Abstract
BackgroundType 2 diabetes (T2D) imposes a heavy burden in developing countries, requiring effective primary prevention policies. Randomized clinical trials have identified successful strategies in T2D prevention. However, translating these results to real-life scenarios and adapting to ethnocultural differences is a major challenge. Transculturalization allows incorporating cultural factors to diabetes prevention strategies to optimize implementation of clinical trials results. The purpose of this paper is to review the transcultural adaptations developed for T2D prevention in Latin America (LA). MethodsA comprehensive literature review spanning 1960-2016 was performed, using “Diabetes,” “Latin America,” “Prevention,” “Screening,” and “Tools” as key words. ResultsTwo major tasks are underway in LA: adaptation of screening tools for high-risk individuals, and implementation of diabetes prevention programs. The Finnish Diabetes Risk Score (FINDRISC) is the most widely used screening tool to detect new cases of T2D and people with prediabetes, and it has been adapted (LA-FINDRISC) to include the waist circumference cutoff values appropriate for LA population (≥94 cm for men and ≥90 cm for women). The validation of the LA-FINDRISC performance depends on the local characteristics. A LA-FINDRISC score >10 may be the best cutoff to identify individuals with impaired glucose regulation in population-based studies, but a higher score (>12-14) might be more appropriate in a clinical setting. A shorter version of the FINDRISC using only the 4 variables with highest impact has been developed and validated in Colombia (ColDRISC). The translation of the Diabetes Prevention Program study in a Latino population in Venezuela found a significant improvement in cardiometabolic risk factors. An adaptation of the Diabetes Prevention Study in the DEMOJUAN study in Barranquilla, Colombia, reduced 2-hour postload glucose. ConclusionSuccessful transculturalization strategies have been implemented in screening tools and prevention programs in LA.
Highlights
IntroductionProspective studies have found that Type 2 diabetes (T2D) can be prevented by early intervention in people with impaired fasting blood glucose (IFG) and/or impaired glucose tolerance (IGT).[8,9,10,11,12] translating results from controlled clinical trials to real-life scenarios represents a major challenge, when adapting ethnocultural differences.[13] Transculturalization describes the process of adapting concepts from one culture to another, without changing either culture.[14] In other words, transculturalization in diabetes prevention involves the incorporation of cultural factors to optimize implementation of a scientific template for diabetes prevention.[15]
The worldwide prevalence of diabetes in the adult population was 415 million (8.8%) in 2015 and predicted to rise to 642 million (10.4%) by 2040.5 In Latin America (LA), the International Diabetes Federation estimated that 9.4% adults had diabetes and 7.9% had impaired fasting blood glucose (IFG) in 2015, and these numbers are expected to rise to 11.9% and 9.4%, respectively, in 2040.5 In the South and Central America region, 24% of adults with diabetes are undiagnosed, extending to 50% in some countries.[6]
Prospective studies have found that Type 2 diabetes (T2D) can be prevented by early intervention in people with IFG and/or impaired glucose tolerance (IGT).[8,9,10,11,12]
Summary
Prospective studies have found that T2D can be prevented by early intervention in people with IFG and/or impaired glucose tolerance (IGT).[8,9,10,11,12] translating results from controlled clinical trials to real-life scenarios represents a major challenge, when adapting ethnocultural differences.[13] Transculturalization describes the process of adapting concepts from one culture to another, without changing either culture.[14] In other words, transculturalization in diabetes prevention involves the incorporation of cultural factors to optimize implementation of a scientific template for diabetes prevention.[15]. Randomized clinical trials have identified successful strategies in T2D prevention Translating these results to real-life scenarios and adapting to ethnocultural differences is a major challenge. An adaptation of the Diabetes Prevention Study in the DEMOJUAN study in Barranquilla, Colombia, reduced 2-hour postload glucose
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