Asian and Pacific Islander teens face higher prediabetes risk, study finds
Twenty-seven percent of Asian youths had prediabetes compared to 12% of white youths, according to the study, which was published this week in Diabetes Care. All youths in the study were overweight or obese.
And there were significant differences in prediabetes rates among Asian subgroups: Native Hawaiian or Pacific Islander youth were at highest risk (32%), followed by South Asian (31%), Filipino (28%), Chinese (26%) and Vietnamese (18%), the study found.
The analysis is one of the first to break down prediabetes rates in Asian subgroups rather than grouping all Asians together as a single monolith, which many medical research studies typically do.
The findings are important because they reinforce that some people are more likely to develop prediabetes — a condition where one's blood sugar level is higher than normal, but not high enough to be considered diabetes — than their peers, and should perhaps get tested more frequently or earlier to prevent it.
'We need to think about certain populations as being at higher risk, and maybe they need to be screened for prediabetes at a lower threshold,' said study co-author Dr. Louise Greenspan, a pediatric endocrinologist at Kaiser Permanente San Francisco Medical Center. 'We lump all adolescents into one category, and we'd love to be able to personalize things a little more.'
Screenings also give doctors a chance to educate patients and their families about diabetes and talk to them about lifestyle factors that can help their health, she said.
There is no standard recommendation for when adolescents should start getting screened for diabetes. The U.S. Preventive Services Task Force, the group of medical experts that issues recommendations for what age people should start getting screened for breast cancer and other diseases, does not have a recommendation on diabetes screenings for youths. The American Diabetes Association recommends screening for high-risk ethnic groups who are overweight. Kaiser screens all adolescents who are overweight, regardless of race or ethnicity.
It's not clear why Asian youths are more likely than white youths to develop prediabetes, or why some subgroups of Asian youths are more prone than other subgroups.
Some potential explanations could be differences in genetics, cultural factors and social determinants of health like income level and neighborhood — or a combination of all those things.
'We know genetics contribute to the risk of developing prediabetes and type 2 diabetes, but the environment that someone grows up in can push them over the edge,' Greenspan said. 'If they're living in a neighborhood where they don't have access to safe places to exercise, or their school doesn't have adequate physical education, or they live in a food desert … those all lead to less activity and more food intake than someone who lives in an environment where it's safe to ride their bike to meet friends in the park and come home to meals parents are able to resource that are plant-based.'
The study included about 38,000 Kaiser Permanente Northern California members between ages 10 and 17 who were overweight (85th to 95th percentile BMI for their age) or obese (96th percentile or higher BMI for their age) at a pediatric visit between 2012 and 2019, and had a hemoglobin A1c test within a year of that visit. A1c measures one's average blood sugar level over the last three months. An A1c level between 5.7% and 6.4% is considered prediabetic.
The findings add to an already established body of research showing that Asian adults are at a higher risk of developing type 2 diabetes at a lower BMI than white adults. It's not entirely clear why, but some researchers have posited it may be because Asians tend to store more fat around abdominal organs, known as visceral fat, which may lead to heightened insulin resistance. This led to the American Diabetes Association in 2015 recommending that Asian adults get screened for diabetes at a BMI of 23 rather than a BMI of 25, which is the standard screening threshold for all adults.
