Diabetes in Asian Americans
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1 Diabetes in Asian Americans Winston F. Wong, MD National Council of Asian Pacific Islander Physicians
2 American Diabetes Association Joslin Diabetes Center National Council of Asian Pacific Islander Physicians Asian American Native Hawai ian Pacific Islanders Diabetes Coalition
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5 10 Leading Causes of Death in 2009 Caucasians 1. CVD 2. Cancer 3. Respiratory disease 4. Cerebrovascular disease 5. Accidents 6. Alzheimer s 7. Diabetes 8. Influenza/pneumonia 9. Kidney disease 10. Suicide Asian/Pacific Islander 1. CVD 2. Cancer 3. Cerebrovascular disease 4 Accidents 5. Diabetes 6. Influenza/pneumonia 7. Respiratory disease 8. Kidney disease 9. Alzheimer s disease 10. Suicide National Vital Statistics Reports, 2011;60;98-103
6 Diabetes Prevalence in the U.S. Total (%) Diagnosed (%) Undiagnosed (%) Prediabetes (%) Mean BMI (kg/m 2 ) Overall White Asian Black Hispanic Menke A, et al. Prevalence of and Trends in Diabetes Among Adults in the United States, JAMA. 2015; 314(10):
7 Prevalence of T2DM 2,123,548 Adult Members of Northern California Kaiser Permanente Hospitals in 2010 Race /Ethnicity Prevalence (%) Pacific Islander 18.3 Filipino 16.1 South Asian 15.9 Latino 14.0 African American 13.7 Native American 13.4 Southeast Asian 10.5 Japanese 10.3 Vietnamese 9.9 Korean 9.9 Chinese 8.2 White 7.3 Karter AJ et al; Diabetes Care 2013: 36;574-9
8 Standardized Diabetes Incidence (per 1,000 person-years) in 16,283 adults diagnosed with diabetes in 2010, KP Northern California Karter AJ et al. Diabetes Care 2013:36;574-9
9 BMI of 1,704,363 Adult Members by Race & Diabetes Status KP Northern California, 2010
10 Countries with Highest Estimated Diabetes Cases WHO 2000 and millions 1. India China US Indonesia 8 5. Japan 7 6. Pakistan 5 7. Russian Fed 5 8. Brazil 5 9. Italy Bangladesh millions 1. India China US Indonesia Pakistan Brazil Bangladesh Japan 9 9. Philippines Egypt 7 Diabetes Care 2004;27:
11 Adipose Tissue Is an Endocrine Organ: Function in Health and Disease Lipoprotein lipase Hypertension Inflammation TNF CRP Atherosclerosis IL-6 Adipsin (Complement D) Adiponectin Angiotensinogen Plasminogen activator inhibitor-1 (PA-1) Insulin Free Fatty Acids Resistin Leptin Lactate Atherogenic Dyslipidemia Type 2 Diabetes Thrombosis CRP = C-reactive protein; IL-6 = interleukin-6; TNFα = tumor necrosis factor-alpha Reprinted in adapted form from Trayhurn P, Wood IS. Br J Nutr. 2004;92: , with permission of Cambridge University Press. Eckel RH, et al. Lancet. 2005;365: Lyon CJ, et al. Endocrinology. 2003;144:
12 Visceral Adipose Tissue by Computed Tomography African American vs Filipina women African-American Filipina Weight: 160 lbs, Height: 5 7 BMI=25 kg/m 2 VAT: 25.4cm 3 Weight: 115 lbs, Height: 5 4 BMI=20 kg/m 2 VAT: 84.0 cm 3
13 Percent distribution of Asian-Americans with newly diagnosed Type 2 Diabetes by Body Mass Index 16.0% 14.0% Proportion who may not be screened at BMI<25 kg/m 2 Men Women 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% BMI (kg/m 2 ) 37% of women and 21% of men with T2DM had BMI<25 kg/m 2
14 T2DM by BMI>25 kg/m 2 cut-point BMI (kg/m 2 ) T2DM No diabetes Total >= < Total % (n=102) of AAs with T2DM might be undiagnosed if screening is limited to BMI >=25 kg/m 2 Sensitivity: 179/281 = 64% Specificity: 652/1382= 47% Youden s index: (64% + 47%) 1 = 11% Misclassification rate: 102 / / 1382 = 89%
15 Sensitivity, Specificity, PPV and AUC among Asian-American adults, ages >=45 years BMI (kg/m 2 ) Diabetes (%) Sensitivity (%) Specificity (%) Misclassification Rate (%) >= (14.3) >= (12.5) >= (10.8) >= ( 8.7) >= ( 7.3) >= ( 6.1) ,8 0.86
16 Sensitivity at Selected BMI Cut-points Total Filipino Japanese 100% South Asian Youden's Index 80% 60% 40% 20% 0% >=22 >=23 >=24 >=25 >=26 >=27 >=27.5 Diabetes screening at a lower cutpoint of BMI>=23 kg/m2 should be considered and will enable early diagnosis and management
17 Best of Care at 2015 ADA in Boston One of 9 most noteworthy articles published in Diabetes Care in 2014
18 Conclusions Current guidelines to screen adults with BMI >25 kg/m 2 fail to identify 1 out of 3 Asian-Americans with newly diagnosed type 2 diabetes. BMI Cut-Point of 23 kg/m 2 Most Practical for Asian- Americans. Limiting screening to HbA1c and fasting glucose measures may fail to identify half of Asian-Americans with diabetes.
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