Newswise Boston May 7, 2012 As the diabetes epidemic spreads worldwide, there is growing concern for Asian American populations, who are nearly twice as likely to develop diabetes, particularly type 2 diabetes. Compounding the problem, many of the standard ways to detect diabetes fail in people of Asian descent.

The medical profession needs to be aware of and address the unique characteristics of this population, said George L. King, M.D., Chief Scientific Officer at Joslin Diabetes Center and Professor of Medicine at Harvard Medical School (HMS). Without this understanding, diabetes could be misdiagnosed or missed altogether.

Dr. King was lead author of nine diabetes specialists nationwide who collaboratively wrote an article published in the May 2012 edition of Diabetes Care highlighting a comprehensive range of research findings presented at an international symposium held in Honolulu in September 2011.

The authors compiled extensive data on various groups that comprise the Asian American population, encompassing immigrants from numerous East Asian countries and those born in the United States. They also studied diabetes incidence in Native Hawaiians and Pacific Islanders.

Although there are large differences in immigration patterns and lifestyle adaptations to U.S. culture among these groups, common threads and new insights are emerging. Researchers are finding significant differences in how diabetes affects the bodys chemistry, how to view body weight, and why commonly used laboratory tests may not be reliable in Asian populations.

Type 1 diabetes can be difficult to clinically differentiate from type 2 diabetes in Asians, said Dr. William C. Hsu, M.D., who with Dr. King co-directs the Asian American Diabetes Initiative at Joslin. Dr. Hsu, an Assistant Professor of Medicine at HMS, was lead author of a team of 12 experts who wrote a second article published in the same edition of Diabetes Care. These authors focused on the pathophysiology, or the disease process, of diabetes.

Type 1 diabetes is relatively rare in Asians, with incidence five to 10 times lower than in people of European descent. But diagnosing the disease is more difficult because genetic markers and blood factors generally associated with type 1 diabetes are present in only 30 percent of patients of Asian descent. In other words, simply relying on conventional tests would lead to misdiagnosis of a large percentage of Asians who have type 1 diabetes. More research is needed to learn what other biological factors in Asians patients lead to the destruction of insulin-making beta cells, resulting in type 1 diabetes. Lab tests then could be developed to detect these specific factors.

Type 2 diabetes is the most common form of diabetes in Asian Americans, with prevalence of diagnosed cases in recent years jumping from approximately 1 or 2 percent to 10 percent today, compared with 6 percent in the general population. Many others are undiagnosed or at risk, falling into the "pre-diabetes" category. In type 2 diabetes, the pancreas produces insulin but not enough, or the bodys cells resist its effect. A risk factor commonly associated with type 2 diabetes is excess weight, often measured by calculating the body mass index (BMI).

But for Asian Americans with type 2 diabetes, the average BMI is between 24 and 25, well within the normal BMI range (1925) for the general population.

The BMI in Asian patients can be misleading. They can look quite skinny, Dr. Hsu said. Instead, were learning that a better indicator of type 2 diabetes risk in Asians is fat deposits at the waistline. More research is needed to understand how visceral fat contributes to the onset of type 2 diabetes. If detected in the pre-diabetes stage, the disease often can be prevented.

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Researchers Find Unique Physiology Is Key to Diagnosing and Treating Diabetes in Asian Populations