Diabetes and diabetes care among non-obese South Asian Americans: Findings from a population-based study

Prevalence and management of type 2 diabetes among Chinese Americans

AIMS

: This study examines: (a) the prevalence rate of type 2 diabetes mellitus (T2DM) in Chinese Americans (CAs); (b) the influence of acculturative status (i.e. generational status and linguistic fluency) on T2DM prevalence; (c) and differences in diabetes management between CAs and Non-Hispanic Whites (NHWs).

METHODS

: We used 2011-2018 data from the California Health Interview Survey (CHIS) to analyze the prevalence rate and management of diabetes among the CAs. Chi-squares, linear regressions, and logistic regressions were used to analyze the data.

RESULTS

: After controlling for demographic, socioeconomic, and health behaviors, there were no significant differences in the T2DM prevalence rate between CAs overall or of varying acculturative statuses compared with NHWs. However, there were differences in diabetes management, with first-generation CAs being less likely to exam glucose daily, have medical care plans developed by medical providers, or have confidence in controlling diabetes compared to NHWs. CAs with limited English proficiency (LEP) were less likely to perform self-monitoring of blood glucose or have confidence in managing their diabetes care compared to NHWs. Finally, non-first generation CAs were also more likely to take diabetes medication compared to NHWs.

CONCLUSIONS

: Although the prevalence rate of T2DM was found to be similar between CAs and NHWs, significant differences were found in diabetes care and management. Specifically, those who were less acculturated (e.g. first generation and those with LEP) were less likely to actively manage and have confidence in managing their T2DM. These results highlight the importance of targeting immigrants with LEP in prevention and intervention efforts.

Prevalence of prediabetes and diabetes vary by ethnicity among U.S. Asian adults at healthy weight, overweight, and obesity ranges: an electronic health record study

BACKGROUND

Asian adults develop Type 2 diabetes at a lower body mass index (BMI) compared to other racial/ethnic groups. We examined the variation in prevalence of prediabetes and diabetes among Asian ethnic groups within weight strata by comparing middle-aged Chinese, Filipino, South Asian, and White adults receiving care in the same integrated healthcare delivery system.

METHODS

Our retrospective cross-sectional U.S. study examined data from 283,110 (non-Hispanic) White, 33,263 Chinese, 38,766 Filipino, and 17,959 South Asian adults aged 45-64 years who were members of a Northern California health plan in 2016 and had measured height and weight. Prediabetes and diabetes were classified based on laboratory data, clinical diagnoses, or diabetes pharmacotherapy. Age-standardized prevalence of prediabetes and diabetes were compared by race/ethnicity within healthy weight, overweight, and obesity categories, using standard BMI thresholds for White adults (18.5 to < 25, 25 to < 30, ≥ 30 kg/m2) and lower BMI thresholds for Asian adults (18.5 to < 23, 23 to < 27.5, ≥ 27.5 kg/m2). Prevalence ratios (PRs) were used to compare the prevalence of diabetes and prediabetes for Asian groups to White adults in each weight category, adjusted for age and BMI.

RESULTS

Across all weight categories, diabetes prevalence was higher for Asian than White adults, and among Asian groups it was highest for Filipino and South Asian adults. Compared to White, PRs for South Asian men/women at healthy BMI were 1.8/2.8 for prediabetes and 5.9/8.0 for diabetes, respectively. The PRs for Filipino men/women at healthy BMI were 1.8/2.6 for prediabetes and 5.0/7.5 for diabetes, respectively. For Chinese men/women at healthy BMI, the PRs for prediabetes (2.1/2.9) were similar to Filipino and South Asian, but the PRs for diabetes were lower (2.1/3.4).

CONCLUSION

Chinese, Filipino, and South Asian adults have higher prevalence of prediabetes and diabetes than White adults in all weight categories, despite using lower BMI thresholds for weight classification in Asian groups. Within Asian ethnic groups, Filipino and South Asian adults had considerably higher diabetes prevalence than Chinese adults. Our data emphasize the disproportionate metabolic risk among middle-aged Asian adults and underscore the need for diabetes screening among high-risk Asian groups at healthy BMI levels.

