South Asians and Diabetes: Higher Risk with Traditional Beliefs
Abstract Number: 1002-P
Authors: ALKA M. KANAYA, DEEPIKA MATHUR, VISHAL RANPURA, SWARNA BYRI, CHRISTINA WASSEL FYR, San Francisco, CA
Institutions: San Francisco, CA
Results: South Asians have a high prevalence of metabolic disorders and cardiovascular disease worldwide. There are approximately 4 million people of South Asian origin in the United States, but no population-based studies of this ethnic group with assessment of glucose tolerance.
We performed a population-based study of 150 South Asians (SA) between 45-84 years without known cardiovascular disease in the San Francisco Bay Area. We modeled this study on the Multi-Ethnic Study of Atherosclerosis (MESA) using identical methods and measurements for comparison with other U.S. ethnic groups. We obtained demographic and lifestyle information, fasting and 2-hour glucose tolerance tests, physical examination, abdominal CT scan, and carotid ultrasound for intima media thickness. We compared diabetes prevalence in SA to the four MESA ethnic groups. We used proportional odds models to examine risk factors associated with impaired and diabetic glucose tolerance.
Approximately 98% of SA were immigrants who had lived a median of 26 years in the United States. SA had high socioeconomic attainment with 77% having earned ≥Bachelor’s degree and 67% had a family income ≥$75,000. SA had higher age-adjusted prevalence of diabetes than the MESA ethnic groups (26% SA vs. 7% in Whites, 14% in Chinese Americans, and 19% in African Americans and Latinos, p<0.001). Using the comprehensive definition of diabetes (use of hypoglycemic medication, fasting plasma glucose ≥126 mg/dl and/or 2-hour post-challenge glucose ≥200 mg/dl), 43 (29%) had diabetes, 56 (37%) had pre-diabetes (fasting glucose 100-125 mg/dl and/or 2-hour glucose 140-199 mg/dl), and 51 (34%) had normal glucose tolerance. Men had higher prevalence of diabetes than women (21% vs. 8%, p<0.001), and those with stronger traditional cultural beliefs were more likely to have diabetes (p=0.03). In multivariable models adjusted for sex and age, variables significantly associated with pre-diabetes and diabetes were hypertension (OR 4.2, 95% CI 2.0-8.9), traditional cultural beliefs (OR 2.5, 95% CI 1.1-5.9), visceral fat area (OR 2.1, 95% CI 1.4-3.2, per SD), alanine aminotransferase (OR 1.9, 95% CI 1.1-3.2, per SD), internal carotid intima media thickness (OR 1.7, 95% CI 1.1-2.5, per SD) and log microalbuminuria (OR 1.53, 95% CI 1.1-2.14).
South Asians have a paradoxically increased prevalence of diabetes in the United States despite high education and socioeconomic attainment. Future studies should focus on which aspects of traditional cultural beliefs may be modifiable to decrease diabetes risk.