---

Health Equity Forum Podcast: Episode 3 – Transcript

RADM Richardae Araojo: Hello and welcome to the Health Equity Forum Podcast, hosted by the FDA Office of Minority Health and Health Equity. I'm your host, RADM Richardae Araojo, the Associate Commissioner for Minority Health and Director of the Office of Minority Health and Health Equity at FDA. In this episode, we will be talking about the impact of diabetes on Asian Americans. We know that racial and ethnic minorities are disproportionately burdened by many chronic diseases like diabetes and are much more likely to succumb to certain illnesses.

We've seen the significance of this highlighted during the COVID-19 pandemic, as reported data shows a disproportionate impact on diverse communities within the United States. And these disparities highlight the importance of raising awareness and education on diabetes prevention, screening, treatment, and management. To provide a little bit of background about diabetes screening, the general rule has been that if you have a body mass index or BMI at or above 25, you are at risk for diabetes.

However, research on Asian Americans proves different. The American Diabetes Association, National Institutes of Health, and the Centers for Disease Control and Prevention have acknowledged that Asian Americans with a BMI of 23 or above should be screened for diabetes. Asian Americans may have a different fat distribution, with more fat in the abdominal area, which puts them at increased risk for chronic diseases like diabetes.

BMI is a measure to determine if a person is underweight, overweight, or obese, and it's calculated using a formula based on a person's height and weight. BMI is one screening tool used to determine if a person is at increased risk for developing certain health problems. To explain why these differences in BMI among Asian Americans impacts their diabetes risk, we've invited a group of experts from the National Council of Asian Pacific Islander Physicians.

I'm joined today with Dr. Winston Wong, Chair and Acting CEO of the National Council of Asian Pacific Islander Physicians, Dr. Maria Rosario Araneta, Professor of Epidemiology with the Department of Family Medicine and Public Health at the University of California, San Diego School of Medicine, and Mr. David Hawks, consultant with the National Council of Asian Pacific Islander Physicians and Coordinator of the Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition. Dr. Wong, Dr. Araneta, and Mr. Hawks, thank you so much for being here. Welcome.

Dr. Winston Wong: Oh, and thank you, Richardae and the FDA, for hosting this really important opportunity for us to amplify on diabetes in Asian Americans [inaudible 00:02:45] and Native Hawaiians.

Dr. Maria Rosario Araneta: Yes. Thank you for this opportunity to share these important messages.

Mr. David Hawks: Hi, everyone. Glad to be here.

RADM Richardae Araojo: To kick things off, I'm going to start with you, Dr. Wong. Can you tell us about diabetes and how it affects the body?

Dr. Winston Wong: Sure. I think some of these concepts may be familiar to many of our listeners, but as many people know, diabetes is a disease that affects the body's ability to produce the insulin necessary for processing the glucose we get from food. There are two types with type 1 usually being diagnosed in young people and implying that the pancreas produces insufficient or little insulin. Type 2, which most people are more familiar with, is caused by elevated levels of glucose in the body, coupled with the pancreas that does not produce enough insulin.

Subsequently, it's usually diagnosed in older adults, although we're starting to see many more young people with this type 2 diabetes as well. High blood glucose in the body can lead to things like heart disease, stroke, kidney failure, nerve damage, eye damage, and even foot problems, and a number of other various very serious complications.

RADM Richardae Araojo: Thank you, Dr. Wong. Dr. Araneta, can you tell us about how diabetes specifically impact Asian American populations?

Dr. Maria Rosario Araneta: Diabetes affects over 30 million people in the United States. The majority of these have type 2 diabetes. And as with many diseases and conditions, we see a significant disparity in the prevalence and incidence of diabetes in Asian American, Pacific Islander, and Native Hawaiian communities when compared to non-Hispanic white Americans. From a public health standpoint, we try to look at all the factors that contribute to this gap, and these include social determinants of health, along with genetic or biological factors.

Researchers have found that Asian Americans across all Asian subgroups are at significant risk of developing type 2 diabetes at a body mass index of 23. Any Asian American that sees a healthcare provider should not be deemed not at risk simply because they have a low BMI and look like they wouldn't get type two diabetes because of their size. It's also important to note that Asian Americans is an incredibly diverse group of people.

In fact, we are talking about different people with different cultures and languages, but are reported aggregately. Within this Asian American designation, the groups most at risk for diabetes are Pacific Islanders, which includes Samoans, Marshallese and others, Native Hawaiians, Filipinos, and South Asians, which include Asian Indian, Pakistani, and others. While East Asian Americans, such as Chinese, Japanese, and Korean have lower incidents rates of diabetes, they still have a higher risk compared to non-Hispanic whites.

The risk is higher for every subgroup within Asian American, Pacific Islander, and Native Hawaiian, but the groups mentioned first are at a much higher risk comparable or in some cases higher than other ethnic minority groups.

