Challenges and Opportunities in Immigrant Health and Diabetes 

Immigrants may be at heightened risk for having their type 2 diabetes go undiagnosed, leading to preventable downstream outcomes. Using nationally representative data with laboratory-collected measurements, we found that the prevalence of diagnosed diabetes was about the same between US- and foreign-born adults. Alarmingly, however, foreign-born adults had a higher prevalence of undiagnosed diabetes, putting them at increased risk for future diabetes complications due to unnecessarily prolonged periods of undetected and untreated diabetes.

Do immigrants receive the same level of car for their type 2 diabetes as their US-born counterparts? We examined whether immigrant status is associated with differences in pharmacological treatment for diabetes, with a specific focus on whether the person was being treated with oral hypoglycemic agents only, insulin only, or both. Immigrants were not more or less likely to be taking oral hypoglycemic agents, but immigrants were less likely to have their diabetes treated by insulin, even after controlling for HbA1c, diabetes duration, and the presence of diabetes complications. 

Following health belief theory, we examined whether nativity modifies one’s perception of how likely they are to develop type 2 diabetes. In a nationally representative sample of adults without a diabetes diagnosis, we found that foreign-born status adults are less likely than US-born adults to say they are at risk for developing diabetes—this was found even among those with confirmed prediabetes. This lower risk perception amongst immigrants may result in poor preventative health behaviors.

Using virtual patients, we experimentally examined whether patients’ immigrant status had any influence on physician trainees’ diabetes treatment decisions. Participants viewed eight virtual patients that differed in immigrant status (born in Mexico or U.S.; other characteristics held constant). We found that trainees were less likely to refer foreign-born patients to endocrinology. Importantly, half of individual-level decisions were influenced by patient immigrant status, but group-level analyses mask these differences. Systematic treatment differences based on non-relevant factors could lead to adverse outcomes for immigrants.