Treating a silent epidemic

Associate Professor Tam H.

Nguyen’s plan to improve diabetes prevention among Vietnamese Americans

by n athaniel m oore

In just a couple generations, type 2 diabetes has gone from being a relatively rare disease to America’s seventh leading cause of death. Today, more than one in 10 Americans live with the condition, while at least 100 million more are prediabetic. In response to this crisis, public health officials have often tried to help prediabetics with a one-size-fits-all approach, but the intervention that effectively helps one community may not meet the needs of another. As a result, many of America’s most vulnerable people are effectively denied access to lifesaving care.

Tam H. Nguyen, an associate professor at the Connell School, believes that one way to expand access is to tailor treatment programs to the unique culture and circumstances of each community. Her latest research project, which is funded by a three-year, $450,000 Betty Irene Moore Fellowship for Nurse Leaders and Innovators from the nursing school at UC Davis and the Gordon and Betty Moore Foundation, aims to determine the most effective ways of doing so.

In partnership with Quincy Asian Resources, Inc. (QARI), a nonprofit focused on promoting the welfare of immigrant communities in New

York and Boston, Nguyen will be designing and evaluating prediabetic interventions tailored to Vietnamese American communities of varying income levels and proficiency in English. This research could not be more urgent, since diabetes rates are rising faster among Asian Americans than among any other racial group. “One in two Asian Americans will become diabetic or prediabetic in their lifetime,” Nguyen said. “Supporting the health and well-being of the community is important to me not just because I am Vietnamese American but because this community is extremely under-researched and underserved.”

The Challenge

The diabetes epidemic results from the interaction of many complex causes, but Nguyen singled out a few particular culprits.

“Asian Americans, like all Americans, live in an environment that promotes obesity,” she explained. “We’ve systematically taken physical activity out of our daily lives, and our work is often sedentary. For Asian Americans, however, what makes the situation more challenging is that the diabetes epidemic is largely silent.”

Asian Americans tend to be less obese than the general population, Nguyen explained, so they are less likely to be considered high risk or screened, which means diabetes often goes undetected. The problem is exacerbated by widespread ignorance about consequential physical differences between Asian American populations and others.

“The problem is that for Asian Americans, most of their fat is concentrated in the belly, which is the most metabolically active,” she said. “That creates a situation where there’s a greater likelihood of chronic illnesses such as diabetes and cardiovascular disease at a lower BMI than you would see in other racial groups.”

The fast-rising rates among Asian Americans also result from earlier well-intentioned but ill-conceived outreach efforts from health officials. These efforts proved inadequate, Nguyen argues, because they tended to take a simplistic view of the communities they were trying to help.

“What the health services research world has done over the last 30 years is take an existing medical intervention, translate it, adapt some details, and say all Vietnamese Americans can now do this program,” she said. “The problem with that approach is that even within the Vietnamese American community, there’s far too much diversity for a one-size-fits-all program to work.”

That’s because the prevailing paradigm for treating prediabetics—the Diabetes Prevention Program (DPP)—is simple yet difficult to put into practice. The DPP is an evidence-based self-management and lifestyle intervention that focuses on helping patients lose 5–7% of their body weight through dietary changes and increased physical activity. When followed, the program has been shown to reduce the incidence of type 2 diabetes by more than 50 percent—but following the program requires a certain level of privilege and stability.

“The DPP works really well for someone who has the resources to engage in the program and buy the groceries to change their diet,” said Nguyen. “But not everyone has the resources to buy fresh fruits and vegetables, or the control of their lives required to show up for coaching once a week for six months.” These people, she explained, are not going to be well served by an intervention that puts the onus on the individual to make and sustain different choices.