Understanding the High Prevalence of Diabetes in U.S. South Asians Compared With Four Racial/Ethnic Groups: The MASALA and MESA Studies

Kanaya, Alka M.; Herrington, David M.; Vittinghoff, Eric; Ewing, Susan K.; Liu, Kiang; Blaha, Michael J.; Dave, Swapna S.; Qureshi, Fareeha; Kandula, Namratha R.

doi:10.2337/dc13-2656

Cited by 200 publications

(159 citation statements)

References 37 publications

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“…Third, the Asian Indian participants in IDDP were substantially leaner than those enrolled in DPP (baseline BMI of 25.8 vs 34.0, respectively) with higher diabetes risk (baseline HbA1c of 6.2% [42 mmol/mol) vs 5.9% [41 mmol/mol], respectively], which may be explained by greater rates of β-cell dysfunction observed in this population relative to other racial/ethnic groups. 35 Though weight loss mediated the observed treatment effects observed in DPP, 24,25 there was no weight loss associated with active treatment in IDPP.…”

Section: Discussionmentioning

confidence: 96%

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin

O’Brien

Perez

Scanlan

et al. 2017

American Journal of Preventive Medicine

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Introduction Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions (ILI) and metformin to prevent Type 2 diabetes, no studies have tested their comparative effects in pragmatic settings. This study was designed to compare the real-world effectiveness of ILI, metformin, and standard care among Hispanic women (Latinas) with prediabetes. Study design RCT. Setting/participants Ninety-two Latinas, who had a mean hemoglobin A1c of 5.9%, BMI of 33.3 kg/m2, and waist circumference of 97.4 cm, were recruited from an urban community and randomly assigned to ILI, metformin, or standard care using 1:1:1 allocation. Data were collected from 2013–2015 and analyzed in 2016. Intervention The 12-month ILI was adapted from the Diabetes Prevention Program’s ILI and delivered by community health workers (promotoras) over 24 sessions. Metformin participants received 850 mg twice daily. Those randomized to standard care continued their regular medical care. Main outcome measures Weight and secondary outcomes (waist circumference, blood pressure, hemoglobin A1c, fasting plasma glucose, insulin, and lipids) were assessed at baseline and 12 months. Results ILI participants demonstrated significantly greater mean weight loss (−4.0 kg, 5.0%) than metformin (−0.9 kg, 1.1%) and standard care participants (+0.8 kg, 0.9%) (p<0.001). The difference in weight loss between metformin and standard care was not significant. The ILI group experienced a greater reduction in waist circumference than standard care (p=0.001), and a marginal improvement in hemoglobin A1c compared with metformin and standard care (p=0.063). Conclusions In the first comparative effectiveness trial of diabetes prevention treatments, a 12-month ILI produced significantly greater weight loss than metformin and standard care among Latinas with prediabetes. These data suggest that ILI delivered by promotoras is an effective strategy for preventing diabetes in this high-risk group, which may be superior to metformin. Future pragmatic trials involving larger samples should examine differences in diabetes incidence associated with these treatments.

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Section: Discussionmentioning

confidence: 96%

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin

O’Brien

Perez

Scanlan

et al. 2017

American Journal of Preventive Medicine

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“…Population-based studies indicate a higher prevalence of diabetes among the South Asian diaspora compared with other ethnic and the local populations in many Western nations, including the U.S. and the U.K. (13,(56)(57)(58)(59)(60). Among South Asians, T2DM is usually diagnosed at an earlier age and is associated with increased mortality compared with the white population in these countries.…”

Section: Diabetes In the Diasporamentioning

confidence: 99%

Diabetes in Asia and the Pacific: Implications for the Global Epidemic

et al. 2016

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The last three decades have witnessed an epidemic rise in the number of people with diabetes, especially type 2 diabetes, and particularly in developing countries, where more than 80% of the people with diabetes live. The rise of type 2 diabetes in South Asia is estimated to be more than 150% between 2000 and 2035. Although aging, urbanization, and associated lifestyle changes are the major determinants for the rapid increase, an adverse intrauterine environment and the resulting epigenetic changes could also contribute in many developing countries. The International Diabetes Federation estimated that there were 382 million people with diabetes in 2013, a number surpassing its earlier predictions. More than 60% of the people with diabetes live in Asia, with almost one-half in China and India combined. The Western Pacific, the world’s most populous region, has more than 138.2 million people with diabetes, and the number may rise to 201.8 million by 2035. The scenario poses huge social and economic problems to most nations in the region and could impede national and, indeed, global development. More action is required to understand the drivers of the epidemic to provide a rationale for prevention strategies to address the rising global public health “tsunami.” Unless drastic steps are taken through national prevention programs to curb the escalating trends in all of the countries, the social, economic, and health care challenges are likely to be insurmountable.

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“…12 In addition, South Asian Americans are less physically active than other racial/ethnic groups. 13 …”

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confidence: 99%

Neighborhood Walkability and Walking for Transport Among South Asians in the MASALA Study

Kelley

Kandula

Kanaya

et al. 2016

Journal of Physical Activity and Health

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Background The neighborhood built environment can have a strong influence on physical activity levels, particularly walking for transport. In examining racial/ethnic differences in physical activity, one important and understudied group is South Asians. This study aims to describe the association between neighborhood walkability and walking for transport among South Asian men and women in the United States in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Methods A cross-sectional study was conducted in 2014 using the baseline dataset of the MASALA study (N = 906). Mean age was 55 years old and 54% of the sample was male. Weekly minutes spent walking for transport was assessed using a questionnaire adapted from the Cross-Cultural Activity Participation Study. Neighborhood walkability was measured using Walk Score, a composite index of walkability. Results After adjusting for covariates, with each 10-point increase in Walk Score, South Asian American men engaged in 13 additional minutes per week of walking for transport (P = .008). No association was observed between walkability and walking for transport in South Asian American women. Conclusions Results provide new evidence for how the effects of environmental influences on walking for transport may vary between South Asian men and women.

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Understanding the High Prevalence of Diabetes in U.S. South Asians Compared With Four Racial/Ethnic Groups: The MASALA and MESA Studies

Cited by 200 publications

References 37 publications

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin

Diabetes in Asia and the Pacific: Implications for the Global Epidemic

Neighborhood Walkability and Walking for Transport Among South Asians in the MASALA Study

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