Older asian couple checking blood sugar level.

Surprising statistics

Despite having a lower body weight, Asian Americans are more likely than Caucasians to have diabetes. Diabetes is a rapidly growing health challenge among Asians and Pacific Islanders who have immigrated to the United States, affecting about 20 percent of Asian Americans; about 90 to 95 percent of Asians with diabetes have type 2 diabetes. In addition, 32 percent of Asian Americans have pre-diabetes, which means that one in two Asian Americans you meet may have diabetes or at risk of having diabetes. The higher rate of type 2 diabetes in Asian descents results from a combination of genetic and environmental influences.

The rate of diabetes in Chinese Americans is notably higher than the rate in the Chinese population living in rural China. Likewise, studies show that rates of diabetes are higher in Japanese Americans living in the U.S. compared to Japanese living in Japan, pointing to the environment as an important contributing factor. On the other hand, second and third-generation Japanese Americans, who are well acculturated in the mainstream American lifestyle, still have higher diabetes rates compared with Caucasians, suggesting genetics to also be an important factor.

  • $322 billion: the cost for diabetes and pre-diabetes care in the United States per year.

  • Over 14.3% of the population in the United States has diabetes, 38.0% is pre-diabetic and at least 36.4% remains undiagnosed.

About Asian Americans

  • Between 2000 and 2010, the Asian population grew by 46 %, which was faster than any other ethnic group. In 2012, this population continued to be the fastest-growing ethnic group.

  • Currently, the Asian population represents 5.6 % of the total population in the country.

  • In the United States, the Chinese (4.0 million) were the largest detailed Asian group, followed by the Filipinos (3.4 million) and Asian Indians (3.2 million).

Diabetes in the Asian American Population

  • ​The National Health and Nutrition Examination Survey (NHANES) in 2011 – 2012 showed that 20.6% of Asian Americans have diabetes and 32.2% of Asian Americans have pre-diabetes, and 50.9% of diabetes cases were undiagnosed which is higher than any other ethnic or racial group.

  • Diabetes is the 5th leading cause of death among Asian Americans and Pacific Islanders.

  • According to data from the NYC Health Department, 48.5% of Asian American adults living in NYC have either diabetes or pre-diabetes.

  • According to a study in NYC, South Asians have about 5 times the odds of having diabetes as U.S. born Caucasians.

Diabetes is a condition in which the body cannot produce or properly respond to insulin. Insulin is a hormone produced from the pancreas. It acts as a key that unlocks the cells to allow glucose (simplest form of sugars derived from food) to travel from the blood into the cells and be used or stored as energy. When there is too little or no insulin, glucose builds up in the blood and will result in what we call "high blood sugar" or "high blood glucose." Uncontrolled high blood glucose levels can damage blood vessels and nerves, and eventually lead to the development of long-term complications that affect the eyes (retinopathy), heart, kidney (nephropathy), feet and skin (neuropathy) and could lead to sexual dysfunction. Studies show that early diagnosis and treatment of diabetes can reduce the risk of complications significantly. In fact, many people with diabetes today can live healthy and happy lives. Diabetes disproportionally affects minority populations, including Asian descents despite their lower body weight. However, there is little public awareness of this epidemic in the Asian American population.

Types of Diabetes

Diabetes is a disease in which the body is unable to produce insulin or unable to properly use and store glucose (a form of sugar). Glucose backs up in the bloodstream - causing one's blood glucose (sometimes referred to as blood sugar) to rise too high. There are two major types of diabetes.

Type 1 Diabetes

In type 1 (formerly called juvenile-onset or insulin-dependent) diabetes, the body completely stops producing any insulin, a hormone that enables the body to use glucose found in foods for energy. People with type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults but can occur at any age. It is also more common in Northern American and European countries. People of East Asian descent have lower rates of type 1 diabetes compared with Caucasians.

