05-07-2025
- Health
- 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.
