Despite Higher Diabetes Risk, Fewer Asian Americans Get Screened

Marcia Frellick

November 18, 2016

Fewer than half of Asian Americans who should be screened for type 2 diabetes get tested, according to a new survey published online November 15 in the Journal of General Internal Medicine.

Elizabeth Tung, MD, clinical instructor of medicine at the University of Chicago in Illinois, and colleagues found that Asian Americans, the most rapidly growing ethnic population in the United States, were the group least likely to undergo recommended screening, even though they have rates of undiagnosed diabetes that are three times that of non-Hispanic whites.

"Even after accounting for education, access to healthcare, and other key factors, Asian Americans had 34% lower odds of being screened than non-Hispanic whites," Dr Tung said in a University of Chicago press release.

Yet about 21% of Asian Americans have type 2 diabetes, nearly double the rate for non-Hispanic whites.

Racial/Ethnic Group and Percentage Who Receive Appropriate Screening

Racial/ethnic groups Percentage (%) who receive appropriate screening
Non-Hispanic blacks 60.2
Non-Hispanic whites 59.2
Multiracial adults 58.8
Hispanics 58.1
American Indians/Alaska natives 55.6
Non-Hispanic Pacific Islander 50.3
Asian Americans 47.1

Lack of Awareness That Asians at Higher Risk of Diabetes at Lower BMI

Asian Americans are at higher risk of diabetes at lower body mass indexes (BMIs) compared with other racial groups, and recognition of this last year led the American Diabetes Association (ADA) to change its guidelines and recommend screening for Asian Americans with a body mass index (BMI) of 23 kg/m2 or higher, as reported by Medscape Medical News.

But the authors suspect that this knowledge has not yet filtered down to physicians or the general population.

"Doctors shouldn't neglect to screen Asian Americans just because they appear to be thin," Dr Tung emphasized. And "Asian Americans should confirm with their doctors that they have been screened for diabetes."

It's not that Asian Americans are averse to screening in general, the authors say.

Although Asian Americans in the study population had lower numbers of colorectal-cancer screenings, compared with other ethnic groups, this was not the case for breast-cancer screening, which is much more involved than screening that for diabetes.

Crucial That More Asian Americans Are Screened for Diabetes

To compare screening rates for diabetes, the researchers analyzed data from more than 526,000 participants in the 2012–2014 Behavioral Risk Factor Surveillance System. This annual telephone survey asks US residents for information on health risks and preventive behaviors.

Their sample included 9310 Asian Americans who were at least 45 years old or were younger than 45 but had a BMI of at least 25 kg/m2. Participants were asked whether they had had a test for high blood sugar or diabetes in the past 3 years.

The study has some limitations — the authors note that Asian Americans in this study had higher education levels than the general population, which may have reduced barriers to accessing healthcare and, consequently, the extent of the disparity.

Also, the data cover only 42 of the 50 states, excluding California and Texas, the states with largest Asian populations.

Dr Tung and colleagues say that one of the potential policy implications is that given the disparities revealed in this study, Asian Americans and Pacific Islanders should not be grouped together for BMI cutoffs as the new ADA guidelines suggest.

They are often grouped together because of shared biological and genetic factors. But the authors note that "doing so may mask important underlying differences."

They conclude that the study findings have wide-ranging implications: "Given the deleterious health effects of delayed diagnosis and treatment of diabetes, it is crucial that public-health and clinical professionals improve screening and diagnosis of diabetes in Asian Americans."

The study was funded by the National Institutes of Health, the Agency for Healthcare Research Quality, and the Chicago Center for Diabetes Translation Research. The authors report no relevant financial relationships.

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J Gen Intern Med. Published online November 15, 2016. Abstract

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