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Diabetes mellitus, more simply known as diabetes, is a group of diseases that affects how your body uses glucose. Glucose, or blood sugar, is essential to your body because it provides energy for your brain and muscles (Mayo Clinic, 2018).

According to the American Diabetes Association, 25% of people over the age of 65 have diabetes and 50% have prediabetes. Older adults with diabetes have higher rates of premature death, functional disability, accelerated muscle loss, and other comorbidities such as hypertension, heart disease, and stroke (American Diabetes, 2019).

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Diabetes Among Japanese Americans

nurse helping man with diabetes

Diabetes has a greater prevalence among Asian Americans and Pacific Islanders, affecting about 20% of the population, and about 90-95% of those with diabetes have Type 2 diabetes (Joslin Diabetes Center, 2016). Specifically, non-obese Japanese Americans have a higher prevalence of diabetes compared to nonobese Caucasians. This was found to be 8 percent prevalence for Japanese Americans and 4.5 percent among Caucasians (Kobayashi et al., 2019).

This is alarming since diabetes is the fifth leading cause of death among Asian Americans and Pacific Islanders. The high prevalence rate is due to a combination of genetics and environment. Japanese Americans have higher rates of diabetes compared to Caucasians, pointing to a genetic influence (Joslin Diabetes Center, 2016).

Additionally, environmental factors contribute towards the higher rate of diabetes in Japanese Americans compared to native Japanese living in Japan (Joslin Diabetes Center, 2016). A Westernized lifestyle (such as bigger food portions and higher consumption of dietary fat) fosters greater weight gain and thus promotes insulin resistance. This resistance can lead to glucose intolerance, which then develops into diabetes (Fujimoto et al., 2012). This in turn can lead to elevated blood sugar levels causing severe health problems such as skin infections, eye complications, nerve damage, kidney disease, high blood pressure, and stroke (Complications, n.d.). However, with treatment and lifestyle changes, many people with diabetes can prevent or delay these complications.

Types and Stages of Diabetes

There are two types of diabetes: Type 1, and Type 2. The stage before Type 2 diabetes is called prediabetic.

  • Prediabetics have higher than normal blood sugar levels that are not high enough to be considered diabetes. Prediabetes can increase the risk of developing type 2 diabetes, heart disease, and stroke (Reinhard et al., 2018).
  • Type 1 diabetes is typically diagnosed in children and teens and is caused by the body’s inability to produce insulin, a hormone needed for glucose control. Those with Type 1 diabetes may be the only ones in their families to have diabetes (Johns Hopkins, n.d.).
  • Type 2 diabetes is typically diagnosed in adults who are overweight and have a family history of diabetes. Type 2 diabetes is caused by insulin resistance in the body, and the eventual reduction in insulin production (Johns Hopkins, n.d.).

While Type 1 and Type 2 diabetes differ in causes and treatments, they do not necessarily affect quality of life differently. In a survey of 1,783 adults with diabetes, there were no reported differences in health-related quality of life between those with Type 1 and Type 2 being treated by diet alone (Imayama, Plotnikoff, Courneya, & Johnson, 2011). The same symptoms and diagnostic criteria are used to diagnosis diabetes, and a blood test can help distinguish between the two types (Johns Hopkins, n.d.).

Negative Consequences of Diabetes (American Diabetes Association, n.d.)

Many people with diabetes can prevent different complications through treatment and lifestyle changes. However, if diabetes is untreated and lifestyle modifications are not made, there are a variety of medical complications that can develop. Here are a few of the negative health consequences that can result from diabetes.

  • High Blood Pressure
    • Two out of three people with diabetes also report having high blood pressure or taking medications to lower their blood pressure.
    • If you have high blood pressure, your heart has to work harder, which increases the risk of developing heart disease and strokes.
  • Strokes
    • If you have diabetes, the chances of you having a stroke are 1.5 times higher than people who do not have diabetes.
    • Strokes can cause issues with movement, pain, numbness, and problems with thinking and speaking.
  • Kidney Disease
    • Diabetes can damage your kidneys and cause them to fail by making them work too hard due to high levels of blood sugar.
    • When kidneys fail, they are unable to filter out waste products from blood, which results in kidney disease.

