Raising Awareness: Diabetes in Asian American Communities

Authored By: Mia Hsu

Art By: Stefanie Chen

Chronic diseases do not affect all groups equally. Based on standard BMI calculations, Asian Americans have a significantly lower prevalence of obesity than adults of other ethnicities [1]. However, Asian Americans are 40 percent more likely to be diagnosed with diabetes than non-Hispanic Whites [2]. This disproportionate prevalence of diabetes among Asian American populations, particularly in Chinese, Filipino, and South Asian groups, must be addressed through awareness and tailored interventions [3]. 

A primary biological risk factor for Type 2 Diabetes (T2D) is visceral adiposity, or a high accumulation of fat around abdominal organs [4]. Visceral fat is particularly harmful because it contributes to hepatic insulin resistance, or a reduction of the liver’s ability to respond to insulin and remove excess glucose from the blood, leading to higher risks of diabetes [5]. This is especially relevant to Asian Americans as Asian men and women have higher levels of visceral adiposity compared to other ethnicities at the same BMI [6]. They are therefore more likely to develop T2D in general, and most notably at lower BMI values. This claim has been supported through research; T2D tends to occur in Asian Americans starting from a “normal” BMI of 24, whereas T2D tends to occur in White populations with an “overweight” or “obese” BMI of 25 and above, with a BMI of 30 and above being a significant risk factor [7]. The role of visceral fat accumulation as a key factor driving diabetes risk in normal-weight Asian Americans ultimately emphasizes the need for diabetes screening for Asian Americans at lower BMI thresholds. 

Diet modifications can be made independently or in collaboration with a nutritionist or healthcare professional to help reduce the risk of developing T2D among Asian populations. Asians and Asian Americans following a Traditional Asian Diet (TAD) instead of a Traditional Western Diet (TWD) have shown improved insulin sensitivity and weight management. TADs are high in carbohydrates and fiber, but low in fat and animal-based protein, whereas the opposite is true for TWDs [7]. Following a TAD requires a higher consumption of legumes, fruits, vegetables, tofu and soy products, rice and noodles, whole grains, and moderate consumption of eggs, poultry, dairy, and health cooking oils. Consumption of sweetened beverages, dairy products, sugary desserts, and red meat is minimized [8]. Following a TAD can be beneficial in reducing visceral adiposity and therefore the development of T2D in Asians and Asian Americans. While many Asian Americans already follow a TAD, research has shown shifts in dietary patterns for various subgroups, highlighting the increasing diversity of individual dietary patterns. For instance, Asian students who immigrated to the United States began consuming more American-style fast food and salty and sweet snack items and consuming significantly less vegetables [9]. These observed dietary shifts among recent Asian immigrants highlight an even greater likelihood of Westernized eating habits among Asian Americans raised in the U.S. Nutritionists, primary care physicians, and other healthcare professionals must be capable of assessing patients’ unique needs and health profiles to provide individualized dietary recommendations for effective T2D risk reduction. 

Another risk factor for T2D is physical inactivity; studies have demonstrated that Asian American immigrants were 50 percent less likely to achieve the recommended level of physical activity compared to non-Asians born in the U.S. [10]. However, this behavioral risk factor is highly modifiable, and offers a clear opportunity for improvement. Creating awareness of accessible apps and fitness trackers, and working together with community leaders to promote physical activity may lead to changed behavioral and therefore health outcomes. For instance, encouraging the use of stairwells, creating spaces for physical activities in workspaces, and providing free group fitness classes and resources may all be effective methods of promoting increased physical activity and therefore lower T2D risks in Asian American populations [11]. 

To further address the unique needs of Asian American populations, it is essential to consider the higher effectiveness of certain diabetes medications in these groups. For instance, DPP-4 inhibitors are a class of oral medications to treat T2D. They increase insulin secretion and decrease glucagon secretion to promote glucose homeostasis [12]. DPP-4 inhibitors have been shown to have higher effectiveness in lowering glucose levels in Asians compared with non-Asians [13]. While the exact reasons behind this finding is unknown, it is important that physicians are aware of the nuances behind different diabetic treatments with respect to different ethnic populations. 

Addressing T2D in Asian American populations, as well as the U.S. population in general, ultimately requires a complex approach that takes into account both biological and behavioral factors. Higher visceral adiposity in Asian Americans and the subsequently higher risks of T2D in these populations highlights the need for earlier diabetes screening and the development of tailored BMI thresholds for different populations. Encouraging dietary shifts towards a TAD and making efforts to promote physical activity through community engagement and accessible resources can further mitigate these risks. Healthcare professionals must also be aware of the differing effectiveness of diabetes medications across medical groups to provide optimal care. By integrating culturally sensitive interventions and individualized treatment plans, healthcare providers can more effectively manage and reduce the burden of T2D within Asian American communities. 

Bibliography

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