Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Unique physiology key to diagnosing and treating diabetes in Asian populations

09.05.2012
As the diabetes epidemic spreads worldwide, there is growing concern for Asian American populations, who are nearly twice as likely to develop diabetes, particularly type 2 diabetes. Compounding the problem, many of the standard ways to detect diabetes fail in people of Asian descent.

"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!
Further information:
http://www.joslin.org

More articles from Health and Medicine:

nachricht Scientists learn more about how gene linked to autism affects brain
19.06.2018 | Cincinnati Children's Hospital Medical Center

nachricht Overdosing on Calcium
19.06.2018 | Albert-Ludwigs-Universität Freiburg im Breisgau

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Overdosing on Calcium

Nano crystals impact stem cell fate during bone formation

Scientists from the University of Freiburg and the University of Basel identified a master regulator for bone regeneration. Prasad Shastri, Professor of...

Im Focus: AchemAsia 2019 will take place in Shanghai

Moving into its fourth decade, AchemAsia is setting out for new horizons: The International Expo and Innovation Forum for Sustainable Chemical Production will take place from 21-23 May 2019 in Shanghai, China. With an updated event profile, the eleventh edition focusses on topics that are especially relevant for the Chinese process industry, putting a strong emphasis on sustainability and innovation.

Founded in 1989 as a spin-off of ACHEMA to cater to the needs of China’s then developing industry, AchemAsia has since grown into a platform where the latest...

Im Focus: First real-time test of Li-Fi utilization for the industrial Internet of Things

The BMBF-funded OWICELLS project was successfully completed with a final presentation at the BMW plant in Munich. The presentation demonstrated a Li-Fi communication with a mobile robot, while the robot carried out usual production processes (welding, moving and testing parts) in a 5x5m² production cell. The robust, optical wireless transmission is based on spatial diversity; in other words, data is sent and received simultaneously by several LEDs and several photodiodes. The system can transmit data at more than 100 Mbit/s and five milliseconds latency.

Modern production technologies in the automobile industry must become more flexible in order to fulfil individual customer requirements.

Im Focus: Sharp images with flexible fibers

An international team of scientists has discovered a new way to transfer image information through multimodal fibers with almost no distortion - even if the fiber is bent. The results of the study, to which scientist from the Leibniz-Institute of Photonic Technology Jena (Leibniz IPHT) contributed, were published on 6thJune in the highly-cited journal Physical Review Letters.

Endoscopes allow doctors to see into a patient’s body like through a keyhole. Typically, the images are transmitted via a bundle of several hundreds of optical...

Im Focus: Photoexcited graphene puzzle solved

A boost for graphene-based light detectors

Light detection and control lies at the heart of many modern device applications, such as smartphone cameras. Using graphene as a light-sensitive material for...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Munich conference on asteroid detection, tracking and defense

13.06.2018 | Event News

2nd International Baltic Earth Conference in Denmark: “The Baltic Sea region in Transition”

08.06.2018 | Event News

ISEKI_Food 2018: Conference with Holistic View of Food Production

05.06.2018 | Event News

 
Latest News

Carbon nanotube optics provide optical-based quantum cryptography and quantum computing

19.06.2018 | Physics and Astronomy

How to track and trace a protein: Nanosensors monitor intracellular deliveries

19.06.2018 | Life Sciences

New material for splitting water

19.06.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>