Screenings/Diagnosis

Several risk factors should immediately prompt diabetes testing. However, if you are unsure, ask your physician to conduct a diabetes test. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and Type 2 diabetes in adults 40-70 years old who are overweight or obese. This screening should be completed every three years as long as results are normal (Pippitt & Gurgle, 2016). The American Association of Clinical Endocrinologists (doctors who specialize in glands and hormones) suggests screening in association with these risk factors: (Pippitt & Gurgle, 2016)

  • 45 years old or over
  • Cardiovascular disease/ family history of Type 2 diabetes
  • Hypertension (blood pressure over 140/90 mm HG or taking hypertension medication)
  • At risk ethnic groups: Asian, Pacific Islander, Hispanic, Black
  • Obese or overweight
  • Sedentary lifestyle

The American Diabetes Association lists these risk factors in asymptomatic adults:

  • Cardiovascular disease
  • First-degree relative with Type 2 diabetes
  • HDL cholesterol level less than 35 mg/dL and/or triglyceride level greater than 250 mg/dL
  • High risk ethnicity: Native American, Hispanic, Black, Asian, Pacific Islander
  • Hypertension
  • Physical inactivity

There are different types of diabetes tests available. The fasting plasma glucose test, A1C test, and oral glucose tolerance test are considered the most accurate for diagnosing prediabetes and diabetes (The Best Tests, 2018). While one test is not necessarily better than the other, some do require fasting, so take that into consideration when choosing a test.

Below are the different  tests for prediabetes and Type 2 diabetes (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.):

Glycated Hemoglobin (A1C) Test

  • No fasting
  • Indicates average blood sugar level for the past two to three months
  • Test results are shown as a percentage, with the higher percentage indicating higher average glucose levels

Random Plasma Glucose (RPG) Test

  • No fasting
  • Blood samples can be taken at a random time

Fasting Plasma Glucose (FPG) Test

  • Overnight fast (8-12 hours)
  • Standard initial diagnostic method for decades
  • Measures glucose levels at a specific point in time

Oral glucose tolerance test

  • Fast overnight
  • Fasting blood sugar is measured
  • Drink a sugary liquid after; blood sugar levels are tested periodically for the next two hours
  • This test is typically done when diabetes is suspected but when you have normal/borderline results on a fasting plasma glucose test

You can ask your physician to perform a diabetes screening for you. Some pharmacies such as Rite Aid, CVS, and Walgreens may offer diabetes screenings. Medicare pays for diabetes screening tests if you are at risk for diabetes and may pay for up to two diabetes screening tests in a 12-month period. Fasting blood sugar tests and other tests approved by Medicare are appropriate tests. Medicare also covers the A1C test if ordered by doctor (Medicare Coverage, 2018).

Prevention and Treatment

Prediabetes and Type 2 diabetes can often be prevented through diet and lifestyle changes. In a three-year study, a group following a diet and lifestyle intervention had a 58% lower risk of developing diabetes. In the same study, participants over the age of 60 had an even better response of 71% lower risk of developing diabetes (Tello, 2018).

Strict glucose control can delay and prevent the progression of complications associated with diabetes. In addition, leading a healthy lifestyle (healthy diet, modest weight loss, and regular physical activity) can reduce the risk of Type 2 diabetes complications (Chong et al., 2017). On a long-term scale, diabetes management involves key health behaviors. Overall, each person needs to work with their physician to create an individualized treatment plan to manage and treat their diabetes.

  • Physical Activity
    • Regular physical activity can help prevent the onset of Type 2 diabetes.
  • Diet
    • A healthy balanced diet can significantly reduce the risk of developing Type 2 diabetes.
    • Dietary changes can include eating enough fruits and vegetables, consuming low-fat dairy products, tree nuts, legumes, and limiting the amount of red meat.
  • Medication
    • When paired together, diet and exercise are associated with lowering the odds of having diabetes (Chong et al., 2017).
    • If diet and exercise do not lower blood sugar, medication is also an option.
  • Diabetes Self-Management Training (DSMT)
    • Diabetes self-management training helps you learn how to manage diabetes.
    • To get covered by Medicare, a doctor or other health care provider must prescribe it. Your doctor can provide information on where to get DSMT (Medicare Coverage, 2018).
    • Medicare covers up to 10 hours of initial training and two hours of follow up training, if needed (Medicare Coverage, 2018).
    • DSMT is available in many Federally Qualified Health Centers (these centers provide primary health services in underserved areas) such as community health centers.
    • The DSMT program and individuals are accredited by the American Diabetes Association or the American Association of Diabetes Educators.

Diabetes significantly affects older adults, especially Asian Americans and Pacific Islanders, which is why it is important to understand its effects on the body. Those who have a family history of diabetes or are at risk of developing diabetes should be tested regularly. After a diabetes diagnosis, learn more about how to manage it. Again, diabetes can be treated and even prevented through diet and lifestyle changes. Consider increasing your consumption of fruits and vegetables, and exercising regularly to prevent or better manage your diabetes.

