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While many think the differences between races are usually cosmetic (facial features and skin tone), the reality is that race and family genetics play a huge role in health risks like diabetes. African Americans, Mexican Americans, Native Americans, Native Hawaiians, Pacific Islanders and Asian Americans have a great risk for heart disease, stroke and diabetes. For many, it is the likelihood of obesity and poor diets. However, new American Diabetes Association (ADA) guidelines for Asian Americans highlights that they are the most susceptible to Type 2 diabetes – even those that are not obese.
Asians are the fastest growing ethnic group in the U.S. However, while many Asian Americans look slim, they face a higher risk of diabetes than people in other ethnic groups, according to the ADA. In fact, they are 18 percent more likely to have Type 2 diabetes than non-Hispanic whites.
The ADA has generally pointed to body mass index, or BMI, as a good predictor of diabetes risk. However, the same metric does not work for all cultures.
Their guidelines specify that adults with a BMI of 25 (considered overweight) should be routinely tested for diabetes. But, the old guidelines did not take race and ethnicity into account.
The new ADA guidelines lower the bar for Asian Americans, saying testing should begin at a BMI of 23. That is because Asian Americans often develop diabetes at a lower BMI than others, due to differences in their body composition. For them, a BMI of 23 presents a similar risk as a BMI for someone else of 27.
Asian Americans tend to gain weight around their waist, rather than in the thighs and other parts of the body like other ethnic groups. Fat gained in the waist, however, poses the greatest risk to health, according to the ADA. As a result, the ADA has published new guidelines for assessing whether Asian Americans are diabetic.
The new recommendation for Asian Americans is not likely to be the only change recommendation in coming months for different ethnic groups. “We’ve never differentiated based on ethnicity because frankly, in the past, we haven’t done a good job evaluating different ethnicities,” admits Dr. Jane Chiang, who is senior vice president of medical and community affairs at the ADA. She acknowledged that the previous belief was that “one size fits all, but now we know that that’s not true.”
The new ADA recommendations arose out of a review of five meta-analyses that evaluated more than 150 studies. The various studies looked at Asian-American populations to consider the effects of an American lifestyle and environment.
Chiang expressed hope that the new guidelines will increase early detection of diabetes in Asian Americans and enable more preventive measures. But she urges doctors to beware of treating all people of any race or ethnicity the same. “Asian-Americans are still a very heterogeneous population, so each individual needs to be evaluated separately,” she says.
Chiang also indicated that this race/ethnic-specific recommendation is not likely to be the ADA’s last. Says Chiang, “I think this is just the beginning of what we need to do making recommendations for people of different ethnicities.”
By Dyanne Weiss