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San Francisco Chronicle
a day ago
- San Francisco Chronicle
Asian and Pacific Islander teens face higher prediabetes risk, study finds
Asian and Pacific Islander adolescents who are overweight or obese are twice as likely to have prediabetes compared to their white counterparts, according to new research from Kaiser Permanente. Twenty-seven percent of Asian youths had prediabetes compared to 12% of white youths, according to the study, which was published this week in Diabetes Care. All youths in the study were overweight or obese. And there were significant differences in prediabetes rates among Asian subgroups: Native Hawaiian or Pacific Islander youth were at highest risk (32%), followed by South Asian (31%), Filipino (28%), Chinese (26%) and Vietnamese (18%), the study found. The analysis is one of the first to break down prediabetes rates in Asian subgroups rather than grouping all Asians together as a single monolith, which many medical research studies typically do. The findings are important because they reinforce that some people are more likely to develop prediabetes — a condition where one's blood sugar level is higher than normal, but not high enough to be considered diabetes — than their peers, and should perhaps get tested more frequently or earlier to prevent it. 'We need to think about certain populations as being at higher risk, and maybe they need to be screened for prediabetes at a lower threshold,' said study co-author Dr. Louise Greenspan, a pediatric endocrinologist at Kaiser Permanente San Francisco Medical Center. 'We lump all adolescents into one category, and we'd love to be able to personalize things a little more.' Screenings also give doctors a chance to educate patients and their families about diabetes and talk to them about lifestyle factors that can help their health, she said. There is no standard recommendation for when adolescents should start getting screened for diabetes. The U.S. Preventive Services Task Force, the group of medical experts that issues recommendations for what age people should start getting screened for breast cancer and other diseases, does not have a recommendation on diabetes screenings for youths. The American Diabetes Association recommends screening for high-risk ethnic groups who are overweight. Kaiser screens all adolescents who are overweight, regardless of race or ethnicity. It's not clear why Asian youths are more likely than white youths to develop prediabetes, or why some subgroups of Asian youths are more prone than other subgroups. Some potential explanations could be differences in genetics, cultural factors and social determinants of health like income level and neighborhood — or a combination of all those things. 'We know genetics contribute to the risk of developing prediabetes and type 2 diabetes, but the environment that someone grows up in can push them over the edge,' Greenspan said. 'If they're living in a neighborhood where they don't have access to safe places to exercise, or their school doesn't have adequate physical education, or they live in a food desert … those all lead to less activity and more food intake than someone who lives in an environment where it's safe to ride their bike to meet friends in the park and come home to meals parents are able to resource that are plant-based.' The study included about 38,000 Kaiser Permanente Northern California members between ages 10 and 17 who were overweight (85th to 95th percentile BMI for their age) or obese (96th percentile or higher BMI for their age) at a pediatric visit between 2012 and 2019, and had a hemoglobin A1c test within a year of that visit. A1c measures one's average blood sugar level over the last three months. An A1c level between 5.7% and 6.4% is considered prediabetic. The findings add to an already established body of research showing that Asian adults are at a higher risk of developing type 2 diabetes at a lower BMI than white adults. It's not entirely clear why, but some researchers have posited it may be because Asians tend to store more fat around abdominal organs, known as visceral fat, which may lead to heightened insulin resistance. This led to the American Diabetes Association in 2015 recommending that Asian adults get screened for diabetes at a BMI of 23 rather than a BMI of 25, which is the standard screening threshold for all adults.
Yahoo
3 days ago
- Yahoo
Lopez: A candid take on mortality and the power of friendship