Sources

American Diabetes Association. (n.d.). Complications. Retrieved from https://www.diabetes.org/diabetes/complications

American Diabetes Association, (2019). 12. Older Adults: Standards of Medical Care in Diabetes-2019. Diabetes care, 42(Supplement 1), S139-S147. https://doi.org/10.2337/dc19-S012

Carlson, S. J. (2018, May 8). Caring for a loved one with diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/caring-for-a-loved-one-with-diabetes/faq-20424136.

Chong, S., Ding, D., Byun, R., Comino, E., Bauman, A., & Jalaludin, B. (2017). Lifestyle Changes After a Diagnosis of Type 2 Diabetes. Diabetes spectrum: a publication of the American Diabetes Association30(1), 43–50. doi:10.2337/ds15-0044

Complications, (n.d.). Retrieved from https://www.diabetes.org/diabetes/complications.

Dansinger, M. (2019, May 25). 6 Lifestyle Changes to Help Control Your Diabetes. Retrieved from https://www.webmd.com/diabetes/diabetes-lifestyle-tips.

Diabetes. (2018, August 8). Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444.

Diabetes-Diagnosis. (2018, August 8). Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451.

Fujimoto, W.Y., Boyko, E.J., Hayashi, T., Kahn, S. E., Leonetti, D.L., McNeely, M. J., & Shuman, W.P. (2012). Risk factors for type 2 diabetes: Lessons learned from Japanese Americans in Seattle. Journal of Diabetes Investigation, 3(3), 212-224. http://doi.org/ 10.1111/j.2040-1124.2012.00195.x

Imayama, I., Plotnikoff, R.C., Courneya, K.S., & Johnson, J.A. (2011). Determinants of quality of life in adults with type 1 and type 2 diabetes. Health and Quality of Life Outcomes, 9. Retrieved from https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-9-115

Johns Hopkins Patient Guide to Diabetes. (n.d.). Type 1 and Type 2 Diabetes. Retrieved from https://hopkinsdiabetesinfo.org/diagnosis-of-diabetes/

Kingston, J. (2016, May 7). Diabetes emerges as Japan’s hidden scourge. Retrieved from https://www.japantimes.co.jp/opinion/2016/05/07/commentary/diabetes-emerges-japans-hidden-scourge/#.XaX82vZFzcs.

Kobayashi, K. Tsz-Kit Chan, K. Roy, A. Khan, M. Fuller-Thomson, E. (2019). Diabetes and Diabetes Care among Nonobese Japanese-Americans: Findings from a Population-Based Study. Advances in Preventive Medicine, vol. 2019 (3650649), 8 pages. https://doi.org/10.1155/2019/3650649

Laiteerapong, N., Karter, A., Liu, J., Moffet, H., Sudore, R., Schillinger, D.,… Huang, E. (2011). Correlates of Quality of Life in Older Adults with Diabetes: The Diabetes & Aging Study. Diabetes Care, 34(8), 1749-1753. DOI: 10.2337/dc10-2424

Medicare Coverage of Diabetes Supplies and Services. (2018). In Section 4: Medicare-Covered Diabetes Services. Retrieved from https://www.medicare.gov/pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf

One in Two Asian Americans Develop Diabetes or Pre-Diabetes in Their Lifetime. (2016). Retrieved from https://aadi.joslin.org/en/diabetes-mellitus-in-asian-americans.

Pippitt, K., Li, M., & Gurgle, H. E. (2016, January 15). Diabetes Mellitus: Screening and Diagnosis. American Family Physician, 93(2), 103-109. Retrieved from https://www.aafp.org/afp/2016/0115/p103.html.

Reinhard et al. (2018). The Facts About Prediabetes and Older Adults. Retrieved from https://www.aarp.org/ppi/info-2018/the-facts-about-prediabetes-and-older-americans.html

Resources for People Living with Diabetes. (n.d.). Retrieved from https://www.diabeteseducator.org/living-with-diabetes/been-referred.

The Best Tests to Diagnose Diabetes. (2018, October 22). Retrieved from https://www.healthandwellnessalerts.berkeley.edu/topics/diabetes/the-best-tests-to-   diagnose-diabetes/.

Tello, M. (2018, September 6). Healthy lifestyle can prevent diabetes (and even reverse it). Retrieved from https://www.health.harvard.edu/blog/healthy-lifestyle-can-prevent-diabetes-and-even-reverse-it-2018090514698.