Pathophysiologic Differences Among Asians, Native Hawaiians, and Other Pacific Islanders and Treatment Implications
William C. Hsu, M.D., Edward J. Boyko, M.D., M.P.H., Wilfred Y. Fujimoto, M.D., Alka Kanaya, M.D., Wahida Karmally, D.R.P.H., R.D., C.D.E., Andrew Karter, Ph.D., George L. King, M.D., Mele Look, M.B.A., Gertraud Maskarinec, M.D., Ph.D., Ranjita Misra, Ph.D., Fahina Tavake-Pasi, M.S., Richard Arakaki, M.D.
Differences in pathophysiology may affect the diagnosis, prevention, and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). Equally important are differences in cultural beliefs, dietary habits, and behavioral patterns among AANHPIs that require culturally effective translation of interventions into the community. These issues were discussed by clinicians and investigators at a conference held in Honolulu, Hawaii, in September 2011 with the theme “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action” by a coalition of health care organizations, clinicians, and scientists with strong interests in the topic and in the health of AANHPI populations (1). The discourse begins with an evaluation of pathophysiologic differences, followed by a discussion of the standard diagnostic criteria and current treatment algorithms as well as dietary recommendations. The focus then shifts to various diabetes prevention studies specific to AANHPIs and their relevance to this growing ethnic minority group in America. This review concludes with two investigations that demonstrate culturally appropriate interventions and a brief description of the role played by the National Diabetes Education Program (NDEP).