Last month marked National Diabetes Awareness Month, yet diabetes remains one of those diseases that remains largely misunderstood by the population at large.
Diabetes refers to a loss of the body’s ability to regulate blood glucose levels by reduced (or absent) activity of a hormone called insulin, which normally helps the body cope with the complex sugars we intake and convert into energy. Too much or too little glucose in the body can produce catastrophic effects on health, and can even be fatal; thus patients with diabetes require close monitoring of their blood glucose levels. Type I diabetics (diagnosed in children) suffer from an inability to make insulin and must inject insulin multiple times a day to keep their blood glucose levels within normal ranges, while Type II diabetics develop an insensitivity to their naturally produced insulin, which can become progressively worse as they age.
Interestingly, it appears as if Asian Americans (and African Americans) have increased risks for diabetes compared to other racial populations. One study, conducted in 2004, found that Asian Americans with a given body mass index (BMI) had a higher prevalence of diabetes than non-Asians at the same BMI, suggesting that the standard cut-offs of BMI that are used to determine increased risks for disease may be ignoring racial differences in how body-fat is distributed and contributes to disease. Dr Sophia Cheung, with the Joslin Diabetes Center, describes the problem thusly:
According to Cheung, important studies that look at prevention and treatment for people with type 2 diabetes use Caucasian patients primarily. “Due to differences in body size, physiology and cultural differences between Asians and Caucasians, results may not be applicable to Asians,” she states. A classic example of this, she says, is the body mass index (BMI). “At a lower BMI, Asians tend to accumulate more body fat compared to Caucasians,” which she says underscores the need for different BMI thresholds for Asian American patients.
In addition, 7.5% of Asian Americans are diagnosed with diabetes, compared to 6.4% of total Americans, and diabetes is the fifth leading cause of death for Asian Americans, while it is seventh for all Americans. The prognosis is particularly grim for Pacific Islanders, who have about a 13% prevalence for diabetes. This higher incidence of diabetes is associated with higher risk for end-stage renal disease, although it hasn’t been linked to higher risks of other health complications.
Recently, another study revealed that Chinese- and Korean-American women are also at increased risk for developing gestational diabetes, a special form of diabetes that afflicts pregnant mothers that can produce complications for both mother and child. Unique compared to other Asian ethnicties, Korean- and Chinese-American women have about a 10% risk for gestational diabetes, compared to 6.7% in the pregnant female population at large.
The problem with understanding racial and ethnic factors associated with disease is frequently that the data collected remains inadequte to fully understand all the issues. Few studies are able to provide the kind of detail needed to fully understand how certain diseases impact communities like ours. Writing about their gestational diabetes study, Dr. Teresa Hillier said:
“Many previous studies have lumped all Asians and Pacific Islanders together,” study co-author Teresa Hillier said in a statement. “We now know that the risk for developing [gestational diabetes] varies greatly depending on your specific ethnic background. Future studies should also look at whether women in these higher risk groups also have more complications.”
Nonetheless, these increased risk factors underscore the importance of healthcare reform, which will help all Americans — including Asian Americans — prevent and treat their diabetes. Recently, Health and Human Services Secretary Kathleen Sebelius released a report detailing the cost of diabetes and how healthcare reform will help diabetic Americans:
One in six individuals with diabetes report avoiding or delaying needed medical care because of cost. Annual health care expenses for a diabetic topped $11,477 in 2007. A box of 100 test strips for blood sugar monitors can cost up to $60 while the price of a vial of insulin can range from $30 to $70, mainly because generic brands are not manufactured in the United States.
A study showed that 80 percent of people with diabetes went uninsured after having lost coverage due to health insurance
transitions triggered by job change or layoff, a move, divorce, graduation from college, or a change in income or health status.
If all states improved diabetes control to the level of the top four best performing states, at least 39,000 fewer patients would
have been admitted for uncontrolled diabetes in 2004, potentially saving $216.7 million.
Sadly, the prognosis and quality of post-diagnostic care following diagnosis of diabetes is dependent upon insurance status, and many insurance companies refuse to cover people pre-diagnosed with diabetes. And it turns out that while Asian Americans, on average, enjoy higher annual incomes than the total American population, we are still woefully underinsured as a population. The Office of Minority Health notes that only 83.9% of Asian Americans have health insurance, compared to 89% of White Americans. Moreover, the Asian American population, insurance coverage varies widely by ethnicity, with more than 13% of Vietnamese (for example) uninsured.
It’s tempting to, as a community, stick our heads into the sand about issues like health and disease, particularly when we are not confronted on a daily basis with the statistics that show that Asian Americans should care about something like diabetes. After all, diabetes affects all Americans, so it’s not a problem we should specifically make a stink about, right? Sadly, no, diabetes, like several other diseases, is of particular concern to racial minorities like Asian Americans, and yet we spend comparatively little time sponsoring private studies, or petitioning for federal studies, to help shed light on these health risks. These diseases are the silent killers in our community, and we must do more to bring the facts about these illnesses out into the open.
Act Now! I know I missed National Diabetes Awareness Month by about two weeks, but it’s not like there’s a bad time to let your Asian American friends know about the risk factors they face associated with Type II diabetes. Send this podcast, released by the CDC, to your friends and family about the risk factors for diabetes amongst Asian Americans, and what one can do to help prevent the development of Type II diabetes, in particular. The Joslin Diabetes Center, at Harvard University, has also developed a Chinese-English bilingual site to help support Asian Americans with diabetes.
Also, you can donate to the following foundations to help support diabetes research: