Minorities face grim diabetes prospects

Diabetes will afflict 1 in 2 Hawaii children in their lifetime.

The grim projections by the American Diabetes Association and the rising tide of diabetes among minority Asians, Native Hawaiians and Pacific Islanders prompted a call for action last week by diabetes experts, government and health care providers.

The National Council of Asian Pacific Islander Physicians assembled national and local experts from academia, the health care industry and government for a two-day conference in Hono­lulu to discuss ways to reduce diabetes among minority populations whose disease rates are generally masked by the healthier majority.

"For Asian Americans, Native Hawaiians and Pacific Islanders, we have seen over the year a sharp increase in diabetes, but we don’t have enough information about how it affects our populations," said Ho Luong Tran, president and CEO of the National Council of Asian Pacific Islander Physicians. "We want more resources that are equitable so we can treat patients better."

Diabetes is the fifth leading cause of death — and among the most costly diseases — in Hawaii and the U.S., according to the American Diabetes Association.

One in 3 children born in America in 2000 will have diabetes in their lifetime. The statistic is higher in Hawaii due to a larger number of ethnic minorities who live in poverty, the ADA said.

About 8.3 percent of the U.S. population had diabetes in 2009. In Hawaii that number is closer to 8.5 percent, up from 4.2 percent in 1994, according to the state Department of Health’s Hawaii Behavioral Risk Factor Surveillance System.

That equates to an estimated 113,000 people living with diabetes in Hawaii, 28,000 of whom remain undiagnosed, according to 2009 statistics. Diabetes killed 307 people in Hawaii in 2009, though frequently the disease is an underlying cause of death, not the principal cause.

The disease is on the rise globally as obesity continues to soar. Diabetes gained worldwide attention last week at the first United Nations General Assembly meeting on noncommunicable diseases in New York.

World leaders at the summit pledged to fight chronic disease and set reachable targets by 2012 to reduce mortality related to diabetes, cancer and heart and lung disease, which are projected to cost the global economy $47 trillion by 2030, according to the World Economic Forum.

The state’s Chronic Disease Disparities Report 2011, released last month, highlights the social determinants of chronic diseases: poverty, lack of education, employment and health insurance. 

"Native Hawaiians and Pacific Islanders and immigrant populations — people who make up the fabric of this state — are doing worse in their own land," said Maile Taualii, founding director of Native Hawaiian Epidemiology Center. "There’s something unsettling about that."

Diabetes accounted for $52.2 million in state Medicaid costs, or $3,190 per Medicaid beneficiary in 2007, according to the Chronic Disease Disparities Report.

Kokua Kalihi Valley Comprehensive Family Services, a federally funded community health center that caters to low-income Asian and Pacific Island immigrants living in Kalihi, is integrating diabetes care with cultural practices, growing traditional foods and building social relationships within the community. About 20 diabetes patients meet once a month at the center’s 1.5-acre organic garden at the back of Kalihi Valley to learn about healthy living, nutrition, exercise and growing fresh food.

Last week the state won a five-year, $9.9 million grant from the U.S. Centers for Medicare and Medicaid Services to increase services to Medicaid recipients with diabetes. The money will fund programs to improve early detection and self-management of diabetes for Native Hawaiians, Asian Americans and Pacific Islanders statewide.