They gather several times a week in the parking lot of a Vons supermarket in Mar Vista, and no subject is off-limits. Not even the grim medical prognosis for 70-year-old David Mays, one of the founding members of the coffee klatch. 'It's one of our major topics of conversation,' said Paul Morgan, 45, a klatch regular. Mays is a cancer survivor with a full package of maladies, including diabetes, a faltering heart and failing kidneys. But since I met him almost two years ago, he has told me repeatedly that he doesn't want dialysis treatment, even though it might extend his life. 'I get it, because it's a lot of hours out of your day,' said Morgan, a schoolteacher who lives nearby. 'People think you go in for dialysis for 15 minutes before you go straight to work. But really, it's a part-time job.' His treatment would require that he visit a dialysis center three times a week, for four hours each time, Mays said. 'For the rest of my life.' 'I don't think I could do it,' said klatcher Kit Bradley, 70, who lives in a van near the supermarket with his dog, Lea. I met Mays in October 2023, when he was living in his Chevy Malibu in a downtown garage that was part of the Safe Parking L.A. program. Mays later moved into an apartment in East Hollywood and still lives there, but his health has continued to deteriorate. 'He is Stage 5,' said Dr. Thet Thet Aung, Mays' nephrologist at Kaiser Permanente West Los Angeles. For such patients, Aung said, death can be imminent. She told me she's had many conversations with Mays about his treatment options, including dialysis in a clinic or self-administered at home. But not everyone does well on dialysis, she added, and when a patient makes an informed choice, 'we respect their wishes.' Mays has a refreshingly healthy attitude about mortality. Multibillion-dollar industries cater to those who want to look younger and live longer, and about 25% of Medicare's massive outlay is spent on patients in the last year of life, many of whom choose life-extending medical procedures. Mays, in the time I've known him, has been realistic rather than fatalistic. He has told me he doesn't think bravery, faith or spirituality has anything to do with his desire to let nature take its course. Read more: Almost 70, unemployed, worried about his health and living in his car 'It transcends those things,' he said. He's at peace with his fate, he explained, because he's got friends, love and support. On a recent day at his apartment, I watched Mays load medication from more than 20 vials into a weekly pill organizer. 'I could almost do this in my sleep,' he said as he arranged meds that resembled miniature jelly beans. This one for his kidneys, that one for his heart, his blood pressure, and on and on. There were 18 pills in each compartment. And none of that will cure any of what ails him, he said. 'You just have to keep doing it, and doing it, just to stay at a sustained level,' he said. 'It's not like … I feel great because I took this stuff.' Two women in Mays' life are heartbroken about his condition but respectful of his refusal to try dialysis. 'I don't want him to suffer for the sake of placating other people,' said Mays' daughter Jennifer Nutt, 47, of Merced. Her parents divorced when she and her brother were young, and Nutt had no relationship with Mays until recently. She's had her own trials, Nutt said, including homelessness. Read more: The monthly tab for her in-home elder care: $18,000. She can cover it, but how many others can? Father and daughter began connecting in the fall of 2024. 'We spend hours every day talking. It's like a nonstop festival of catching up,' and they've discovered they have the same cheeky sense of humor and pragmatism, and similar traits and interests. 'We like big words and thick books,' Nutt said. The other woman is Helena Bake, of Perth, Australia, a registered nurse Mays affectionately refers to as "Precious." They met in 1985, when Mays was visiting London, and Bake, 18 at the time, was working in a restaurant he visited with friends. After Bake moved to Australia, Mays visited her many times and became close to her entire family. 'He was lovely,' said Bake, who is not surprised by Mays' attitude about his deteriorating health. 'He's always very positive and so pragmatic. He has this wonderful view of the world and the people in his life. It's such a gift that he has.' Mays, who gets by on Social Security payments, has set up a GoFundMe page to help pay for his cremation and send his ashes to Bake, to be scattered in his favorite places in Australia. Lately, medical appointments with his several doctors, and the occasional ER visit, have gotten in the way of one of Mays' favorite activities — the gatherings in the Vons parking lot. Mays worked for many years in the Mar Vista area as a live-in elder care provider, and he'd bump into Bradley at a park, or Morgan in the strip mall that includes the grocery store. Several years ago, they made a habit of grabbing coffee around 7 a.m. and hanging out near Mays' car. Bradley's dog often hops into the vehicle, a Vons employee named Elvis comes out for a smoke break, and others come and go. 'I had a cousin who had diabetes, and he called my mom one day and said, 'I'm not doing it anymore,' ' Morgan was saying the other day. His mother wasn't supportive at first, he told the klatch, but she listened to her nephew's explanation and came around. 'Who could judge someone for the choices they make in that situation?' 'There's a waiting list for kidneys of two to eight years,' Mays said. 