What disease occurs in higher rates in Asian Americans, Native Hawaiians, and Pacific Islander Americans than in the general American population?
Can you guess?
You have a hint right in the title…
Not only do AAPIs have higher risks for developing Type 2 diabetes than the general population, but they also respond differently to diabetes and treatment.
I learned all this at a fascinating conference, the Asian American Native Hawaiian Pacific Islander Diabetes Coalition Conference, organized by that group, the National Council of Asian Pacific Islander Physicians, and the Joslin Diabetes Center last Friday.
Here are 5 reasons why the Asian American Native Hawaiian Pacific Islander Diabetes Coalition Conference was such an eye-opener:
1. DATA IS SPARSE BUT CRUCIAL
This was the most shocking thing I learned.
The medical community lacks data on AAPI populations, even though data is crucial. The AAPI community has disproportionately high rates of diabetes.
Not only that, but our diagnostic considerations and complications are different than Caucasian patients.
Currently the CDC is doing a study of the AAPI population, but that data won’t be out for another two years.
There is practically no data on Native Hawaiian and Pacific Islander populations, even though they have asked to be studied for years. It may be even more important for them because 8 of the worlds top 10 obese nations are the Pacific Islands nations. As you may know, obesity is linked to Type 2 diabetes.
2. DIAGNOSIS AND TREATMENT OF DIABETES IN AAPIS ARE DIFFERENT THAN CAUCASIANS
Here’s why data is crucial: AAPI patients are different than Caucasian diabetes patients.
We Look Different
- AAPIs don’t look like “typical” (read: Caucasian) diabetes patients. We’re smaller in size, so some healthcare providers may not think to check for diabetes because we don’t always have the high body mass indexes (BMI) of Caucasian diabetes patients.
- Type 2 diabetes often doesn’t have visible symptoms in the early stages, so detection is challenging, especially if people rely on risk factors that don’t apply to our populations.
We’re More Sensitive to Weight Changes
- We’re more sensitive to changes in weight. Higher BMIs are associated with diabetes, in general, but even with smaller increases in BMI (that would not be significant for Caucasians), AAPIs have a higher risk for developing diabetes.
We Have Higher Proportions of Dangerous Body Fat
- Even at the same BMI as a Caucasian person, an Asian American generally has a higher body fat percentage.
- AAPIs have more visceral fat, which is the fat that surrounds abdominal organs and that is linked with higher rates of diabetes.
We React Differently to Gestational Diabetes
- Among Asian American gestational (pregnancy) diabetes patients, particularly Chinese Americans, the babies don’t have the higher birth weights that are typically a result of gestational diabetes. It is unclear why that is true.
We Have Different Rates of Complications
- Even though AAPIs experience higher rates of diabetes, they have fewer complications than Caucasian diabetes patients.
Why do we differ in these ways? Healthcare professionals and researchers need more data to understand.
3. DIVERSITY ISSUES AFFECT HEALTHCARE TOO
I was shocked and disappointed that there isn’t more data on AAPI diabetes patients, especially because it seems that every third Asian American (particularly South Asian American) has done research at some time or another in his or her quest to get a health sciences degree.
Why don’t we study our own populations?
One presenter argued that we shouldn’t consider Caucasian diabetes patients the baseline.
What if Caucasians are the outliers and somehow more susceptible to complications from diabetes, for example?
What if AAPIs have better biological coping mechanisms for this disease?
A Caucasian-focused view could cause researchers to overlook this possibility.
Additionally, because AAPI diabetes patients look different than Caucasian patients and because they have different complications, all healthcare practitioners should be aware of these issues to provide the best possible treatment to AAPI patients.
4. HEALTH IS POLITICAL
Do your eyes glaze over when someone starts talking politics?
Do you prefer to remain neutral?
You shouldn’t. Your political activity may be the difference between life and death — or at least health and sickness in our communities.
We all need to be talking to our elected officials to support further research on diabetes in the AAPI community.
Representative Mike Honda, a Democrat from California, spoke at the event, emphasizing that Asian Americans, Native Hawaiians, and Pacific Islander Americans need to pressure their elected officials to support AAPI health initiatives. He encouraged health experts in the room should be working with elected officials to create policy.
5. AAPIs NEED TO STICK TOGETHER, BUT WE NEED TO BE SEPARATED
The AAPI community needs to band together for collective action. This conference was a success because many Asian American and Pacific Islander groups came together to present information on a poorly-studied community.
But from a clinical perspective, and in many other ways, the AAPI community is a diverse group.
We come from 30 countries and speak over 100 different languages.
We have vastly different rates of diabetes, and South Asians lead this group.
One presenter at the conference made the point that data from one Asian American group (e.g. Chinese Americans) cannot be extrapolated to other groups. Therefore, we need to advocate for more research and funding for all of the different AAPI groups.
THE CALL TO ACTION
The Asian American Native Hawaiian Pacific Islander Diabetes Coalition Conference was inspiring in that it did not just educate the attendees but also inspired them to act in their communities.
Here’s what YOU can do about AAPI Diabetes:
1. Manage Risk FactorsWe can do lots of things to reduce our risk of developing diabetes:
Manage Your Weight
- Small changes in weight can significantly decrease your risk of developing diabetes.
- I know it is discouraging to try to lose weight when you have a lot to lose. But even by losing part of that weight, you will gain the benefit of cutting your diabetes risk.
- This works the other way too–those 5 or 10 pounds that creep on over the years could hurt you more than people from non-AAPI backgrounds.
- Here are some healthy recipes to get you started.
Mind Your Waistline
- In AAPIs, BMI is a poor measure of body fat (which is associated with diabetes risk).
- Instead, you should measure your abdominal circumference (a tape measure around the belly, folks) to assess diabetes risk.
- People who tend to carry weight in their bellies (like me) are at greater risk of developing diabetes. We can’t spot reduce, but reducing overall weight is a good way to shrink our waists and lower diabetes risks.
Get Enough Sleep
- Diabetes and sleep deficits are strongly correlated, and if you are the parent of young children I can bet you are sleep deprived!
- It’s not clear whether lack of sleep causes diabetes, but it can’t hurt to get some shut eye instead of putting away that last load of laundry.
2. Take Action in Your Community
Speak Out In Your Communities and Families
- Public health programs that empower members of the community to teach others about diabetes prevention and management have been successful in many AAPI groups.
- In my family and many South Asian families, we typically bond by gathering around the dining table to snack and feast (often on sweets and unhealthy goodies) Instead, what if we bonded by going for a walk outside?
- Instead of bringing something sugary for dessert to a temple, church, or mosque event, why not try bringing fruit or a healthy salad?
Write or Call Your Elected Officials
- Call or write your elected officials to support diabetes research and education efforts. The American Diabetes Association has a helpful website that shows exactly how you can take action.
- Representative Mike Honda (D-CA) urged us all to inform elected officials of the pressing health needs in our community and to insist on accountability.
3. Support Research
- Many presenters said that AAPIs don’t participate in studies and clinical trials as often as they would like. Greater participation could lead to better treatment options for AAPIs.
- Consider participating in studies or clinical trials, taking into account the risks and benefits.
Have you had experiences with diabetes? What are your tips for managing it? How do you minimize risk factors for diabetes in your family?
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