Diabetes Care of Non-obese Korean Americans: Considerable Room for Improvement

Abstract

Background Family doctors are increasingly managing the diabetes care of Korean-Americans. Little is known about the prevalence of diabetes among non-obese Korean-Americans, or the extent to which they receive timely and appropriate diabetes care. The purpose of this investigation is to: (1) identify the prevalence of diabetes and to determine the adjusted odds of diabetes among non-obese Korean-Americans compared to non-Hispanic White (NHW) Americans, (2) examine the factors associated with having diabetes in a large sample of non-obese Korean-Americans, and (3) determine the prevalence and adjusted odds of optimal frequency of eye care, foot care and A1C blood glucose level monitoring among non-obese Korean-Americans with diabetes in comparison to NHWs with diabetes. Methods Secondary analysis of population-based data from the combined 2007, 2009, and 2011 adult California Health Interview Survey. The sample included 74,361 respondents with body mass index (BMI) <30 kg/m 2 (referred to as ‘non-obese BMI’), of whom 2,289 were Korean-Americans and 72,072 were NHWs, and 4,576 had diabetes. Results The prevalence and adjusted odds of diabetes among non-obese Korean-Americans are significantly higher than among their NHW peers. More than 90% of Korean-Americans with diabetes were non-obese. NHWs had substantially higher odds of having optimal frequency of eye care, foot care and A1C glucose level monitoring, even after adjusting for insulin dependence, sex, age, education, income, and BMI. Conclusion Non-obese Korean-Americans are at higher risk for diabetes and are much less likely to receive optimal diabetes care in comparison to NHWs. Targeted outreach is necessary.

Increasing Individual Target Glucose Levels to Prevent Hypoglycemia in Patients with Diabetes

“…In clinical practice, blood glucose level targets are often increased based on experience rather than any systematic basis. 37) Clinicians should identify the maximum level of blood glucose level that will not cause hypoglycemia-related complications. Our future studies are aimed at developing a systematic basis for such adjustments.…”

“…Most members of the diabetes healthcare team are only aware of the general goals of blood glucose level management and are often unfamiliar with the adjustment of blood glucose level targets. In clinical practice, blood glucose level targets are often increased based on experience rather than any systematic basis [ 37 ]. Clinicians should identify the maximum level of blood glucose level that will not cause hypoglycemia-related complications.…”

The prevalence and management of diabetes among Vietnamese Americans: A population-based survey of an understudied ethnic group

“…This is in stark contrast to our previous work comparing non-obese Korean Americans with NHW cohorts, where we found that Korean Americans had a significantly lower prevalence of optimal foot care, eye care, and A1C blood glucose level testing compared to their NHW counterparts. 33 One possible explanation for this equivalency of care is that the majority of Vietnamese immigrants have become naturalized U.S. citizens (76%) compared with only 45% of all foreign-born adults in the U.S. 4 Assimilation to American culture increases immigrants' access to care. 34,35 One-quarter of the Vietnamese Americans in the sample were living below the poverty line and thus those who were naturalized citizens, or who were born in the U.S., would have access to Medicaid-funded care.…”

Self-Care in Korean Immigrants with Chronic Diseases: A Concept Analysis

“…14 According to a study that analyzed data from the adult California Health Interview Survey, the prevalence of diabetes among KIs aged 50 and older with body mass index <30 kg/m 2 was greater than that of non-Hispanic Caucasians (6.8% vs. 4.3%). 15 Moreover, although KIs rated their health as poorer than other Asian immigrant groups, their health care-seeking and health insurance rates were significantly lower. 16 Studies report that KIs are hesitant to seek health care due to a variety of reasons such as a lack of societal resources, financial restrictions, limited language proficiency, mistrust of the US health care system, or experience with Korea's affordable medical insurance before immigration.…”