Asian Americans are at high risk for diabetes but rarely get screened

Asian Americans being screened for diabetes at a health fair in Chinatown, 2014

Less than half of Asian Americans who ought to be screened for type 2 diabetes actually get tested, according to a study published Nov. 15, 2016, in the Journal of General Internal Medicine. Asian Americans have a high prevalence of undiagnosed diabetes. Yet they were the racial and ethnic group least likely, by far, to undergo recommended screening.

A team of University of Chicago researchers found that only 47.1 percent of Asian Americans received appropriate screening, compared to 60.2 percent of non-Hispanic blacks, 59.2 percent of non-Hispanic whites, 58.8 percent of multiracial adults, 58.1 percent of Hispanics, 55.6 percent of American Indians or Alaskan Natives and 50.3 percent of Pacific Islanders.

"Even after accounting for education, access to healthcare and other key factors, Asian Americans had 34 percent lower odds of being screened compared to non-Hispanic whites," said the study's lead author, Elizabeth Tung, MD, clinical instructor of medicine at the University of Chicago. "This may be an important driver of undiagnosed diabetes in this group."

The researchers analyzed data from the 2012-14 Behavioral Risk Factor Surveillance System, an annual telephone survey that collects information on health risks and preventive behaviors of United States residents. Their sample included 526,000 respondents, including 9,310 Asian Americans, who met the criteria for diabetes screening.

"Asian Americans are not necessarily averse to screening tests," said Tung. The researchers examined a subgroup of Asian Americans who completed both breast and colon cancer screening, and the lower rates of diabetes screening persisted. Both breast and colon cancer screening are "logistically and technically more involved than diabetes screening," the researchers note.

The authors of the study were concerned that many Asian patients and some of their physicians may not be fully aware that even at lower body weights, Asians are at high risk for type 2 diabetes. About 21 percent of Asian Americans have type 2 diabetes, nearly double the rate for non-Hispanic whites. Undiagnosed diabetes is almost three times higher among Asian Americans.

Recognizing this increased risk, the American Diabetes Association (ADA) revised its screening guidelines for Asian Americans last year. They formerly recommended that Asian Americans should be screened if they were at least 45 years old. Overweight adults, those with a body mass index (BMI) of 25 or more, should be screened even if they were younger than 45.

In 2015, the ADA changed their guidelines to recommend screening for Asian Americans with a BMI of 23 or higher.

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

The study has several limitations, the authors note. Asian Americans in their study had higher educational attainment and were more fluent in English than the general population, which may have reduced barriers to accessing healthcare and the extent of the disparity. Their data source covers only 42 of the 50 United States, excluding California and Texas, the states with largest Asian populations. Additionally, the data about diabetes, breast cancer and colon cancer screening was based on self-reported information by those interviewed, which was not subject to external validation.

The study was funded by the National Institutes of Health, the Agency for Healthcare Research Quality, and the Chicago Center for Diabetes Translation Research. Additional authors were Arshiya Baig, Elbert Huang, Neda Laiteerapong, and Kao-Ping Chua.