The prevalence and management of diabetes among Vietnamese Americans: A population-based survey of an understudied ethnic group

OBJECTIVES

Although obesity remains relatively rare among Vietnamese Americans, the prevalence of diabetes has increased in this population. This study aims to: 1. Estimate the prevalence of diabetes among non-obese Vietnamese American adults compared to non-obese non-Hispanic whites (NHW). 2. Identify factors associated with diabetes among non-obese Vietnamese Americans. 3. Examine whether Vietnamese Americans and NHW with diabetes are equally as likely to receive optimal frequency of diabetes care (i.e., hemoglobin A1C monitoring, foot care, eye care).

METHODS

We conducted a secondary analysis of non-obese adult Vietnamese Americans using pooled data from the 2007, 2009, 2011 and 2013-2016 waves of the California Health Interview Survey (CHIS).

RESULTS

Only 9% of Vietnamese Americans with diabetes are obese. Non-obese Vietnamese Americans have 60% higher adjusted odds of diabetes compared to non-obese NHW. Among non-obese Vietnamese Americans, those who were older, ever smokers and born outside US had a higher prevalence of diabetes. We found both Vietnamese Americans and NHW with diabetes received similar levels of care.

DISCUSSION

Non-obese Vietnamese Americans have much higher odds of diabetes than NHW. Health professionals can effectively minimize disparities between Vietnamese Americans and NHW with diabetes through appropriate monitoring of foot care, eye care and A1C levels.

A Biopsychosocial Framework to Examine Risk for Type 2 Diabetes in Asian Pacific Islander Immigrants

There is large disparity in the incidence of Type 2 diabetes (T2D) for Asian Pacific Islanders (APIs), one of the fastest growing minority populations in the United States. It is critical to examine biopsychosocial pathways and vulnerability factors that intensify risk for T2D in API. Increasing evidence links chronic stress to poor health outcomes and accelerated development and progression of diseases of aging, such as diabetes. Immigrant populations face unique life stressors, including the challenges associated with the process of adapting to a new environment, new language, and cultural differences. In addition, immigrants experience high levels of psychological distress related to changes of identity and values, loss of support, discrimination, and disempowerment. The purpose of this article is to propose a biopsychosocial framework to explicate potential mechanistic pathways that link cumulative life stress to risk for T2D in the API immigrant population. Unique to the proposed framework is the emphasis on inflammatory processes and accelerated cellular aging (telomere biology). A deeper understanding of biopsychosocial pathways can lead to tailored and targeted interventions to reduce the incidence of T2D in the API immigrant population.

Diabetes and Diabetes Care among Nonobese Japanese-Americans: Findings from a Population-Based Study

Objectives

The objectives of this study are as follows: (1) to determine the prevalence of diabetes among nonobese Japanese-Americans and to determine the adjusted odds of diabetes among nonobese Japanese-Americans compared to non-Hispanic Whites (NHWs); (2) to identify the risk factors associated with having diabetes in a large sample of nonobese Japanese-Americans; and (3) to determine the prevalence and adjusted odds of diabetes management behaviors among nonobese Japanese-Americans with diabetes in comparison to NHWs with diabetes.

Methods

The combined 2007-2016 waves of the adult California Health Interview Survey (CHIS) were used to analyze a nonobese (BMI<30) sample of 2,295 Japanese-Americans and 119,651 NHWs. Chi-square and logistic regression analyses were performed using Stata.

Results

The findings of this representative community study of nonobese Californians indicate that the prevalence of diabetes among Japanese-American respondents was higher than their NHW counterparts (8.0% versus 4.5%). Prevalence increased markedly with age; one-quarter of nonobese Japanese Americans aged 80 and older had diabetes.

Conclusions

The prevalence of diabetes among nonobese Japanese-Americans is significantly higher than that among NHWs. There is an urgent need to develop appropriate intervention and prevention approaches with lifestyle modification specifically targeted towards nonobese Japanese-Americans.