Diabetes is a growing national and global health threat affecting people of all ages — and certain populations are disproportionately affected by the disease, including Asians.

In 2007, the Centers for Disease Control (CDC) determined that diabetes affected 23.6 million people in the United States. That means that about 7.8 percent of the U.S. population is living with the disease. However, only 17.9 million people have been diagnosed with diabetes, while 5.7 million people are undiagnosed. The American Diabetes Association estimates 57 million people have pre-diabetes.[i]

The number of people with diabetes is growing rapidly in Asian countries too. There are currently more people with diabetes in China than with diabetes in the United States, and the number of people with diabetes will grow more rapidly in China than in this country in years to come.[ii] According to estimates from the International Diabetes Foundation and others, the number of people with diabetes worldwide is expected to triple by 2025. The United States will experience the third largest increase in patients with diabetes, with the other top five countries located in Asia.[iii]

diabetes

Diabetes in Asian Americans and Pacific Islanders and the impact of Western culture

Data on the number of Asian and Pacific Islander Americans with diabetes is limited, though studies show that type 2 diabetes is a growing problem. For example, the prevalence of type 2 diabetes is two to three times higher among Japanese Americans living in Seattle compared to non-Hispanic whites.  And the prevalence of diabetes is two and a half times higher among Native Hawaiians compared to white residents of Hawai‘i.[iv]

For Asians, the increase in type 2 diabetes is associated with lifestyle changes experienced when they adapt to Western culture. Data shows a prevalence of type 2 diabetes to be higher in migrant Asians than in nonmigrant Asians. Similarly, studies in Pacific Islander populations suggest that changes in diet and reduced physical activity contribute to the cause of type 2 diabetes.[v]

The prevalence of obesity also increases as those of Chinese or Asian origin move to Western environments.[vi] But, diabetes occurs in Asians at a seemingly normal weight with low body mass index (BMI) too. The current standards set by the World Health Organization (WHO) for taking action on risks related to overweight and obesity do not provide an adequate basis for most Asian populations.[vii]

The food choices of some Asian Americans and Pacific Islanders have changed due to their migration to the United States and to modern times. Instead of their traditional plant- and fish-based diets, many are choosing foods with more animal protein, animal fats, and processed carbohydrates. In addition, they have become less physically active. As a result, their chances of developing diabetes have increased.[viii]

Samoans and native Hawaiians are among the most obese people in the world. In each population, both men and women have average BMIs that exceed those currently used to define obesity in the general U.S. population.[ix] Native Hawaiians have more than twice the rate of diabetes as whites and are more than 5.7 times as likely as whites to die from diabetes.[x] Whether residing on their home islands or the U.S. mainland, Samoans, native Hawaiians, and Micronesians are frequently affected by obesity and type 2 diabetes.[xi]

To find out your risk for type 2 diabetes, check each item that applies to you.  The more items you check, the higher your risk.[xii]

  • I have a parent, brother, or sister with diabetes.
  • My family background is Alaska Native, American Indian, African American, Hispanic/Latino, Asian American, or Pacific Islander.
  • I have had gestational diabetes, or I gave birth to at least one baby weighing more than nine pounds.
  • My blood pressure is 140/90 mm Hg or above, or I have been told that I have high blood pressure.
  • My cholesterol levels are not normal. My HDL cholesterol — “good” cholesterol — is below 35 mg/dL, or my triglyceride level is above 250 mg/dL.
  • I am fairly inactive. I exercise fewer than three times a week.
  • I have polycystic ovary syndrome, also called PCOS — women only.
  • On previous testing, I had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).
  • I have other clinical conditions associated with insulin resistance, such as a condition called acanthosis nigricans, characterized by a dark, velvety rash around my neck or armpits.
  • I have a history of cardiovascular disease.

The following was derived from information produced by the American Diabetes Association.

What is Diabetes?[xiii]

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

Type 2 diabetes

Results from insulin resistance (a condition in which the body fails to properly use insulin) combined with relative insulin deficiency. Most Asians who are diagnosed with diabetes have type 2 diabetes. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

  • Right away, your cells may be starved for energy.
  • Over time, high blood glucose levels may hurt your eyes, kidneys, nerves, or heart.

Type 1 diabetes

Type 1 diabetes results from the body’s failure to produce insulin, the hormone that “unlocks” the cells of the body, allowing glucose to enter and fuel them. It is estimated that few Asians who are diagnosed with diabetes have type 1 diabetes. Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes.

Gestational diabetes

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4 percent of all pregnant women — about 135,000 cases of gestational diabetes in the United States each year.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia.

Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes.

Pre-diabetes

Before people develop type 2 diabetes, they almost always have “pre-diabetes” — blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.

If you or anyone you know has been diagnosed with any type of diabetes and are taking complimentary or alternative medicine, please consult with your physician.

[1] National Diabetes Fact Sheet, 2007. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed on October 16, 2008.

[1] Diabetes Action Now. World Health Organization: Diabetes Programme. Available at: http://www.who.int/diabetes/actionnow/booklet/en/. Accessed on: June 26, 2009.

[1] Anderson PA, McGill JB, Tuttle KR. Protein kinase C ß inhibition: the promise for treatment of diabetic nephropathy. Nephrology and Hypertension (2007), 16:397-402.

[1] National Diabetes Information Clearinghouse (NDIC): A service of the national institute of diabetes and digestive and kidney diseases (NIDDK), NIH. Am I at risk for type 2 diabetes?: taking steps to lower your risk of getting diabetes. Available at: http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.htm#6. Accessed on June 17, 2009.

[1] Fujimoto WF. Diabetes in Asian and Pacific Islanders Americans. In: Diabetes in America, 2nd edition.  Published by the National Institutes of Health, NIH publication no. 95-1468, 1995.

[1] Reducing health disparities in Asian American and Pacific Island populations: A provider’s guide to quality & culture seminar. Available at http://erc.msh.org/quality&culture. Accessed on June 24, 2009.

[1] Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet (2004) Volume 363:157-163.

[1] Diabetes and Asian Americans and Pacific Islanders. National Diabetes Education Program. National Diabetes Information Clearinghouse. Available at: http://diabetes.niddk.nih.gov/dm/pubs/asianamerican/. Accessed on: June 24, 2009.

[1] Reducing health disparities in Asian American and Pacific Island populations: A provider’s guide to quality & culture seminar. Available at http://erc.msh.org/quality&culture. Accessed on June 24, 2009.

[1] Native Hawaiians/Other Pacific Islanders profile. U.S. Department of Health and Human Services: The Office of Minority Health. Available at: http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=71. Accessed on: June 26, 2009.

[1] Reducing health disparities in Asian American and Pacific Island populations: A provider’s guide to quality & culture seminar. Available at http://erc.msh.org/quality&culture. Accessed on June 24, 2009.

[1] Diabetes Overview and Diabetes in Asian and Pacific Islander Americans, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Available at: http://www.ndep.nih.gov/am-i-at-risk/DiabetesRiskFactors.aspx. Accessed on June 26, 2009.

[1] “All about Diabetes.” American Diabetes Association, http://www.diabetes.org/about-diabetes.jsp. Accessed June 8, 2009.

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