I’m thrilled today to be sharing the work of my intern Evan Huang-Ku, a Taiwanese-Canadian dietitian and certified diabetes educator who takes us on an exploration on the topic of diabetes prevalence within the Asian community.

Excellent work Evan!

Diabetes In The Asian Community

By Evan Huang-Ku RD, CDE

Diabetes Canada’s Clinical Practice Guidelines identify that East, Southeast and South Asians are all at an increased risk of developing type 2 diabetes, a disease which itself can contribute to heart disease, kidney failure, nerve damage, eye damage and even limb amputation.

How can something as innocent as your ethnicity increase risk for type 2 diabetes?

My name is Evan Huang-Ku. I am a Taiwanese Canadian registered dietitian and a certified diabetes educator.

Today, I am seeing more Asian clients, that are also younger, concerned about their risk of diabetes. Many of them asked why being Asian is a risk factor. And to be honest, I did not have a straightforward answer.

Being Asian, I also want to understand this health disparity specific to people like me. So I decided to explore this topic in the blog post.

The Stats Paint A Picture

Chinese communities in Canada are developing type 2 diabetes at a rate almost two times faster than Caucasian Canadians (Diabetes Canada, n.d.).

The numbers are even more severe for South Asians, who are developing diabetes 3.4 times faster than Caucasians.

Similar findings are also shown in the United States, where the prevalence of diabetes among White adults is 11.9%, but for Asian adults, the number is higher at 14.9% (CDC, 2020).

So Why Are Asians At Increased Risk?

One possible explanation is through socioeconomic status, which is highly associated with one’s racial-ethnic identity (William & Anderson, 2016).

Studies worldwide have confirmed that low-level education, occupation, and income were associated with an increased risk of diabetes. (Agardh et al., 2011) (Bjilsma-Rutte et al., 2018) (Tang et al., 2016) (Tang et al., 2003).

People with less social and economic resources are less able to afford healthy foods, engage in regular physical activities, have limited access to healthcare services, which can call lead to a poorer health outcome.

Having less socioeconomic resources can also increase one’s psycho-social stress level, which increases one’s risk of diabetes (Kim et al., 2015). (Dendup et al., 2018) (Kelly & Ismail, 2015).

Another possible explanation is the difference in body composition.

Numerous studies examined the body composition of racial groups and the risk of metabolic disease, including insulin resistance and diabetes.

Asians tend to have more body fat, organ fat, specifically liver fat, compared to Caucasians at the same Body Mass Index (BMI) (Rush et al., 2009) (Wulan et al., 2009),. When you have more organ fat, the risk of insulin resistance increases.

This may explain why Asians develop insulin resistance and diabetes at a lower BMI (CDC, 2021).

A consequence of higher risk at a lower BMI means that Asians are not adequately screened for diabetes because they appear thinner, and diabetes is a chronic disease that people often associate with being heavier (CDC, 2021; Tung et al., 2017)..

Underdiagnosis

Cross-sectional data from 45 U.S. states and territories revealed that Asian Americans had 34% lower odds of receiving diabetes screening than non-Hispanic whites (Tung et al., 2017).

This makes them the ethnic group least likely to get screened, despite having a higher risk of developing diabetes (Tung et al., 2017).

In addition, new immigrants with a language barrier have difficulty navigating the healthcare system, adding to the underdiagnosis.

The National Health and Nutrition Examination Survey (NHANES) found that foreign-born Asians have the highest prevalence of undiagnosed diabetes compared to other foreign-born racial groups (Hsueh et al. 2020).

Since the conventional BMI categorization cannot catch at-risk Asians, the Centre of Disease and Control suggests that people of Asian descent should be tested for high blood sugar when their BMI is 23 or higher (CDC, 2021).

For Caucasians, the risk for diabetes is not flagged until their BMI exceeds 24.9 (CDC, 2021)

Adding to the BMI and risk, age also matters. According to a population study published by the Canadian Journal of Diabetes, South Asians 25 years old have the same risk for diabetes as East Asians 35 years old and Caucasian 40 years old (Creatore et al, 2020).

This constitutes a 15-year difference in age equivalence for risk between ethnic groups.

The study tells us that screening for diabetes should be done earlier for Asian groups.

Putting It All Together

Talk with your primary care provider ask to be screened if you think you are at risk for diabetes.

Use the online CANRISK questionnaire for pre-diabetes and type 2 diabetes to assess your risk.

If possible, work with a registered dietitian who has a deep understanding of your cultural food and health practices for additional help.

Eating healthier every day can be a drastic change for many and working with a dietitian who can creatively incorporate your culture into a healthy diet can make this experience more enjoyable.

Evan Huang-Ku RD, CDE