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Pathophysiologic Differences Among Asians, Native Hawaiians, and Other Pacific Islanders
and Treatment Implications
Featured Article:
William C. Hsu, M.D., Edward J. Boyko, M.D., MP.h., Wilfred Y. Fujimoto, M.D., Alka Kanaya, M.D., Wahida Karmally, DrPH, R.D., C.D.E., Andrew Karter, Ph.D.,
George L. King, M.D., Mele Look, M.B.A., Gertraud Maskarinec, M.D., Ph.D., Ranjita Misra, Ph.D., Fahina Tavake-Pasi, M.S., Richard Arakaki, M.D.
Diabetes Care Volume 35: 1189-1198
May, 2012
Introduction
• Differences in pathophysiology may affect diagnosis, prevention and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders
• Differences in cultural beliefs, dietary habits, and behavioral
patterns among AANHPIs require culturally effective translation of interventions into the community
• These issues were discussed by clinicians and researchers
at a September, 2011 conference:
Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action
Hsu W et al. Diabetes Care 2012;35:1189-1198
PATHOPHYSIOLOGIC DIFFERENCES
• Type 1 diabetes: less prevalent in AANHPIs than in
Caucasians • High-risk HLA haplotypes and other genes are less
prevalent in AANHPIs
• Type 1 and type 2 can be difficult to distinguish in East Asian Americans, especially under age 35 years, because BMI is equally low (~ 24 kg/m2) in both types
Hsu W et al. Diabetes Care 2012;35:1189-1198
PATHOPHYSIOLOGIC DIFFERENCES
• Type 2 diabetes: Relationship between excess adiposity and diabetes is not straightforward in AANHPIs
• Native Hawaiians and Pacific Islanders have high prevalence of both type 2 DM and obesity
• South Asians and East Asians have lower average BMI and
waist circumference but higher prevalence of diabetes compared with Caucasians
• Visceral fat is a strong determinant of diabetes risk in Japanese
Americans • Japanese-American and Filipino-Americans have higher more
visceral fat even for equivalent waist circumference • For all quartiles of BMI or weight change, diabetes risk is higher
in Native Hawaiians and Japanese Americans
Hsu W et al. Diabetes Care 2012;35:1189-1198
Hsu W et al. Diabetes Care 2012;35:1189-1198
Hsu W et al. Diabetes Care 2012;35:1189-1198
Diabetes Complications
• As an aggregate, AANHPIs have lower rates of CVD and lower extremity amputation than Caucasians, but higher rates of ESRD
• Differences by ethnicity:
Pacific Islanders have higher rates of MI than Caucasians, and equivalent rates of LEA
South Asians have equal rates of MI and lower rates
of ESRD than Caucasians
Hsu W et al. Diabetes Care 2012;35:1189-1198
TAILORING DIAGNOSIS, PREVENTION, AND TREATMENT TO REFLECT ETHNIC
DIFFERENCES
Diagnosis:
• Asian Americans tend to have more prominent post-challenge hyperglycemia than fasting hyperglycemia
• • Both FPG and HbA1c have significantly lower sensitivity
compared to OGTT• • Since Asians have high risk but often do not have overt
obesity, consider test with the highest sensitivity (OGTT)
Hsu W et al. Diabetes Care 2012;35:1189-1198
Treatment:
• Unclear whether there are differences in medication responses in AANHPI populations
• Cultural differences in food preferences need to be
accounted for • Many Asian cultures include foods high in sodium (sauces,
pickled foods) • “Plate method” may be difficult for some cultures that use
communal plates or multiple small dishes
Hsu W et al. Diabetes Care 2012;35:1189-1198
TAILORING DIAGNOSIS, PREVENTION, AND TREATMENT TO REFLECT ETHNIC
DIFFERENCES
Hsu W et al. Diabetes Care 2012;35:1189-1198
Hsu W et al. Diabetes Care 2012;35:1189-1198
COMMUNITY-BASED INTERVENTIONS AND CULTURE-BASED DIABETES EDUCATION
Models:
• Community-based diabetes prevention and management program in South India reduced fasting blood glucose, reduced body weight, increased intake of dietary fiber
• Healthy Eating and Lifestyle Program, Mai ka Mala’ai:
diabetes self-management programs for Pacific Islanders that combine classroom education with reconnecting to the land to grow produce
Resources: • NDEP AANHPI materials
• AAPCHO: Community Approach to Responding Early
Hsu W et al. Diabetes Care 2012;35:1189-1198
Hsu W et al. Diabetes Care 2012;35:1189-1198
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