By Faine Greenwood
At health fairs, community clinics and even 5K fun runs, preventative care is a refrain that Asian Americans in the Bay Area hear a lot these days.
Under the Affordable Care Act, private insurance purchased after March 23, 2010 must cover a range of preventative services, including screenings for cancer and diabetes. This is especially important for Asian Americans, who get Type 2 diabetes at higher rates — and at lower weights — than their Caucasian counterparts.
“The biggest problem with diabetes is that people don’t even know they have it,” said Dr. Atul Butte, an associate professor at the Stanford University School of Medicine. With Dr. Keiichi Kodama and other study authors, he is trying to figure out how genetic differences might explain the higher incidence of this potentially deadly but preventable disease in some ethnicities.
Many people develop Type 2 as adults due to a combination of age, weight and genetic predisposition. It is defined as insulin resistance: a body becomes unable to properly use insulin and, as a result, builds up excessively high levels of blood sugar.
The Stanford researchers found that ethnic background plays a surprisingly large role in how diabetes develops, concluding that the genetic risk is highest for Africans and decreases along the global path that the first humans took as they migrated out of Africa toward East Asia.
But the research raised a caution flag for East Asians, who were to found to have more difficulty secreting enough insulin to maintain normal blood glucose levels, as well as low pancreatic beta cell function. As they get older and gain weight, the risk of developing Type 2 diabetes increases. Caucasians are in between Africans and East Asians when it comes to insulin sensitivity.
“If Asians get even any little bit of insulin resistance, they plummet to diabetes because they don’t have any reserve to make more,” Dr. Butte said.
“Right now, we think of diabetes as one disease with one set of drugs, or one common panel of drugs,” he said. “All we’re suggesting is that maybe there’s two diseases here, two different ways to get diabetes. Instead of treating an African with diabetes the same as an Asian, maybe we should have specific therapies for each ethnicity.”
Neil Bhatiya, a policy associate at the Century Foundation in New York, has an Indian father and a European mother. He was diagnosed with Type 2 diabetes in 2004 while in college. He wasn’t experiencing any worrisome symptoms at the time of diagnosis, which is common, but the disease was detected through blood work.
Now when he goes to see new physicians, “They’ll tell me that I’m the thinnest Type 2 they’ve ever seen,” Bhatiya said.
“I’ve talked to doctors about it before,” he added, “and have not gotten the best explanation for why that would be, other than them guessing that has something to do with genetics.”
Likewise, Dr. Greeshma Shetty of the Joslin Diabetes Center in Boston believes a barrier to early detection for Asian-Americans is that many appear at low risk based on their body mass index and weight. “But even with a slightly elevated weight, they carry a much higher risk for developing diabetes,” she said.
For recent immigrants, an abundance of U.S. junk foods and a reduction in physical activity can contribute to a rise in both obesity and diabetes, according to Dr Shetty. Add to that Asian diets high in rice and other carbohydrates, coupled with a dining style that favors family-size portions.
All experts agree that prevention is key. On the Peninsula, some members of the Asian-American community are working to help others access preventative health care, which will assist those at risk of developing Type 2 diabetes.
A Vietnamese community health fair in San Jose in early October saw long lines around a table dedicated to diabetes screening. Technicians spoke in Vietnamese and English as they poked fingers free of charge.
The outreach from San Jose-based Bascom Pharmacy was one example of how the local Asian-American community is acting to address the problem, which can be compounded by language barriers and limited understanding about diabetes in their country of origin.
Community liaisons like Channary, a San Jose web designer and member of the Cambodian Women’s Association, help bridge these gaps. “When they immigrate to America, they have no knowledge of diabetes at all,” Channary said of her fellow Cambodians, whom she assists with translating from Khmer to English during their doctor’s visits.
She also has worked to sign up Cambodian community members for Covered California, the state’s new insurance marketplace.
“Many of them have worked quite hard through their lives —but their job was very low-paying, so they lived day to day, month to month,” she said. “When there’s no job anymore, they couldn’t buy insurance, and they didn’t qualify for Medi-Cal before, because they weren’t sick or disabled. I think this gives them a chance to see a doctor.”