Diabetes Prevalence and Risk Factors in Four Asian American Communities

Our objective was to estimate the prevalence of diabetes and pre-diabetes and the risk associated with BMI above the Asian cut-point of 23 in 4 Asian American communities. In a convenience sample of 981 Chinese, Hmong, Korean, and Vietnamese Americans in Sacramento County, California we measured hemoglobin A1c (HbAlc), height, weight, and waist circumference. Diabetes was defined as self-reported diabetes diagnosis or HbA1c≥6.5%, and pre-diabetes as HbAlc 5.7-6.4% with no diabetes diagnosis. We computed age-standardized prevalence of diabetes, pre-diabetes, and BMI and waist circumference above standard and Asian cut-points, and developed multivariable models of the association of diabetes and pre-diabetes with BMI and waist circumference. The 4 ethnic groups differed substantially with respect to diabetes prevalence, BMI, and waist circumference. Hmong had the highest prevalence of diabetes (15.0%, 95% confidence interval [CI] 10.7-19.4%). Diabetes and pre-diabetes were associated with BMI≥25 (diabetes: odds ratio [OR] 3.4, 95% CI 2.1-5.7; pre-diabetes: OR 4.0, 95% CI 2.7-5.8) or between 23 and 25 (diabetes: OR 1.8, 95% CI 1.0-3.1; pre-diabetes: OR 1.6, 95% CI 1.0-2.4). When waist circumference was added to the model, BMI effects were attenuated, and waist circumference ≥40 inches (men) or ≥35 inches (women) was associated with increased risk of diabetes (OR 3.2, 95% CI 1.6-6.2) and pre-diabetes (OR 1.7, 95% CI 1.0-2.9). Our findings support the use of a BMI cut-point of 23 and the importance of central adiposity as a risk factor for diabetes in Asians. Diabetes risk reduction interventions for Asians are essential.