Skinny-Looking Asians Not Free Of Diabetes Risk, Study

As the diabetes epidemic spreads worldwide, there is growing concern for Asian American populations as many of the standard ways to detect diabetes fail in people of Asian descent.

AsianScientist (May 9, 2012) – As the diabetes epidemic spreads worldwide, there is growing concern for Asian American populations, who are nearly twice as likely to develop diabetes, according to nine diabetes specialists in the May 2012 edition of Diabetes Care.

Compounding the problem, many of the standard ways to detect diabetes fail in people of Asian descent, with ‘skinny-looking’ Asians still at a risk for diabetes, particularly type 2 diabetes, they say.

“The medical profession needs to be aware of and address the unique characteristics of this population,” said lead author Prof. George L. King, Chief Scientific Officer at Joslin Diabetes Center and Professor of Medicine at Harvard Medical School (HMS). “Without this understanding, diabetes could be misdiagnosed or missed altogether,” he cautioned.

Based on extensive data taken from Asian American populations, including immigrants from East Asia and those born in the United States, researchers are finding significant differences in how diabetes affects those of Asian descent versus the general population.

“Type 1 diabetes can be difficult to clinically differentiate from type 2 diabetes in Asians,” said Dr. William C. Hsu, who co-directs the Asian American Diabetes Initiative at Joslin.

While Type 1 diabetes is relatively rare in Asians, with incidence five to 10 times lower than in people of European descent, the genetic markers and blood factors generally associated with type 1 diabetes are present in only 30 percent of patients of Asian descent.

In other words, simply relying on conventional tests would lead to misdiagnosis of a large percentage of Asians who have type 1 diabetes.

As for Type 2 diabetes, the most common form of diabetes in Asian Americans, the prevalence of diagnosed cases in recent years has jumped from approximately 1-2 percent to 10 percent today, compared with 6 percent in the general population.

More concerningly, many insulin deficient Asian Americans remain undiagnosed, as a risk factor commonly associated with type 2 diabetes is excess weight, often measured by calculating the body mass index (BMI).

But for Asian Americans with type 2 diabetes, the average BMI is between 24 and 25, well within the normal BMI range for the general population, leading to misleading conclusions.

“The BMI in Asian patients can be misleading. They can look quite skinny,” said Hsu. “Instead, we’re learning that a better indicator of type 2 diabetes risk in Asians is fat deposits at the waistline.”

More research is needed to understand how visceral fat contributes to the onset of type 2 diabetes, Hsu said, as it would help detection at the pre-diabetes stage.

A frequently used tool to diagnose diabetes – the fasting plasma glucose – fails to detect abnormal glucose tolerance in many Asian Americans, they say. The authors recommend the oral glucose tolerance test, which although more cumbersome to do, has greater sensitivity and reliability in Asian populations.

To address the diabetes epidemic, the authors recommend that diabetes treatments – such as insulin dosing, oral medications, exercise, and nutrition – be tailored to individuals, families, and cultural practices.

“Ultimately, all diabetes care needs to be tailored to the individual,” said Hsu. “That’s the direction that medicine is going, and all populations will benefit.”

The review can be found at: King GL et al. (2012) Understanding and Addressing Unique Needs of Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders.

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Source: Joslin Diabetes Center; Photo: Yang Aijun/World Bank.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

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