Latino Communities at High Risk for Diabetes and DME: Causes and Solutions
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When Gladys Soriano’s eyesight became fuzzy, she assumed it was because she was getting older and needed a new prescription. But, when she went to the optometrist, he revealed a different reason: diabetic macular edema (DME), an eye condition caused by diabetes that can lead to vision loss.
“I said, ‘What?’ I’d had some problems seeing, but nothing crazy,” recalls the 60-year-old native of Puerto Rico who lives in Harrison, New York. “And, I had no symptoms of diabetes. I had no idea I had it.”
Since then, Gladys has revamped her diet to help control her type 2 diabetes and slow the progression of her DME. “I still love my rice, beans, and plantains, but I’m very careful about how much of them I eat now,” she says.
Like Gladys, many people in the Latino community have a high risk of type 2 diabetes and, as a result, DME. The Centers for Disease Control and Prevention predict that more than half of Latino people could face a type 2 diabetes diagnosis in their lifetime, and more than a third will have eyesight-related complications.
Why are diabetes and eye-related issues so common in Latino communities? Here are some of the reasons, plus possible solutions to close the gap.
Factors That Put Latino People at Greater Risk of Diabetes and DME
There’s no one cause of Latinos’ disproportionate risk of diabetes and DME. Logistical, geographical, and cultural factors all play a role. These may include:
Underrepresentation in Research
An analysis published in 2021 of 31 ophthalmology drug trials over 20 years found that Latino people accounted for just 8 percent of the studies’ participants. Ethnically diverse research studies are needed to see how treatments work for specific populations.
Social Determinants of Health (SDOH)
SDOHs, or environmental conditions where people are born or live, saddle many minority neighborhoods with inadequate and pricey healthy food options; spotty healthcare access; unreliable transportation and child care; and paltry or nonexistent health insurance. The time, money, and energy required for medical care can present an unsustainable burden.
Lack of Health Insurance
Retina specialist Raj K. Maturi, MD, an ophthalmologist at Midwest Eye Institute in the Indianapolis area, studies the link between diabetes and health insurance in Latino areas. His work reveals that Latinos without health insurance seek care later, when very sick and more prone to complications.
Language Barriers
If your first language isn’t English, it could be more difficult to communicate with your physician and get proper care, notes Dr. Maturi.
Delayed Treatment
Having to constantly test and monitor blood sugar levels can be so overwhelming that people simply neglect their care. As a result, 42 percent of Latino people with blood sugar problems showed evidence of eye complications in the Los Angeles Latino Eye Study. “Hispanic patients were more likely to come in at a later stage and with more severe diabetic retinopathy — indicating a longer disease duration — and poor blood sugar control, particularly among those on Medicaid,” says Maturi.
Slower Improvement
Latino people also improve more slowly than white people, because Latinos “[receive] fewer screening tests and less diabetes education training, and perform less self-monitoring,” says Maturi.
Last, it can be tricky to catch signs of DME in the first place — regardless of ethnicity. “In many people, there are no real signs of DME,” says Rajeev Ramachandran, MD, an associate professor of ophthalmology at the University of Rochester and chair of Prevent Blindness. “There can be good vision for a while with [retinal disorders]. And, even when problems appear, they may not be noticed.”
That’s exactly what happened to Gladys. “I had small floaters, but they didn’t bother me,” she says.
Left untreated, the symptoms of DME can lead to blindness. For Soriano, the brief bout of blurriness was a vision saver and a wake-up call that regular eye exams are crucial.
How Latino Communities Can Get Better DME Care
Technology and more affordable eye treatment may be the best bets for broadening care options for the Latino community. “We’re testing ways to screen for diabetes using telemedicine and teleophthalmology in primary care clinics, where pictures of your eyes can be read by artificial intelligence [for signs of diabetic damage],” says Dr. Ramachandran.
When it comes to the dearth of Latino people in research studies, the National Institutes of Health, pharmaceutical companies, and public and private research groups are attempting to remedy the situation. ResearchMatch encourages marginalized groups to join projects and trials, while the National Library of Medicine’s ClinicalTrials.gov seeks diverse participants.
Consumer resources, including some in Spanish, offer online information on DME. PreventBlindness, the American Academy of Ophtalmology (AAO), the American Diabetes Association, and Mayo Clinic are just a few sites providing educational materials. Plus, the National Eye Institute and other organizations offer links to affordable eye care.
Among them are:
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