Type 2 Diabetes in Asian Americans: Prevention & Management

Introduction to Diabetes Mellitus

Diabetes mellitus is a chronic condition that affects the way the human body converts consumed food into energy. The majority of food breaks down into glucose and is released into the bloodstream. The pancreas secretes the hormone insulin, which enables cells to use blood sugar as energy. Three forms of diabetes have been identified: gestational, type 1, and type 2. In type 2 diabetes (T2D), the patient's body is ineffective at utilizing insulin and is therefore unable to maintain normal blood sugar levels. Ninety percent of all diabetes patients suffer from this form of the disease. Its onset may be postponed — or even avoided altogether — if one adopts a healthful lifestyle, such as routine physical exercise, eating nutritious foods, and achieving or maintaining a healthy weight (Centers for Disease Control and Prevention [CDC], 2017).

Asian Americans and T2D Prevalence

T2D has been found to be highly prevalent among Hispanic Americans, Native Americans, and non-Hispanic Black Americans. However, Asian Americans — the nation's fastest-growing ethnic and racial minority — are also being diagnosed with the disease at a disturbing rate. This subpopulation's perceived low disease burden, self-sufficiency, and educational attainment have impeded healthcare services directed at it. This myth has largely persisted due to the absence of reliable data, which typically grouped all Asian Americans into a single, homogeneous category rather than recognizing the group's internal heterogeneity.

This problem proves especially significant when studying T2D prevalence within this subgroup. In 2014, for instance, the CDC reported an age-adjusted T2D prevalence of nine percent for the Asian-American population overall. This rate is higher than that for non-Hispanic White Americans (7.6 percent), though lower than the rates for Native Americans (15.9 percent), non-Hispanic Black Americans (13.2 percent), and Hispanic Americans (12.8 percent) — thus characterizing Asian Americans as a "moderate risk" population. However, analysis of disaggregated data for Asian-American ethnic subgroups reveals significant differences in disease burden across those subgroups (Nguyen et al., 2015).

Culturally Tailored Interventions

One major issue linked to diabetes among Asian Americans is population awareness. A decade earlier, this group exhibited relatively low diabetes prevalence; however, educating the subpopulation about the disease's seriousness has now become imperative. Unlike other ethnic groups, Body Mass Index (BMI) is not always an applicable measure of disease risk for Asian Americans, which poses an additional challenge. Most diabetes therapies support lifestyle modifications, with researchers revealing that ample exercise and a proper diet aid both diabetes management and prevention and can delay its onset. The traditional low-fat, high-complex-carbohydrate, high-fiber Asian diet, combined with regular physical activity, may facilitate both T2D prevention and management.

Group education and self-management initiatives are recommended for Asian-American diabetics and have demonstrated positive patient outcomes. However, scant evidence exists regarding the efficacy of these interventions for other minority ethnic groups. Cultural tailoring is an approach that draws on an understanding of how cultural characteristics influence health behavior in order to design effective programs. A meta-analysis of randomized controlled trials (RCTs) by Nam et al. revealed that culturally adapted diabetes education improved glycemic control more than standard care among diabetics from ethnic minority populations. Very few researchers have examined the efficacy of culturally adapted diabetes education and self-management programs specifically for Chinese diabetics (Sun et al., 2012).

References

Centers for Disease Control and Prevention. (2017, June 1). Diabetes home. https://www.cdc.gov/diabetes/basics/diabetes.html

The CDC works to improve Americans' health security. As the nation's health protection agency, it saves lives and shields citizens from health hazards through critical scientific research, dissemination of relevant health data, and timely response to emerging threats. The CDC sources cited in this paper offer improved insights into diabetes and its many forms.

Kerr, D., Partridge, H., Knott, J., & Thomas, P. W. (2011). HbA1c 3 months after diagnosis predicts premature mortality in patients with new onset type 2 diabetes. Diabetic Medicine, 28(12), 1520–1524.

Kerr and colleagues used patient HbA1c survey data to ascertain five-year mortality following T2D diagnosis within a large community-based cohort enrolled in a local diabetes education program shortly after diagnosis. Referrals for T2D patients were reviewed over five years (1999–2003), and the causes underlying mortality rates through end-2007 were determined through regression analysis.

King, G. L. (2014, May 5). Stopping diabetes in the Asian American community.

American Diabetes Association researcher King drew on survey data from Joslin Diabetes Center to describe the individual impact of diabetes on himself, his family members, and the broader Asian-American community. The paper describes the causes underlying high diabetes prevalence among Asian Americans, outlines the researcher's motivations for studying the disease in this population, and proposes solutions to the key challenges in diabetes management and prevention within this community.

Nguyen, T. H., Nguyen, T.-N., Fischer, T., Ha, W., & Tran, T. V. (2015). Type 2 diabetes among Asian Americans: Prevalence and prevention. World Journal of Diabetes, 6(4), 543–547. http://doi.org/10.4239/wjd.v6.i4.543

This article focuses on the growing problem of high T2D prevalence among Hispanic Americans, Native Americans, and non-Hispanic Black populations, while devoting considerable attention to diabetes incidence in the Asian-American population. The paper draws on prior studies to analyze increasing diabetes cases in this population and the factors driving that growth.

Sun, A. C., Tsoh, J. Y., Saw, A., Chan, J. L., & Cheng, J. W. (2012). Effectiveness of a culturally tailored diabetes self-management program for Chinese Americans. The Diabetes Educator, 38(5), 685–694. http://doi.org/10.1177/0145721712450922

This paper assessed the effectiveness and feasibility of a support-group-style diabetes education and self-management program targeting Chinese-American diabetics. The authors hypothesized that, by the end of the intervention, participants would demonstrate greater knowledge of sound diabetes practices and better application of those practices, improved social support, and improved HbA1c results. Study goals specified that at least half of participants would show appreciably improved diabetes knowledge and practice; at least half would self-report increased emotional support; and no fewer than thirty percent would exhibit significantly improved A1C levels.

Theobald, M. (2014, September 16). 5 ways to lower your A1C. https://www.everydayhealth.com/hs/type-2-diabetes-live-better-guide/lower-your-a1c/

The author outlines the significance of home blood glucose testing as a valuable tool in everyday diabetes management, while noting that this practice provides only a snapshot of the body's momentary state rather than a picture of long-term trends. The paper also explains the periodic HbA1c test administered by physicians to measure average blood glucose over three months, which offers a more accurate assessment of a patient's long-term T2D management plan.