and innovation.
Key national statistics regarding the impact of diabetes in Latinos include:
- Hispanics/Latinos constitute 17.6 percent of the US population.
- The Hispanic/Latino population is younger than other US populations; nearly half of US-born Hispanics/Latinos are < age 18.
- Type 2 diabetes is more common in lower-income individuals and those without a college degree.
- Prevalence of diabetes among US Hispanics/Latinos is twice as high as among non-Hispanic Whites.
- Overall control of blood glucose levels is poorer among Hispanic/Latinos than among non-Hispanic Whites.
- More Hispanic/Latinos have extremely elevated HbA1c values compared to non-Hispanic Whites.
- Diabetes is a leading cause of death in Latin America.
- US Hispanic/Latinos are 1.5 times more likely to die from diabetes than non-Hispanic Whites.
- Hispanics/Latinos are more likely to develop diabetes-related eye and kidney disease than non-Hispanic Whites.
- Hispanics/Latinos have a higher mortality rate from stroke than non-Hispanic Whites.
What are the biggest barriers the Latino population faces in terms of health when living in the US?
In the United States, the prevalence of both diagnosed and undiagnosed T2D is nearly twice as high among Mexican-origin Hispanic/Latino adults compared to non-Hispanic whites. Rates of diabetes-related complications including premature death from diabetes, acute stroke and end-stage renal disease are also higher among Hispanic/Latino adults. For minority populations in the United States such as Hispanic/Latinos, it is recognized increasingly that sociocultural influences are important factors in determining an individual’s risk related to the development and progression of T2D and the associated complications. These influences include ethnicity (e.g., Mexican-Americans have a greater diabetes burden than Cuban-Americans); duration and impact of acculturation (the process by which immigrants adopt the attitudes, values, customs, beliefs and behaviors of a new culture); place of residence; achieved education level; and economic status.
Compounding this burden, Hispanic/Latinos are also a minority among diabetes care providers, researchers and research participants (e.g., Hispanic/Latinos are about 40 percent of California’s population but only 8 percent of nurses and 5 percent of doctors). Given that Latinos are 17 percent of the US population but only 1 percent of clinical trial participants, the FDA has placed a priority on increased participation in clinical research by US minorities who have an excess burden of chronic disease such as diabetes.
Are cultural differences addressed in this program? How?
Mil Familias focuses solely on people of Latino/Hispanic background, among whom there is much diversity in socio-demographics and culture. Program activities take place in the participant’s language(s) of preference (Spanish and/or English) and materials have been designed for this population. For instance, questionnaires have been validated for application in Spanish, mostly Mexican Spanish as the majority of Mil Familias participants are of Mexican origin. The entire program is about collecting information on differences—genetic, biological, psychological, behavioral or environmental—that impact diabetes.
Tell us a bit about the “Especialistas”—Are they members of the community? Health professionals? How is this team built?
Especialistas are bilingual, specially trained community health workers who are knowledgeable about type 2 diabetes, interact directly with families to collect data, answer questions and connect families to timely and appropriate resources when necessary. SDRI trains bilingual Latino community health workers in diabetes, clinical research methods, wearable technologies and local care navigation. They are then employed as diabetes research scientists who serve their local community and the broader research community. At enrollment, each Mil Familias participant is paired with an Especialista who speaks their preferred language (Spanish and/or English). Especialistas conduct research activities, i.e., recruit participants, administer informed consent and schedule and conduct face-to-face study visits, in which they assess health, conduct interviews, apply questionnaires and train participants to use wearable activity and sleep monitoring devices.
How can people help Mil Familias and/or receive help from this program?
Mediated by Especialistas, each family member contributes information about themselves to create a one-of-a-kind database about Latino health, behavior, lifestyle and environment. Based on the data, Mil Familias plans to collaboratively create new diabetes interventions in the areas of education, prevention, technology, policy, treatment and more.
Participants receive—free of cost—a health promotion assessment, a diabetes-relevant lab panel, the chance to use physical activity and sleep monitors (Fitbit and ActiGraph) and especially a one-on-one relationship with a trusted, trained Especialista (see above).
Anyone interested in participating in Mil Familias can: