Medical professionals working with Asians are becoming alarmed by the greater numbers of patients they see suffering from diabetes.

Nearly 7 percent of Americans, or about 21 million, have diabetes, according to the Centers for Disease Control and Prevention. But in Asia, where the illness is spreading rapidly, the World Health Organization and the International Diabetes Federation predict that the number of diabetics across the continent may increase to 160 million by 2025.

The growth of diabetes among Asians is so noteworthy that the Joslin Diabetes Center in Boston, working closely with the Harvard Medical School, has what it calls the Asian Diabetes Initiative, targeted at improving awareness and management of diabetes in Asian Americans.

What is diabetes?
Type 2, the most common form of diabetes, is a lifelong disease marked by high levels of sugar in the blood. It occurs when the body does not respond correctly to insulin, a hormone released by the pancreas.

How common is diabetes?
The disease is expected to affect at least 350 million people worldwide by the year 2030, which is double the current number of diagnosed cases, according to WHO statistics. Studies show that roughly half of the more than 300 million individuals with diabetes in the year 2025 will be of Asian descent.

What are the complications of diabetes?
Diabetes is one of the leading causes of death and disability in the United States, costing more than $98 billion each year. It is the fifth-leading cause of death in Asian Americans between the ages of 45 and 64.

Formerly called adult-onset diabetes, Type 2 can go undetected for years while it wreaks havoc on the body in its uncontrolled state, resulting in serious and sometimes potentially life-threatening complications that include heart disease, strokes, nerve damage, kidney failure, blindness, limb amputations and sexual dysfunction.

What is the profile of an Asian who gets diabetes?
Results from what little research does exist on Asians and diabetes — studies conducted on Chinese populations — can be extrapolated to those of Vietnamese and other Asian backgrounds, said Dr. William Hsu, an endocrinologist and co-director of the Joslin Diabetes Center’s Asian American Diabetes Initiative, whose purpose is to enhance the quality of life and health outcomes for Asian Americans living with diabetes through research, education, outreach and improved diabetes treatment outcomes.

The studies of residents from industrialized Hong Kong and in rural parts of mainland China show that 10 percent of Hong Kong’s population has diabetes while only 1 to 2 percent of the population in rural areas of the country is affected, Hsu said.

“In Viet Nam, Type 2 diabetes is low because it is still not an industrial nation. Lifestyle changes are part of the cause,” he said.

Traditionally, residents of Viet Nam and other Southeast Asian countries have been mainly agrarian workers whose levels of occupational physical activity have been high, but with more people working in urban-based industrialized jobs, an inevitable decline in physical activity follows, he said. Diets also have changed greatly and decreased in their overall healthful quality.

How does weight relate to diabetes?
A decrease in physical activity and a change in dietary habits can cause numerous problems, starting with weight gain, Hsu said. “In the Caucasian population, diabetes is related to weight gain. At first glance, it doesn’t seem to be the same for Asians. They (think that they) don’t gain weight. I challenge that.

“Even if they gain a little bit of weight, they are at risk (for diabetes). It’s probably because most of the weight gain occurs in the belly. They don’t have large hips or thighs. Weight around the belly - or central obesity — seems to be the worst kind of fat to have. Asians who gain weight around their bellies are at risk for heart disease, diabetes, all the bad stuff. They are overweight, but they are not 200 or 300 pounds. They look lean but have diabetes.”

Part of the reason for the extra weight gain is because “immigrants want their children to do well, and they are growing bigger and taller than their parents, who consider this to be good, but they are heavier” than they should be, Hsu noted.

In the general population, one-third of individuals, both young and old, have diabetes and don’t know it, he said. “In the Asian population, this number is probably higher because there are access-of-care issues,” he said.

How do language barriers affect health?
“We’ve found linguistic issues for the Chinese, and linguistic barriers exist for the Vietnamese, as well,” Hsu said. Studies of Chinese Americans show that those who want to speak English with their doctors “gain more knowledge better than those who don’t speak English, even with the same care. (Those who did not speak English) seemed to have less knowledge of how to manage their diabetes — and generally had a trend toward poor blood glucose control — compared with Asian American immigrants who preferred to speak English.”
 

Bilingual materials in Vietnamese and other languages are desperately needed, as are doctors who either are of the various cultural backgrounds or who understand them well, he said. “We need to fill the knowledge gap. The lack of medical resources (for Asian immigrants) is very bad,” he said.

Is Type 2 diabetes preventable among Asians?
Yes. According to WHO studies, up to 90 percent of Type 2 diabetes cases could be avoided through lifestyle changes. The Diabetes Prevention Program, a research study sponsored by the National Institutes of Health, showed that by increasing their physical activity, eating a healthier diet and losing between 10 and 15 pounds, 58 percent of participants at high-risk for diabetes were able to prevent the onset of the disease.

While most studies reflect the general population, the advice on how to prevent diabetes is applicable to Vietnamese Americans, Hsu said, stressing the importance for Vietnamese and other immigrants and their children to get more involved in their own health care.

Children of immigrants “have to know that this will be one of the major epidemics to hit their lives. It already is an epidemic. They will not be immune to diabetes,” he said. “They need to be in this fight. We need Vietnamese doctors, dieticians, politicians to move political agendas and we need marketers to help us raise awareness,” Hsu said.

How can Asians help the fight against diabetes?
Vietnamese Americans and members of other Asian backgrounds “need to get involved, take charge of their health and lobby for more research funding,” he said, adding that this is part of the goal behind Joslin’s work. Increased participation means getting annual screenings for diabetes. It also means working with legislators — or better yet, becoming legislators themselves — to get more funding for research involving Asians and health problems such as diabetes, he said.

“I really want to call to the attention of Vietnamese to take action of their own health and to act socially responsible. No one is going to advocate for them. If they do not advocate for themselves, they will get lost in the vast sea of voices out there.”