'Let's say [in] four or five years, there was a kidney available. Your body can reject it … and then you're back to the drawing board…. I told Precious about this like a year and a half ago … and she said, 'I have to hang up now because I have to process this.' And the next time I talked with her, she said, 'I get it.' ' Mays said he doesn't want to be 'a prisoner to a process, like a machine or something." "And you have to do this indefinitely. It's not like you're on it for two or three years…," he said. "It is. The. Rest. Of. Your. Life." 'I've seen people that were on dialysis,' said Bradley, a former musician. 'I think I'd rather be just, if I gotta go, I gotta go.' Morgan said his father, who died last year, had kidney problems in the end and resisted extreme measures to extend his life. 'It's not like he was at all suicidal, just like David's not,' Morgan said. 'The thing about David is, he's always been so resolute about it. We've never had a discussion where I felt like we could waver him, or like he was on the fence.' When he first resisted dialysis, Mays said, doctors set him up in a room with a video that explained the process. 'I watched the whole thing, and that was the clincher,' Mays said. 'By the time I got through looking at that, I'm just going, 'Oh HELL no.'' It's not that he wants to die, Mays said. It's that he wants to live on his terms. Read more: If people taking care of our elders get deported, will anyone take their place? 'The irony of the whole thing is, it's all the people that I have around me — they're the reason I'm willing to go like this. What I get from them in the way of being … uplifted and loved, well, when you have all that, you can deal with anything." He has his klatch buddies, he has Precious, he has his daughter in his life again. 'With people around that give a damn about you, care about you, you can deal … with death, you can deal with dying.... And I told my doctors I would rather live a shorter period of time, but with what I feel to be some decent quality of life, than live a longer period of time and be miserable. And I would be miserable on dialysis,' Mays said. 'Plus, I'm 70. It ain't like I'm 30 and there's so much life to live. I am the age that I am, and I would like to go further, sure, but it has to close out soon. And I'm fine with that, because I have lived.' Sign up for Essential California for news, features and recommendations from the L.A. Times and beyond in your inbox six days a week. This story originally appeared in Los Angeles Times.
Los Angeles Times
3 days ago
- Los Angeles Times
A candid take on mortality and the power of friendship
They gather several times a week in the parking lot of a Vons supermarket in Mar Vista, and no subject is off-limits. Not even the grim medical prognosis for 70-year-old David Mays, one of the founding members of the coffee klatch. 'It's one of our major topics of conversation,' said Paul Morgan, 45, a klatch regular. Mays is a cancer survivor with a full package of maladies, including diabetes, a faltering heart and failing kidneys. But since I met him almost two years ago, he has told me repeatedly that he doesn't want dialysis treatment, even though it might extend his life. 'I get it, because it's a lot of hours out of your day,' said Morgan, a schoolteacher who lives nearby. 'People think you go in for dialysis for 15 minutes before you go straight to work. But really, it's a part-time job.' His treatment would require that he visit a dialysis center three times a week, for four hours each time, Mays said. 'For the rest of my life.' 'I don't think I could do it,' said klatcher Kit Bradley, 70, who lives in a van near the supermarket with his dog, Lea. I met Mays in October 2023, when he was living in his Chevy Malibu in a downtown garage that was part of the Safe Parking L.A. program. Mays later moved into an apartment in East Hollywood and still lives there, but his health has continued to deteriorate. 'He is Stage 5,' said Dr. Thet Thet Aung, Mays' nephrologist at Kaiser Permanente West Los Angeles. For such patients, Aung said, death can be imminent. She told me she's had many conversations with Mays about his treatment options, including dialysis in a clinic or self-administered at home. But not everyone does well on dialysis, she added, and when a patient makes an informed choice, 'we respect their wishes.' Mays has a refreshingly healthy attitude about mortality. Multibillion-dollar industries cater to those who want to look younger and live longer, and about 25% of Medicare's massive outlay is spent on patients in the last year of life, many of whom choose life-extending medical procedures. Mays, in the time I've known him, has been realistic rather than fatalistic. He has told me he doesn't think bravery, faith or spirituality has anything to do with his desire to let nature take its course. 'It transcends those things,' he said. He's at peace with his fate, he explained, because he's got friends, love and support. On a recent day at his apartment, I watched Mays load medication from more than 20 vials into a weekly pill organizer. 