2014 Fourth Diabetes Conference

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*new* Complete transcripts of @SFBau's live tweets may be downloaded here: Live Tweets (pdf)
Ignatius Bau @SFBau will be live tweeting the conference. Follow Ignatius here: https://twitter.com/sfbau
Background

In 2011, the National Council of Asian Pacific Islander Physicians (NCAPIP), the Asian American Diabetes Initiative (AADI) at the Joslin Diabetes Center, the American Diabetes Association (ADA) and its Asian Pacific American Diabetes Action Council (APADAC), the Association of Asian Pacific Community Health Organizations (AAPCHO), and local Asian American, Native Hawaiian, and Pacific Islander physician associations and health organizations in New York, New Jersey, Illinois, California, and Hawaii created the Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition (AANHPI Diabetes Coalition). The mission of the coalition is to advance the study of diabetes type 2 in Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations and communities, in order to effectively prevent and treat the condition.

A historic “state of the science” national conference on diabetes in the AANHPI population and community was held in Honolulu, HI in September 2011. The summit brought together leading researchers, physician leaders, diabetes educators, and community-based diabetes program managers to discuss the epidemiology, treatment and management, education and prevention interventions of diabetes among AANHPIs. The unprecedented collaborations
resulted in two co-authored articles.

In May 2012, a second conference took place in Arlington, VA, at which time a set of recommendations to develop clinical management guidelines for various Asian Americans and Pacific Islanders; gather definitive data to guide management; and develop tailored community interventions was finalized. An intranet portal: www.ncapip.org/takeaction/diabetes was developed within the NCAPIP website to support collaboration and discussions on diabetes.

In May 2013, the third conference was held in Washington, DC to convert the recommendations into priorities and action steps. At this conference, the Pacific Jurisdiction health care system assessment with a focus on chronic diseases and diabetes was presented. There is evidence to believe that in Pacific Island groups, adherence to diabetes treatment plans is significantly worse than the U.S. general population and being attributed to many factors including the patient, the provider, health care system and community. As a result of the conference, the AANHPI Diabetes Coalition has engaged in a formal dialogue with the National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK) on a research agenda and presented a request to the NIDDK Director: “for greater understanding and treatments of diabetes and its complications in the AANHPI populations.”

The AANHPI Diabetes Coalition recognized that weight gain in adult life results in an increasing Body Mass Index (BMI) and is associated with increased morbidity and mortality. However, the coalition acknowledged the BMI cut-off points for overweight and obesity should not be interpreted in isolation but in combination with other risk factors. Diabetes type 2, cardiovascular disease and increased mortality are the most important sequelae of obesity and increased abdominal fatness.

On the basis of available data in Asia, the World Health Organization (WHO) concluded that Asians generally have a higher percentage of body fat than non-Hispanic White of the same age, sex, and BMI and that their proportion with risk factors for type 2 diabetes and cardiovascular disease is substantial even below the existing BMI cut-off point of 25 kg/m2 for overweight and 30 kg/m2 for obesity. The purpose of a BMI cut-off point is to identify, within each population, those individuals with a high risk of a disease state that warrants a public health or clinical intervention. Reducing BMI cut-off values for action on overweight and obesity
would increase their prevalence rates overnight and, therefore, increase governmental and public awareness. Such a change would require public health policies and clinical management guidelines to be changed, and could lead to increased costs in the short term (i.e. more treatment at lower BMI thresholds), but cost savings in the long term (less disease and comorbidities).

The release of initial diabetes-related data of the 2011 Asian oversampling of the National Health and Nutrition Examination Survey (NHANES) prompted the coalition to work with CDC/NHANES to disseminate and respond to the data briefs. Requests were also made to allow coalition members to provide their expert guidance in future analyses of the NHANES 2011 Asian oversampling as well as its presentation to the public.

2014 Fourth Diabetes Conference:

In 2014, the AANHPI Diabetes Coalition and its partners NCAPIP, AADI Joslin Diabetes and the ADA/APADAC will organize the fourth conference on May 2nd in San Francisco, California with the theme: “Deepening Knowledge – Effective Treatment and Management.” The objectives are to further deepen the knowledge of diabetes in AANHPI population and community and translate this knowledge and existing data into concrete policies for effective treatment and management of the disease.

The results from the 2011 CDC/NHANES Asian oversampling point to a need for further discussions to understand issues related to the BMI and HDL in AANHPIs. Asian Americans have a disproportionally lower level of high BMI’s with only 38.6% above BMI of 25 compared to non-Hispanic White, Black and Hispanic adults (42%, 48% and 44% respectively). This gives a false impression that obesity and its related diseases is less of a problem in the Asian American population and might implicate that large numbers of at-risk Asians are not getting the proper screening, prevention, or treatment for obesity and obesity-related diseases.

The newly released data from CDC/NHANES showed that Asian men have much higher prevalence of low levels of HDL (<40) than Asian women, compared to other ethnic groups, and foreign born Asians have much lower HDL levels than US born Asians. Any data from CDC regarding Hg-A1C in Asian Americans vs. other ethnic groups would further the understanding and potential development of surrogate markers for increased risks of cardiovascular disease and insulin resistance, diabetes and metabolic syndrome within AANHPIs.


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