"The medical profession needs to be aware of and address the unique characteristics of this population," said George L. King, M.D., 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."
Dr. King was lead author of nine diabetes specialists nationwide who collaboratively wrote an article published in the May 2012 edition of Diabetes Care highlighting a comprehensive range of research findings presented at an international symposium held in Honolulu in September 2011.
The authors compiled extensive data on various groups that comprise the Asian American population, encompassing immigrants from numerous East Asian countries and those born in the United States. They also studied diabetes incidence in Native Hawaiians and Pacific Islanders.
Although there are large differences in immigration patterns and lifestyle adaptations to U.S. culture among these groups, common threads and new insights are emerging. Researchers are finding significant differences in how diabetes affects the body's chemistry, how to view body weight, and why commonly used laboratory tests may not be reliable in Asian populations.
"Type 1 diabetes can be difficult to clinically differentiate from type 2 diabetes in Asians," said Dr. William C. Hsu, M.D., who with Dr. King co-directs the Asian American Diabetes Initiative at Joslin. Dr. Hsu, an Assistant Professor of Medicine at HMS, was lead author of a team of 12 experts who wrote a second article published in the same edition of Diabetes Care. These authors focused on the pathophysiology, or the disease process, of diabetes.
Type 1 diabetes is relatively rare in Asians, with incidence five to 10 times lower than in people of European descent. But diagnosing the disease is more difficult because 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. More research is needed to learn what other biological factors in Asians patients lead to the destruction of insulin-making beta cells, resulting in type 1 diabetes. Lab tests then could be developed to detect these specific factors.
Type 2 diabetes is the most common form of diabetes in Asian Americans, with prevalence of diagnosed cases in recent years jumping from approximately 1 or 2 percent to 10 percent today, compared with 6 percent in the general population. Many others are undiagnosed or at risk, falling into the "pre-diabetes" category. In type 2 diabetes, the pancreas produces insulin but not enough, or the body's cells resist its effect. 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 (19) for the general population.
"The BMI in Asian patients can be misleading. They can look quite skinny," Dr. Hsu said. "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. If detected in the pre-diabetes stage, the disease often can be prevented.
To diagnose diabetes, a commonly used tool—the fasting plasma glucose—fails to detect abnormal glucose tolerance in many Asian Americans. The authors recommend the oral glucose tolerance test, which although more cumbersome to do, has greater sensitivity and reliability in Asian populations.
Per diabetes complications, physicians need be aware that Asian Americans with diabetes tend to have a lower incidence of cardiovascular disease but higher rates of end-stage renal disease. These patients need to be monitored and treated accordingly.
Per treatments for diabetes, the authors cited the need for more studies: "The unique features of diabetes pathophysiology within this very heterogeneous population may indicate a need for different treatment guidelines." Insulin dosing, oral medications and lifestyle factors such as exercise and nutrition should be enfolded into a diabetes care program tailored to individuals, families and cultural practices.
The team of experts at Joslin's Asian Diabetes Initiative has found that educational materials are most effective when published in both the Asian language and English, allowing younger and older generations to communicate fluidly. Joslin also has developed multilingual websites.
Community-based education programs, which also have proved to be highly effective, need to be expanded. And in national data collection, it is important to include Asian groups as subsets of the general population, with culturally appropriate methods incorporated into the design of surveys.
"While there is much to be gained from ethnically sensitive care, these considerations are only a starting point," Dr. Hsu said. "Ultimately, all diabetes care needs to be tailored to the individual. That's the direction that medicine is going, and all populations will benefit."
About Joslin Diabetes Center
Joslin Diabetes Center, located in Boston, Massachusetts, is the world's largest diabetes research and clinical care organization. Joslin is dedicated to ensuring that people with diabetes live long, healthy lives and offers real hope and progress toward diabetes prevention and a cure. Joslin is an independent, nonprofit institution affiliated with Harvard Medical School.
Our mission is to prevent, treat and cure diabetes. Our vision is a world free of diabetes and its complications.
For more information, visit www.joslin.org
Jeffrey Bright | EurekAlert!
Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University
The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy