DIABETES CONFERENCE PRESENTATIONS

Plenary I: Raising Awareness

Panel 1: Status of Diabetes in AAs and NHPIs
National Data - BRFSS and NHIS
Hawaiian Data
Pacific Islander Data
California Data
New York City Data
Pediatric Data

Panel 2: Tracking and Monitoring Metrics
Asian Oversampling in NHANES

Plenary II: Special Problems in Treatment

Panel I: Pathophysiological Differences
Diabetes Type 1
Diabetes Type 2
Obesity among NHPI
Differences in Complications

Panel 2: Guidelines that Reflect Unique Culture and Pathophysiology
Current Guidelines in Detection
/ Treatment
Diabetes Prevention Program
Multicultural Prevention
& Treatment
Chinese Americans and Diabetes

Plenary III: The Community Experience
NHPI Experiences
Chinese in New York Experience
National Diabetes Education
Program
Asian Indians and Diabetes

First, a big "Thank You!" to everyone, from honored guests and speakers, to the conference planners and attendees, who came together and made "Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action" a very successful event. Experts covered a wide range of diabetes topics, and while no two-day conference can be expected to yield the blueprint that effectively ends the diabetes epidemic, it did lay the groundwork for an action plan that will have the full support of the newly formed Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition (AANHPIDC, or "the Coalition" for short) as well as the AANHPI community. Below you will find a breakdown of the conference and action steps. To the right are links to more data in the form of the actual presentations from the conference.

2011 Diabetes Conference – What We've Learned, Where We're Going

Does diabetes really constitute a serious issue for AANHPI?

Absolutely. The data we have seen shows that Diabetes Mellitus (DM), is a national (not to mention global) health problem that adversely affects AANHPI populations.

  • In the aggregate, AANHPI have a 70% increased susceptibility to diabetes., compared to whites (when age, sex, and BMI adjusted)
  • When the data is broken down, South Asians, Filipinos, Pacific Islanders, and Native Hawaiians have a much higher DM prevalence compared to Non-Hispanic Whites; PI are up to three times as likely to develop DM compared to Whites, and about one-in-five NH are affected by DM.
  • DM in AANHPI populations carries with it a disproportionate increased risk of diabetes related complications as well: cardiovascular disease, end stage renal disease, chronic kidney disease, and stroke just to name a few.

The notion that "skinny Asians" are not at risk for developing DM is false:

  • Asians carry significant DM risk below the normal BMI 25 cutoff (i.e. "Asian BMI").
    • Studies in Hawaii also show that, regardless of BMI, Japanese Americans have a still higher prevalence of DM than Non-Hispanic Whites
    • Another example is the growing percentage of Chinese Americans in New York City who are "thin diabetics."

Besides weight, what are some other factors to consider for this higher DM prevalence?

BMI, fat distribution, level of insulin secretion, insulin resistance, brown fat distribution, beta cell masking, visceral fat areas, and more. Some of these factors have been extensively researched with regard to AANHPI subpopulation, for others there is much more to learn. While this data sheds a significant amount of light on the situation, more comprehensive, disaggregated data is needed (ideally by individual ethnic subgroups) to avoid masking DM prevalence to influence health policy and quality improvement.

How would one design treatment guidelines for AANHPI?

The pathophysiological differences among AANHPI subgroups present challenges to diagnosing and prescribing treatments: there is no one size fits all, and continued research and data are critical to form a stronger basis of understanding who is at risk and why, as well as to create diagnostic and treatment guidelines that are subgroup specific.

Something that is nearly universally accepted for the treatment and management of DM is a healthy lifestyle that includes a nutritional diet and exercise. Research from numerous sources shows that diet and exercise intervention programs work to reduce the burden of DM through weight loss and overall health of body and mind.

What about culture and environment?

The term "lifestyle" itself takes on a multitude of factors: communities, industry, policies, and environments that influence behaviors. There has been a failure to adequately address psycho-social variables and their impact on DM. Guidelines and interventions must be created and implemented with regard to community and culture. Initiatives in multiple states were highlighted, and stressed a community based approach that could include classroom education, peer-to-peer teaching, and family support in patients¡¦ DM self management. Experts on nutritional guidelines talked about making alternative choices for healthier eating that maintained the flavor and character of ethnic AANHPI cuisine. All intervention programs and initiatives must have language that patients understand, both linguistically and from a health literacy standpoint. All these considerations need to be made for efficacy and retention of programs, and to achieve better health outcomes. The findings presented in this conference came from national, regional, and local research and data. Some of the richest came from Hawaii, where research on diabetes among AANHPI populations has been leading the way. This made holding this conference in Hawaii not only appropriate, but necessary.

So how are we going to do all this? Where do we go from here?

Action Steps:

Get More Data


Use and support more Community Based Participatory Research (CBPR)
Support and move forward the oversampling of AA AND of NHPI in the National Health and Nutrition Examination Survey (NHANES)
Support funding for more research specific to AANHPIs
Identify and monitor any and all gaps in data

Prioritize major high risk groups (Native Hawaiian, Pacific Islander, Filipino, South Asian)
More information on Type I diabetes is needed

Build on Existing Research

Current recommendations and clinical guidelines put out by professional societies should be assessed for relevance to AANHPIs
Identify evidenced based opportunities (use actionable items we have)
Long term – look at new opportunities to understand DM in various populations, and create population specific guidelines for treatment and management

Tailor Approaches in Culturally Appropriate and Community Driven Way

Rich experiences exist in the community, must be aware and learn from them
Programs created must:

Be sustainable
Offer patient-centered language
Be accessible to the members of the community in need
Educate and involve participants
Community involvement is integral


Partnerships

Industry (both pharmaceutical and insurance) wants more discourse with the community on:


Nuances of AANHPI subgroups
Social determinants of health
Lifestyles of populations
Sharing data bilaterally so "reinventing the wheel" is avoided
What is happening in the community


From a policy perspective, AANHPIs must remain together as one voice to be heard.

Reframe arguments for federal agencies: make DM disparity an issue of cost and incentivize
Continue to collaborate and send the message that AANHPIs need approaches that benefit all, but that they must be tailored to have optimal benefit

Make the Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition (AANHPIDC) an ongoing effort

The Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition¡¦s goal is to move this diabetes agenda forward to a national stage and reduce diabetes disparities among AANHPIs. By coordinating participating members (which include ADA, UHJABSOM, Joslin's AADI, AAPCHO, Office of Hawaiian Affairs, and NCAPIP) and working with the federal and industry sectors, the Coalition hopes to achieve better health for those living with diabetes, as well as for future generations.
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