RADM Richardae Araojo: Can you tell us more about diabetes screening among Asian Americans?

Dr. Maria Rosario Araneta: According to the Centers for Disease Control, as many as one in four people who have diabetes don't know they have it. But for Asian Americans, that number is much higher. One in two, the highest of all racial and ethnic groups. The American Diabetes Association's guidance changed in 2015, and they are working to raise awareness on the low rates of diabetes screening among Asian Americans, the lowest of any race ethnicity in the US, and the broader disparity among Asian Americans, Pacific Islanders, and Native Hawaiians.

Unlike type 1 diabetes, type 2 diabetes can be prevented in the pre-diabetes stage and a BMI of 23 is also a useful risk factor to account for when assessing a patient's status as having pre-diabetes or not. Because of this, it is important that Asian Americans are screened at a BMI of 23.

RADM Richardae Araojo: Thank you, Dr. Araneta for really highlighting why it's important for Asian Americans to be screened at a BMI of 23. Dr. Wong, what are your thoughts about the impact of diabetes on race and ethnicity among Asian Americans, and how can diabetes prevention and management be improved?

Dr. Winston Wong: Well, yes, Richardae, that's such an important critical question. I think if we think about the goal of medicine, the goal of medicine and healthcare is about how we optimally are able to treat each individual patient from intake to prognosis, to diagnosis, treatment, and to follow up. This is often called personalized medicine or care that's tailored to the individual.

The more that is known about a patient, whether it's age, family history, genes, living situation, work situation, race, ethnicity, medical history, among other things, and the greater the knowledge about the impact of these factors, the more tailored healthcare and medicine really can be. To get there, the growing body of research on the impact of diabetes on race and ethnicity and other factors needs to be taken into consideration so that we're not using a one size fits all strategy.

Disaggregated data for sub-populations is a worthy go for population health, but broad categories like South Asian, Southeast Asian, East Asian, and Pacific Islander still provide healthcare teams with really valuable information. Understanding the impact of race and ethnicity is important to help achieve the goal of health equity.

It bears mentioning because sometimes it is not given enough attention in diabetes when it comes to lack of awareness of the disparities among different groups, specifically the higher incidents and prevalence rates, the low rates of diabetes screening, and the high rates of undiagnosed diabetes in the country, as Dr. Araneta referenced.

RADM Richardae Araojo: Thank you, Dr. Wrong. You've really highlighted how important it is for us to understand the impact of race and ethnicity to really achieve our goal of health equity. And Mr. Hawks, can you tell us about the National Council of Asian Pacific, Islander Physicians and the work of the Diabetes Coalition?

Mr. David Hawks: Absolutely, Richardae. NCAPIP is an organization of AANHPI physicians that advocate for optimal health and target policies and health initiatives that address the disparities in AANHPI populations. NCAPIP was the key founder of the Diabetes Coalition back in 2011. We held a State of the Science Conference and brought together researchers, nutritionists, folks from the community, patients in Hawaii together to talk about type 2 diabetes mainly in AANHPI.

After that meeting, we asked the question of, should we or should we not come together as a coalition, have a conference every year, create an action plan on how to reduce these disparities, and to basically do what we had done, make it not a one-off, but a continuing effort. And there was a resounding yes from about 20 organizations, and the coalition's mission is just that. It's to use an evidence-base using the latest and best research on these populations, including the work done by Dr. Araneta, have that research inform our policy targets.

And we have a number of policy experts in the coalition, including Dr. Wong, as well as the clinical expertise that falls under his purview as well. And probably just as if not more importantly, but folks who are embedded and in all of these communities, this diverse community under the AANHPI designation. It's important to note that one of the principles of the coalition was not only reaching the provider and consumer community, but having that community take ownership of the messaging.

And the coalition's team of experts make sure that whatever messaging is tailored by the community for the community is scientifically sound and accurate. Again, this is a coalition of organizations, both national and regional, that have their own networks and do their own great work on diabetes and other issues leverage that network to spread the information in a very, almost dare I say, organic way. For folks who want to learn more, I'd really encourage you to, to go to the NCAPIP website.

That's, again, the National Council of Asian Pacific Islander Physicians at www.ncapip.org to learn more about our work, about the coalition, current campaigns and initiatives, and have access to resources and find out ways to get involved. We would love to hear from you. Thanks.

RADM Richardae Araojo: Thank you, Mr. Hawks, Dr. Wong, and Dr. Araneta for the extremely important and valuable information that you've shared with us today and for all the work that you are doing to improve the health of Asian Americans, and especially for highlighting for us that Asian Americans should be screened at a BMI of 23. For more information about the Health Equity Forum Podcast series, please visit our website, www.fda.gov/healthequity. While you're there, check out our library of resources and sign up for our newsletter.

Also, don't forget to follow us on Twitter @fdahealthequity. Remember, together we can create a world where health equity is a reality for all.

[end of transcript]