YOUR HEALTH: TAKE CHARGE!
By: Edward A. Chow, M.D.
The National Council of Asian American Pacific Islander Physicians (NCAPIP) recently sponsored the second meeting of the Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition (AANHPI- DC) on May 18-19, 2012. Physicians, stakeholders, and policy makers from all over the country came together to review the results of the first conference which had resulted in 2 papers in Diabetes Care referenced at the end of this report, and to develop key actions to improve the status of diabetes in the AANHPI communities. From the informative presentations and robust discussions, the following action steps were identified:
1. Getting Better Identifying Diabetes in Offices
In order to treat diabetes more effectively, we need criteria specifically designed to diagnose and treat diabetes in Asian American, Native Hawaiian, and Pacific Islanders. Body Mass Index, or BMI, is often used to predict the risk for diabetes, but many Asians with diabetes have a lower BMI than their Caucasian counterparts. Furthermore, BMI does not always correlate with the amount of visceral body fat, which is one of the best predictors of risk for diabetes. NCAPIP and the AANHPI Diabetes Coalition will continue working with the Asian Pacific American Diabetes Action Council (APADAC) and the American Diabetes Association to develop more appropriate BMI guidelines for the diagnosis and treatment of diabetes in AANHPI patients. NCAPIP, the Diabetes Coalition, and their partners will also investigate guidelines for risk factors for AANHPI patients, gestational diabetes mellitus (GDM), pre-diabetes, and complications of diabetes.
2. More Data is Needed
Current information about diabetes in the AANHPI population is scarce. In order to guide future actions, we need to work with the Centers for Disease Control to analyze the information in studies already performed to direct future research. Creating a partnership with the National Institute of Diabetes and Digestive and Kidney Diseases will help expand the research being done on diabetes amongst AANHPIs. However, this should not prevent us from taking steps to prevent diabetes in the AANHPI populations now.
3. A Community Based Approach
To increase the overall health of the AANHPI communities, physicians, patients, and community members need to be aware of the risks of diabetes and steps they can take to prevent it. Education is the key. By creating and distributing appropriate resources to physicians and care providers, we can educate them on the importance of ethnicity on the risk of diabetes. Increasing understanding of the impact of diabetes in the AANHPI community will also encourage members who may be at risk to be more aware of their health and seek out treatment. This message, however, must be written in a culturally and linguistically appropriate manner in order to most effectively inform our patients and communities on the impacts and risks of diabetes.
4. Support Understanding Gestational Diabetes
In addition to the action steps identified at the conference, it is important to support ongoing legislation such as the Gestational Diabetes (GEDI) Act of 2011. Gestational diabetes mellitus (GDM) is a unique form of diabetes that is only present in mothers while they are pregnant. GDM disproportionately affects AANHPI mothers and poses a significant danger to the health of both mother and child. The Gestational Diabetes Act of 2011 was recently introduced to gather more information on this disease. This legislation would fund additional public health research projects and enhance the surveillance of gestational diabetes. The bill would also provide much needed grant money to programs aimed at reducing the incidence of gestational diabetes, as well as funding for basic scientific and clinical research for doctors investigating the causes of and treatments for this poorly understood disease. Please see the editorial "Understanding and Addressing Unique Needs of Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders" in the journal Diabetes Care for additional information about the importance of gestational diabetes in the Asian population.
1. George L. King, Marguerite J. McNeely, Lorna E. Thorpe, Marjorie L.M. Mau, Jocelyn Ko, Lenna L. Liu, Angela Sun, William C. Hsu, and Edward Chow. Understanding and Addressing Unique Needs of Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders. Diabetes Care May 2012 35:1181-1188; doi:10.2337/dc12-0210
2. William C. Hsu, Edward J. Boyko, Wilfred Y. Fujimoto, Alka Kanaya, Wahida Karmally, Andrew Karter, George L. King, Mele Look, Gertraud Maskarinec, Ranjita Misra, Fahina Tavake-Pasi, and Richard Arakaki. Pathophysiologic Differences Among Asians, Native Hawaiians, and Other Pacific Islanders and Treatment Implications. Diabetes Care May 2012 35:1189-1198; doi:10.2337/dc12-0212
By: Ho Luong Tran, MD, MPH
Recently, the National Council of Asian Pacific Islander Physicians (NCAPIP) convened in Washington DC for their second annual National Conference, entitled: "Moving Forward on Health Reform: Optimal Health For All." At the same time, NCAPIP held a second conference, "Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action" to specifically discuss how diabetes affects the everyday lives of people. One topic discussed during the meeting was a unique type of diabetes known as gestational diabetes mellitus, or GDM for short. GDM occurs when a woman who becomes pregnant develops high levels of glucose (or sugar) in her blood. Glucose is normally used by every cell in the body to generate energy, but when levels are too high they can jeopardize the health of both the mother and baby.
While the exact cause of gestational diabetes is not fully understood, doctors currently believe the nutritional needs of a baby combined with hormonal changes in the mother's body are the primary causes. As a placenta develops during pregnancy the hormones produced will affect the mother's ability to produce and use insulin, which is important for absorbing glucose from the bloodstream. The mother's body must now produce more insulin to maintain normal function, which is called insulin resistance. Some level of insulin resistance is normal during pregnancy, but in cases of gestational diabetes the mother's body cannot make up for the added demand for insulin and glucose accumulates in the mother's bloodstream.
Gestational diabetes is usually checked for between the 24th and 28th weeks of pregnancy by giving the oral glucose tolerance test. This requires the mother to drink a sugary solution and then monitoring the level of glucose in her blood. If the mother is considered at high risk for gestational diabetes, her glucose tolerance may be tested immediately once the pregnancy is discovered. If you are pregnant or plan on becoming pregnant, talk to your doctor about your own risk for gestational diabetes and when you should be tested.
Women who are of Asian, Native Hawaiian, or Pacific Islander decent are at a higher risk of developing gestational diabetes. In fact, Asian American women are up to 177% more likely to develop gestational diabetes than a non-Hispanic white woman. Many other factors can increase the risk of gestational diabetes during a pregnancy including obesity, a relative with first-degree diabetes, glucose in the urine, glucose intolerance, previous pregnancies with gestational diabetes, or giving birth to a baby large for its gestational age. Since gestational diabetes creates significant health risks to both the mother and the baby, women who are pregnant or plan on becoming pregnant are encouraged to talk to their OB/GYN or primary care doctor about their specific risk for developing gestational diabetes.
There is no guaranteed way to prevent gestational diabetes, but there are steps you can take to reduce the likelihood of developing high blood glucose levels during pregnancy. Adopting good health habits such as eating health foods, regular exercise and losing excess weight prior to pregnancy can help protect the mother from developing gestational diabetes even if she has had it before. Adhering to these healthy practices can also reduce the mother's risk of developing type 2 diabetes in the future.
For more information on gestational diabetes please visit the websites of the American Diabetes Association, the National Institutes of Health, or the National Diabetes Information Clearinghouse and continue to check our website as the National Council of Asian Pacific Islander Physicians will continue to advocate for the health and well being of patients and communities.