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Asian Americans Face Higher Diabetes Risk and Not Being Screened

A significant risk factor for diabetes among Asian Americans — even among those who aren’t overweight. Asian Americans are twice as likely as whites to develop diabetes, studies show. Yet doctors may not screen Asian Americans often enough because doctors don’t know enough about the aspects of diabetes special to this group, says Dr. Ping Wang, director of the Joslin Diabetes Center at UCI Medical Center in Orange, Calif.

For one, the body mass index is not always a reliable diabetes risk factor for Asian Americans. BMI is calculated by dividing weight by height squared.

In the United States, being overweight or obese often is cited as a risk factor for diabetes. Yet some Asian Americans have diabetes despite having a normal BMI of 24.9 or less, King says. A BMI of 25 to 29.9 is considered overweight; 30 is obese.
There’s some research suggesting that the normal BMI threshold should be lowered to 23 or 24 for Asians, says Dr. William Hsu, director of the Asian clinic at Joslin Diabetes Center in Boston.

Meanwhile, health-care providers would be wise to consider visceral fat — belly fat — when they’re evaluating Asian Americans for diabetes risk, even patients who have a normal BMI, Hsu says.

Patients, in turn, need to pay attention to reducing their midsection fat by eating healthful food, controlling calories and being physically active every day, Wang says.

That’s easier said than done because Westernization is a contributing factor. Studies of Japanese Americans and Chinese Americans show that prevalence of diabetes is two to seven times higher than in those who live in Japan and China, says Dr. George King, research director of the Joslin Diabetes Center.

Asian Americans living in the United States adopt the same unhealthful behaviors that contribute to diabetes in other racial groups: lack of physical activity and a diet high in calories, fat, sodium and refined sugars.

But Westernization is only one part of the puzzle that researchers are trying to piece together. "It is probably both genes and lifestyle," King says.

When treating diabetes, Hsu suggests the following: "Hit hard, hit early."
He urges aggressive treatment early in the disease, rather than waiting for it to progress before using a combination of medications.

Aggressive treatment may include using insulin therapy earlier. Too often among Asian-American patients, insulin is used as a threat. Patients have an aversion to starting insulin therapy because they mistakenly believe that taking insulin means their disease has worsened.

Findings presented at a Diabetes symposium at the Joslin Diabetes Center in Boston, April 2005