Diabetes and Asian and Pacific-Islander Americans

How Does Diabetes Affect Asian and Pacific Islander American Women During Pregnancy?

Gestational diabetes, in which blood glucose levels are elevated above normal during pregnancy, occurs in about two to five percent of all American pregnant women. Perinatal problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar) are higher in babies born to women with gestational diabetes. Although blood glucose levels generally return to normal after childbirth, an increased risk of developing gestational diabetes in future pregnancies remains. In addition, studies show that many women with gestational diabetes will develop type 2 diabetes later in life. Asian-American women seem to have rates of gestational diabetes that are similar to those of non-Hispanic white women in the United States.

Diabetes is a major risk factor for cardiovascular disease; data suggest that minorities in general have a rate of risk for this disease similar to that of the non-Hispanic white population. Both impaired glucose tolerance and type 2 diabetes were risk factors for coronary artery disease among Japanese Americans in a Seattle study. Although data on the relationship of stroke and hypertension to diabetes in this population are limited, ischemic heart disease is one of the leading causes of death for both men and women.

Diabetic retinopathy is a deterioration of the blood vessels in the eye caused by high blood glucose levels. It can lead to impaired vision and, ultimately, to blindness. In general, age-standardized rates of blindness from diabetes for nonwhites are double those for non-Hispanic whites. However, no data on Asian and Pacific Islander Americans are available.

Diabetic Nephropathy

Minority groups in general have higher rates of end-stage renal disease related to diabetes than do non-Hispanic white people. Among the minority groups, Asian Americans and Pacific Islanders have the lowest prevalence of end-stage renal disease. Minorities have better survival rates after treatment with dialysis than do non-Hispanic white people.

Lower Extremity Amputation

There are no published reports on the rate of amputations among this population.

Because mortality rates are based on the underlying cause of death on death certificates, the impact of diabetes on mortality among Asian and Pacific Islander Americans has been underestimated.

For APIA populations as a whole, diabetes ranked as the fifth-highest cause on death certificates for people between 45 and 64. Among non-Hispanic whites, diabetes is the seventh leading cause of death. However, the age-adjusted mortality rate for Asian and Pacific Islander Americans from diabetes is 12.4 per 100,000, which falls below the rate of 15.9 per 100,000 for non-Hispanic white Americans. The APIA rate is well below rates for other minority populations (African American, 35.7; American Indian and Alaska Native, 30.3; and Hispanic American, 28.3).

A review of death records in American Samoa for the years 1962 to 1974 showed that the age-adjusted, diabetes-related mortality rate for Samoa was more than double that of the United States.

• Prevalence data for diabetes among Asian and Pacific Islander Americans are limited but studies have shown that some groups within this population are at increased risk for developing type 2 diabetes compared with non-Hispanic white people in the United States.

• Type 1 diabetes in APIA youth is relatively rare; however, recent reports highlight an increasing incidence of type 2 diabetes in children and adolescents.

• Asian and Pacific Islander Americans have genetic, medical, and lifestyle risk factors for type 2 diabetes.

• For Asian and Pacific Islander Americans age 45 to 64, diabetes ranked as the fifth-highest cause of death.

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Reprinted with permission from the National Diabetes Information Clearninghouse

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