Communities Take Action 

Diabetes in AAPI Community Soaring 

By Kauthar B. Umar, MA


Closing the Gap, Diabetes • September/October 2002


“Avoid three things: hurry, worry, and curry,” said South 

Asian members of a community diabetes management 

group. Changing life patterns, reducing stress, and avoiding certain ethnic foods to maintain a healthy diet is easier said than 

done, and only touches on the many challenges facing Asian Americans and Pacific Islanders (AAPI) when trying to overcome the diabetes epidemic now plaguing their community. 

Diabetes poses a rapidly growing health challenge to the 28 

Asian and 19 Pacific Islander ethnic groups that make up the AAPI 

community. Prevalence data for AAPIs are limited, but according to 

the National Institute of Diabetes & Digestive & Kidney Disease 

(NIDDK), studies have shown that some groups within this population are at increased risk for developing type 2 diabetes. 

“Diabetes is not very common in Asia, but when Asians come to 

the U.S., or are born here, their diabetes rates skyrocket,” said Christine Luong, diabetes program coordinator, National Asian Women’s 

Health Organization. “One of the difficulties with diabetes and the 

AAPI community is that each race and ethnic subgroup has different 

risk factors for diabetes. Some subgroups have as much as one fifth of 

their entire population with diabetes.” Studies have shown that Asian 

Americans in Hawaii have prevalence rates at least twice as high as the 

local White population—a rate that far exceeds the nation’s average, 

Luong added. 

According to the Joslin Diabetes Center, the incidence of diabetes in AAPIs is growing at an alarming rate—with 90 to 95 percent of 

those diagnosed with diabetes having type 2. Rates of pregnancy 

induced or gestational diabetes are also higher than the national average in certain AAPI populations. Results from the most recent Centers 

for Disease Control and Prevention (CDC) study on gestational diabetes in the AAPI community show that from 1993 – 1995, the 

overall rate for gestational diabetes in AAPIs was 25.3 per 1,000 

women. Yet, for Asian Indian women, the rate of gestational diabetes 

was the highest in the country at 56.1 per 1,000. According Luong, 

the third-highest prevalence rate of gestational diabetes was among 

Filipino American women at 39.8 per 1,000, followed by Chinese 

American women at 39.1 per 1,000. 

“Among the Asians, the prevalence of gestational diabetes was 

higher than the prevalence observed among Hispanics, African Americans and Whites,” said Dr. Assiamira Ferrara, MD, PhD, senior investigator, Division of Research at Northern California Kaiser Permanente, 

in an unpublished, 2001, limited study of northern California Kaiser 

patients. 

Barriers to Disease Management 

The high rates of type 2 diabetes within the AAPI population and the increasing rates in AAPI youth are leaving community 

leaders, health care workers, and families searching for 

answers. “It’s really hard because we don’t know where 

to start,” said Vuthy Nol-Mantia, project director, Khmer 

Youth and Family Center, in Lynn, MA. “The problem is that this 

community doesn’t know what diabetes is. There is no such thing as 

‘diabetes’ in Cambodian culture or language.” They assume the symptoms associated with diabetes are a normal part of aging, he added. 

NIDDK attributes the rise in diabetes cases among the AAPI 

population to a combination of factors including obesity and a sedentary lifestyle that have risen in the AAPI population. 

Limited funding for diabetes education and research in the AAPI 

community, Nol-Mantia says, makes it difficult to assess the needs, 

and to help people manage this disease. The mismanagement of diabetes leads to long-term complications, such as blindness, kidney failure, heart attacks, and gangrene. 

“Many obstacles interfere with how they [patients] manage their 

health,” said a nurse from the Charles B. Wang Community Health 

Center, in New York, NY. Miscommunication due to language barriers is a common obstacle for AAPIs with diabetes. Obtaining translators for the multiple dialects represented at the center has been very 

difficult, adding to the lack of proper physician/patient communication. 

“Most of the time, when taking medicine, they will say they 

don’t know or understand why they are taking it. They do it just 

because their doctor said to,” continued the nurse. “If the medicine 

doesn’t work immediately, then they tend to stop taking it all together.” 

Bridging the Gap 

“The AAPI community is a high risk community and it’s due 

partially to genetics and partially to adapting to the western lifestyle,” 

said Jackie Liro, program coordinator of the BALANCE Program for 

Diabetes at the Association of Asian Pacific Community Health Organizations (AAPCHO). 

BALANCE—Building Awareness Locally and Nationally 

through Community Empowerment—was created to promote awareness of diabetes and diabetes prevention that: 

3⁄4 Is community-directed; 

3⁄4 Is respectful of cultural practices, languages and beliefs; 

3⁄4 Eliminates health disparities; and 

3⁄4 Improves the quality of life for AAPIs. 

By coordinating diabetes education activities, the BALANCE 

Program teaches that diabetes can be controlled. After assessing the 

community’s needs through qualitative research or focus groups at 

community health centers, in New York, California, Hawaii, Massachusetts, and Washington, a variety of activities were developed. 

continued on page 2>>>> 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Communities Take Action 

Diabetes in AAPI Community Soaring 

By Kauthar B. Umar, MA


Closing the Gap, Diabetes • September/October 2002


“The Family Health Center, in Worcester, MA, established ‘health 

parties’ at the homes of clients as a form of educational outreach. They 

went into the clients’ homes and conducted diabetes education with 

groups, and found it quite effective because in the AAPI community, 

transportation can be an issue,” said Liro. “At the Waimanalo Health 

Center in Hawaii, they established a monthly support group. It’s a 

group of people with diabetes and they get together to talk about 

different issues, maybe problems and solutions that they have come 

up with. It’s a forum to talk about how they manage their disease.” 

Maintaining a healthy lifestyle is one of the most important tools 

in successful diabetes management, according to David J. DeRose, 

MD, MPH, medical director, Lifestyles Center of America in Sulphur, 

OK. This residential program focuses more on natural living than 

conventional medicine. Participants are placed on a plant-based diet 

and an unconventional exercise plan that includes short periods of 

exercise interspersed with short periods of rest. 

According to DeRose, Lifestyle’s has demonstrated success working with AAPIs and other communities that historically don’t have a 

huge suffering from diabetes. “This holistic approach resonates with 

indigenous people,” said Dr. DeRose. “This program shows the wisdom of ancestral people’s roots. Instead of us being perceived as people 

imposing a different set of values on them, we are being perceived as 

calling them back to their roots of healthier living, eating right, and 

exercising.” 

For more information on AAPCHO’sBALANCE Program for Diabetes, go to http://www.aapcho.org or call 510-272-9536.

Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services