'I could almost do this in my sleep,' he said as he arranged meds that resembled miniature jelly beans. This one for his kidneys, that one for his heart, his blood pressure, and on and on. There were 18 pills in each compartment. And none of that will cure any of what ails him, he said. 'You just have to keep doing it, and doing it, just to stay at a sustained level,' he said. 'It's not like … I feel great because I took this stuff.' Two women in Mays' life are heartbroken about his condition but respectful of his refusal to try dialysis. 'I don't want him to suffer for the sake of placating other people,' said Mays' daughter Jennifer Nutt, 47, of Merced. Her parents divorced when she and her brother were young, and Nutt had no relationship with Mays until recently. She's had her own trials, Nutt said, including homelessness. Father and daughter began connecting in the fall of 2024. 'We spend hours every day talking. It's like a nonstop festival of catching up,' and they've discovered they have the same cheeky sense of humor and pragmatism, and similar traits and interests. 'We like big words and thick books,' Nutt said. The other woman is Helena Bake, of Perth, Australia, a registered nurse Mays affectionately refers to as 'Precious.' They met in 1985, when Mays was visiting London, and Bake, 18 at the time, was working in a restaurant he visited with friends. After Bake moved to Australia, Mays visited her many times and became close to her entire family. 'He was lovely,' said Bake, who is not surprised by Mays' attitude about his deteriorating health. 'He's always very positive and so pragmatic. He has this wonderful view of the world and the people in his life. It's such a gift that he has.' Mays, who gets by on Social Security payments, has set up a GoFundMe page to help pay for his cremation and send his ashes to Bake, to be scattered in his favorite places in Australia. Lately, medical appointments with his several doctors, and the occasional ER visit, have gotten in the way of one of Mays' favorite activities — the gatherings in the Vons parking lot. Mays worked for many years in the Mar Vista area as a live-in elder care provider, and he'd bump into Bradley at a park, or Morgan in the strip mall that includes the grocery store. Several years ago, they made a habit of grabbing coffee around 7 a.m. and hanging out near Mays' car. Bradley's dog often hops into the vehicle, a Vons employee named Elvis comes out for a smoke break, and others come and go. 'I had a cousin who had diabetes, and he called my mom one day and said, 'I'm not doing it anymore,' ' Morgan was saying the other day. His mother wasn't supportive at first, he told the klatch, but she listened to her nephew's explanation and came around. 'Who could judge someone for the choices they make in that situation?' 'There's a waiting list for kidneys of two to eight years,' Mays said. 'Let's say [in] four or five years, there was a kidney available. Your body can reject it … and then you're back to the drawing board…. I told Precious about this like a year and a half ago … and she said, 'I have to hang up now because I have to process this.' And the next time I talked with her, she said, 'I get it.' ' Mays said he doesn't want to be 'a prisoner to a process, like a machine or something.' 'And you have to do this indefinitely. It's not like you're on it for two or three years…,' he said. 'It is. The. Rest. Of. Your. Life.' 'I've seen people that were on dialysis,' said Bradley, a former musician. 'I think I'd rather be just, if I gotta go, I gotta go.' Morgan said his father, who died last year, had kidney problems in the end and resisted extreme measures to extend his life. 'It's not like he was at all suicidal, just like David's not,' Morgan said. 'The thing about David is, he's always been so resolute about it. We've never had a discussion where I felt like we could waver him, or like he was on the fence.' When he first resisted dialysis, Mays said, doctors set him up in a room with a video that explained the process. 'I watched the whole thing, and that was the clincher,' Mays said. 'By the time I got through looking at that, I'm just going, 'Oh HELL no.'' It's not that he wants to die, Mays said. It's that he wants to live on his terms. 'The irony of the whole thing is, it's all the people that I have around me — they're the reason I'm willing to go like this. What I get from them in the way of being … uplifted and loved, well, when you have all that, you can deal with anything.' He has his klatch buddies, he has Precious, he has his daughter in his life again. 'With people around that give a damn about you, care about you, you can deal … with death, you can deal with dying.... And I told my doctors I would rather live a shorter period of time, but with what I feel to be some decent quality of life, than live a longer period of time and be miserable. And I would be miserable on dialysis,' Mays said. 'Plus, I'm 70. It ain't like I'm 30 and there's so much life to live. I am the age that I am, and I would like to go further, sure, but it has to close out soon. And I'm fine with that, because I have lived.'
