By Jeffrey Osborn
Northwest Asian Weekly
Diabetes is a disease that is quickly becoming a global epidemic. In recent history, diabetes has become the focus of numerous medical studies. Alarmingly, those that are Asian American or who live in Asian countries are some of the highest at-risk people in the world.
The numbers game
The International Diabetes Federation explains diabetes as “a chronic condition that occurs when the body cannot produce enough or effectively use insulin. Insulin is a hormone produced by the pancreas that allows glucose from food to enter the body’s cells, where it is converted into energy needed by muscles and tissues to function. As a result, a person with diabetes does not absorb glucose properly, and glucose stays circulating in the blood (hyperglycaemia) damaging tissues over time. This damage leads to life-threatening health complications.”
The International Diabetes Foundation helps to keep track of diabetes around the world by conducting studies and maintaining statistics on the spread of diabetes.
Alarmingly, the Western Pacific region, which is home to East Asia and Oceania, has 131.9 million people with diabetes. This number is expected to climb to 187.9 million by the year 2030. In contrast, the North American and Caribbean region is home to only 37.7 million with the condition, a number that is expected to grow to 51.2 million by 2030.
The Southeast Asia region also fares very poorly, with 71.4 million people living with the condition. The Middle East and North Africa region also is noteworthy, with 32.6 million dealing with the condition.
While it may be argued that Asia has a larger population than North America, when viewed per capita, the Middle East and North Africa region has the highest rate at 11 percent of the population. This is followed closely by North America with 10.7 percent. South East Asia is next with 9.2 percent of the population, and the Western Pacific is last in the Asian regions with 8.3 percent.
The total number of people with diabetes is expected to climb 54 percent to a total of 439 million by the year 2030.
Dr. William Hsu, medical director of the Asian Clinic at the Joslin Diabetes Center, explained this dramatic rise around the world. “I think major changes in the way we consume food contribute, namely the availability of highly dense caloric values.”
A difficult pin to point
Hsu also thinks “a major contribution is industrialization. That seems to be a major theme around the world. More calories and less activity and what that translates into is a rise in obesity.”
To support his argument, Hsu points to extremely large diabetes increases in Asia, Southeast Asia, South Asia, and the Middle East. “If you look at the rates of change in developing nations, there are those seeing the sharp rise.” Hsu also points out that during times of industrialization and massive growth, Western countries saw large increases in their numbers of diabetes cases.
“These developing nations are just really in the midst of that growth, economic growth, industrial growth, that’s where we’re seeing the faster rates.”
Not everything is related to diet and culture. Genetics plays a major role in one’s likelihood of contracting diabetes. Although physicians need time to complete more studies on the disease, there is overwhelming evidence to show that “Asian genetics are particularly susceptible to diabetes,” Hsu explained.
“If you look at, in particular, the Asian population of the world, China has about 92 million people with diabetes. India is probably somewhere in the 50 million people. These countries have very high rates. What’s unusual about their diabetes is that the individuals affected by diabetes in those countries generally are not considered overweight or obese by Western standards. They have different genetic makeup in a way that they can get diabetes very early on, even with slight weight gain. So this is an inherent risk that’s brought on even with a little bit of weight gain. That helps to shine into the strong genetic component of this condition.”
The Asian American population is relatively small in the United States, with just under 5 percent of the overall population. Unfortunately, this generates problems when attempting to study the causes and prevention of diabetes in the community.
“Data on Asian Americans health [are] actually quite limited, so data generally [do] not include Asian Americans in particular. So what you have is a bias in most of the health care research.
They tend to cover population groups that are large, because first, it has greater health care implications, and second, it is simply harder to do studies when you have small population groups that are dispersed throughout the country,” Hsu said.
Many websites have diabetes statistics that specifically state Chinese and Chinese American figures. When asked if that was due to Chinese Americans being at a higher risk than other Asian Americans, Hsu added, “That would be an incorrect assumption.” Compared to the Chinese communities in America, groups such as the Filipino, Cambodian, and Vietnamese communities are even smaller, making the collection of data on these groups exceedingly difficult.
Dealing with diabetes
“I was 16. I was like, ‘How can I have diabetes? I’m skinny and don’t drink soda, I should be fine.’ There was so much I didn’t know,” said Huan Zhou, a recent high school graduate and a Chinese American.
“There was a kid in school that we joked about because he had to take shots at lunch. He was overweight, and we thought that he got the disease because he didn’t take care of himself,” she admitted.
“One week, I found myself having to use the restroom a lot, and I was always thirsty. My mother brought me to the doctor, and that’s when I found out I was a diabetic. I was horrified. I thought my life was over and I would be the person everyone made fun of.“
Zhou found herself in a difficult position when oral medication would not work for her. “Suddenly, I had to give myself shots. I kept them in my bag when I was walking around and always did it completely out of sight. I didn’t want anyone to know.“
A group in the United Kingdom called Diabetes UK has taken note of the issue of bullying diabetics and released a viral video to help combat the misconceptions of diabetes.
In an interview with the BBC, Libby Dowling , who works with Diabetes UK, is quoted as saying, “We have to remember that the vast majority of children with diabetes have Type 1, and that is nothing at all to do with being overweight or lifestyle factors.”
On top of the mental anxieties that a diabetic may face when informed he or she has the condition are the physical problems.
“I freaked out in the doctor’s office. I kept thinking to myself what can I eat? Can I go out without carrying something around? Will I always feel sick? I felt hopeless,” admitted Zhou.
Luckily, that was not the case, though treatments have been extremely effective for Zhou. “I do have to watch what I eat. I have to be careful about my blood sugar level, but so far, I’ve been able to live a pretty regular life.”
Prevention over medication
Experts recommend prevention when it comes to combating diabetes. Primarily, this is because diabetes is something that cannot be cured, only treated. Second, and quite often first on many persons’ minds, is the cost.
“If you look at the United States, we only have about 27 million people with diabetes, but diabetes costs about 15 percent to 20 percent of our healthcare dollars.” Hsu stated.
With no cure in sight and extremely high health care costs for treatment options, prevention is the most viable option for the majority of the American public.
“We need to set a national agenda in terms of what we can do,” says Hsu. “There’s now a new collusion formed called the National Council of Asian American and Pacific Islander Physicians. We met just a few weeks ago in Honolulu and tried to examine the evidence and to map out an agenda.“
A federally funded program called the Diabetes Prevention Program (DPP) has been gaining ground in America. “If you can exercise about 150 minutes per week and lose about 7 percent of your body weight, you can lose progression from borderline diabetes by as much as 60 percent or more. This model has been replicated in Europe, China, India, Japan, and other parts of the world,” Hsu said. This is far more difficult to spread than it seems, as Asian American communities are small and fragmented throughout the nation. Now, the question is,‘How do we implement that to the community?’ That has got to be the next step in our message to the Asian American community. Following these recommendations.”
Hsu also has a recommended diet that could help reduce the amount of diabetes in Asian American communities, “We should return to a more traditional diet. If you look at the Asian traditional diets, they are very healthy. Even though the carb contents are higher, the fat contents are low and the protein contents are not very high, and people on the traditional Asian diet really didn’t develop diabetes. There are numerous studies that show returning to a traditional diet would be very healthy.”
In the end, diabetes boards and medical professionals focused on the condition all agree on one thing when it comes to prevention. In Hsu’s own words, “Lifestyle trumps medication in preventing progression in diabetes.” (end)
Jeffrey Osborn can be reached at firstname.lastname@example.org.