Type 2 Diabetes

Type 2 (formerly called adult-onset or non-insulin-dependent) diabetes results when the body doesn't produce enough insulin and/or is unable to use insulin properly (insulin resistance). This form of diabetes usually occurs in people who are over 40, overweight and have a family history of diabetes, although today it is increasingly occurring in younger people, particularly adolescents. People of African, Latino and Asian descent, as well as Native Americans, are at higher risk of developing type 2 diabetes. Up to 95% of diabetes found in Asian descents have type 2 diabetes. A recent study shows that 1 out of 6 Asians living in N.Y.C. has diabetes. Up to 45% of all Asian in N.Y.C. has either DM or pre-diabetes. These patients can often control their diabetes by making lifestyle changes at the early stages. As the disease progresses, patients may need to take oral medications and/or insulin injections to further help them manage their blood glucose.

Gestational Diabetes

Sometimes diabetes is diagnosed during the course of a pregnancy. This condition is common among the Asian population. For a healthy baby, women with 'gestational diabetes' need to learn to manage blood glucose, usually through diet and exercise. Sometimes insulin is required for the remainder of the pregnancy. Blood glucose levels of women with gestational diabetes usually return to normal after delivery of the baby. Women who have had gestational diabetes are at risk for developing type 2 diabetes, however, especially if they are overweight.

Pre-Diabetes

People who have higher than normal blood glucose levels but not high enough to be diagnosed as having diabetes are considered to have "pre-diabetes." People with pre-diabetes are already at risk for developing heart disease. If you have pre-diabetes, you are also more likely to develop type 2 diabetes later in life. The good news is if you have pre-diabetes, you can significantly reduce your chance of developing into diabetes by weight reduction and exercise.
 

Symptoms of Diabetes

  • Excessive thirst 

  • Increased urinary frequency 

  • Unusual weight loss 

  • Blurry vision 

  • Increased hunger 

  • Increased skin, bladder or gum infections 

  • Irritability 

  • Tingling or numbness in hands or feet 

  • Slow to heal wounds 

  • Increased unexplained fatigue 

Only your healthcare provider can tell if you have diabetes. Your provider may do one or more of the following tests to confirm:

TestsResults

Blood Glucose tested any time of the day
(including those tested after meals)

200 mg/dL (or 11.1 mmol/L) or more
and you have symptoms of diabetes.

FPG - Fasting Plasma Glucose
(no food at least for 8hrs)

126 mg/dL (7.0 mmol/L)
or more on two occasions

OGTT - 2hrs Oral Glucose Tolerance Test
(Glucose level 2hrs after drinking a bottle of water containing 75g of glucose)

200 mg/dL (11.1 mmol/L)
or more

A1C
Blood test that measures average blood glucose levels
that were attached to red blood cells over the 2-3 months.
No fasting needed.

6.5% or more


All of the above tests need to be repeated to confirm if you have diabetes. The A1C test is recently approved to be used as a diagnosis of type 2 diabetes. The oral glucose tolerance test (OGTT) may be a better test to determine if an individual of Asian descent has diabetes or pre-diabetes because the fasting plasma glucose test sometimes can miss the diagnosis, especially in this population.
 

If your blood glucose is higher than normal but not high enough to be diagnosed as diabetes, you may have "pre-diabetes." Test results that could indicate pre-diabetes are as follows:

  • FPG   between  100-125 mg/dL or 5.6 – 6.9 mmol/L 
  • OGTT between  140 - 199 mg/dL or 7.8 - 11.0 mmol/L 
  • A1C   between   5.7% -6.4%

The AADI is leading the SCREEN AT 23 Campaign as a member of the Asian American Native Hawaiian Pacific Islander Diabetes Coalition (AANHPI DC).

51% of Asian Americans with diabetes are undiagnosed.

For an appointment or more information, please contact the clinic coordinator by e-mail: aadi [at] joslin.harvard.edu or call 617-309-3444.