Diabetes among South Asian Americans at epidemic levels

NEW YORK: Diabetes, which is a major risk factor for cardiovascular disease, has risen to epidemic levels among South Asian American communities, with studies showing that nearly 35 percent of this community is susceptible to Type II diabetes- which is seven times the likelihood of developing the disease as compared to white Americans.

The community has the highest reported rates of diabetes among immigrant communities in the United States. Statistically, over half of New Yorkers originally from the Indian subcontinent, are already suffering from Type II diabetes or are pre-diabetic.

Considering the gravity of the situation, the Friedman Diabetes Institute of Beth Israel Medical Center and South Asian Health Initiative (SAHI) of NYU's Center for Immigrant Health conducted a first ever roundtable conference focusing on South Asians and Diabetes, at Beth Israel Medical Center in Manhattan on May 20.

A diverse set of individuals working on diabetes in the South Asian community as physicians, community organizations, nutritionists, policymakers and researchers participated in the roundtable to work together and find solutions to the diabetes epidemic that is facing the community.

The Friedman Diabetes Institute's ADEPT (the Queens Action for Diabetes Education Prevention & Treatment) project has been addressing this issue by engaging with doctors serving South Asian community members with diabetes as well as community organizations.

In addition to setting up a network of these doctors, the ADEPT team has been providing free glucose testing, diabetes and nutrition education, and referrals to community members at places of worship, senior centers, airports (to target cab drivers) and other community locales. The ADEPT project is made possible through a grant from the New York State Health Foundation.

According to Dr. Leonid Poretsky of the Friedman Diabetes Institute, typically the factors leading to diabetes among South Asian communities are changing standards in their living, eating more, and genetic background. "South Asians as a demographic are not obese, but for some reason, even a little bit of weight gain seems to cause diabetes among them," said Dr. Poretsky.

Funding has been a major issue to conduct in-depth studies, Dr. Poretsky said, as even the funding from the NY State Health Foundation is set to end this year. Typically, Dr. Poretsky said, these immigrant communities tend to come from backgrounds of relative starvation or deprivation, which changes when they come to the US where there is plenty of food available leading to excessive consumption of rich foods. That combined with lack of physical activity leads to diabetes and thus cardiovascular disease, he said.

Making a detailed presentation, Dr. Sapna Pandya of SAHI said social factors weighed in as the biggest factors causing diabetes among South Asian Americans. "Historically, there is a lot of difference in the kind of immigrants coming from the South Asian countries to the US than what we see today. There's a great disparity among the community itself."

Contradictorily, while Asian Pacific American communities tend to be the most affluent among all immigrant communities, they also rank 12th on the National Poverty Scale. As many as 21 percent of them are either medically uninsured or underinsured and the main barriers affecting their access to healthcare are transportation issues; stigma about diabetes; legal issues, socio-cultural, financial and linguistic issues.

Women of Asian and South Asian descent in the US may have a lower body mass index (BMI) than Caucasians, but are at increased risk for developing gestational diabetes mellitus during pregnancy.

Evidence exists that Asian Indians are more insulin resistant than Whites and such resistance puts them at greater risk for diabetes and heart disease.

Other statistics show that 18% Indian Americans, 28% Pakistani Americans and 31% Bangladeshi Americans in New York are below the poverty line. On an average, 20% South Asians are uninsured that includes 80% South Asian Taxi drivers and 60% South Asian women.

According to Dr. Pandya, it has been found that genetic susceptibility and socio-economic determinants are the reasons for South Asians across the globe for a high prevalence of diabetes among them.

Dr. Poretsky, however said, that it was not really known how genetics lead to diabetes as studies in that area have been inconclusive.

Ironically, while in India diabetes tends to be a disease of the rich, in the US, it's a disease of the relatively poor. "That is because 'healthy food' is expensive here," said Dr. Pandya.
SAHI has been working on mainstream healthcare providers in the area of cultural competence to provide better healthcare access to these communities.

India Post News Service