Determinants of Diabetes Awareness among Hispanics/Latino adults in the US, 2005-2018

Objective: Despite improvements in screening, Hispanics/Latinos bear a disproportionate burden of undiagnosed diabetes in the US. Identifying who is at risk within this large and diverse population is important for targeting interventions. In this study, we sought to characterize risk factors for undiagnosed diabetes among Hispanics/Latinos. We also investigated determinants among insured adults to explore barriers for those with access to care. Research Design and Methods: We used data among 1,883 Hispanic/Latino adults aged > 20 years from the National Health and Nutrition Examination Surveys (2005-2018). Sequential multivariable logistic regression models examined a range of social, healthcare, and individual-level determinants of undiagnosed diabetes (defined as having elevated fasting plasma glucose > 126 mg/dl or HbA1c > 6.5% (48 mmol/mol) in participants self-reporting not having diabetes) in the overall sample, and among those with health insurance (n=1401). Results: Younger age (20-44 years old), male sex, and immigrants (compared to the US-born), but not socioeconomic factors, were significantly associated with higher odds of undiagnosed diabetes compared to being diagnosed. These estimates were attenuated after adjusting for healthcare utilization variables. In fully adjusted models, having no healthcare visits in the past year, reporting no family history of diabetes, and better self-reported health were the predominant risk factors for undiagnosed diabetes in the overall sample, and also among insured Hispanic/Latino adults. Conclusions: Our findings highlight the importance of reaching younger, male, and immigrant Hispanic/Latino adults, as well as addressing barriers to healthcare utilization, even among insured adults, to improve diabetes awareness.