Most physicians know to screen their patients for type 2 diabetes at a BMI of 25. But more and more research shows that people of Asian descent are at risk for type 2 starting at a BMI of 23. The Screen at 23 campaign aims to raise awareness of the issue in doctors’ offices around the country.
On January 22, a resolution will be announced in the Massachusetts legislature to provide guidelines and establish a baseline of support for encouraging diabetes screening for Asian Americans throughout Massachusetts. This resolution was brought about by a coalition between the American Diabetes Association (ADA), National Council of Asian and Pacific Islander Physicians (NCAPIP), Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition (AANHPI-DC) and Joslin’s Asian American Diabetes Initiative (AADI).
Speaking of Diabetes caught up with David Hawks of the NCAPIP to learn more about the resolution and why it’s so important for public health.
Speaking of Diabetes: Why is it important to have a resolution to address this?
David Hawks: The importance is simple: 51% of Asian Americans don’t know that they have type 2 diabetes. A significant portion of these undiagnosed people are at a lower body weight and don’t see themselves at risk, and nor do their providers. Type 2 diabetes is still viewed as a disease that affects overweight and obese people—which it does to a great extent—but this perception only helps mask the risk for Asian Americans who are “normal” weight but still at high, and in some cases higher, risk. Add to that the even higher number of Asian Americans who are pre-diabetic and could prevent diabetes outright if they work with their doctor. You really need to screen at 23 and have everyone be aware of this. The resolution helps that.
SoD: How did the Screen at 23 campaign come about? How did you get involved?
DH: The campaign grew organically. I work for NCAPIP—the National Council of Asian Pacific Islander Physicians—who along with Joslin’s Asian American Diabetes Initiative helped found the coalition (the AANHPI Diabetes Coalition) that pushed the campaign forward. This coalition includes doctors, researchers and providers, and also community health advocates. The research available on Asian Americans clearly showed a diabetes disparity that was significantly exacerbated by screening practices that were outdated;specifically, Asian Americans being screened at a BMI of 25, which works for the general population, but not always Asian Americans.
After the American Diabetes Association (which is also a member of our coalition) changed its guidelines in 2015 to clearly state BMI 23 as a risk factor for screening Asians, we all started talking about the need to have an awareness campaign that could grab people’s attention. It had to be something simple that spoke to the issue but we ruled out “Asian BMI.” It’s a challenge when advocating for a population that, at least subconsciously, is kind of pushed to the margins and so we didn’t want people to see the word “Asian” and think “this doesn’t apply to me or my work.” So we came up with “Screen at 23” and it stuck. The campaign officially launched in San Francisco in the fall of 2016.
SoD: What is this Jan. 25 event?
DH: January 25 is the formal announcement and reading of the new “Screen at 23” resolution in Massachusetts, which will be the third state (after Hawaii and California) to support screening Asian Americans at a body mass index of 23. Approximately thirty state senators and house members sponsored this joint resolution, so thankfully this issue is getting needed recognition.
SoD: How does this resolution help?
DH: These resolutions don’t provide funding for any mandated actions. What they are able to provide is awareness among the legislature for future actions—a precedent if you will—and a baseline of support for screening throughout their public health departments and systems. Also, through these processes we’ve built relationships with the legislators and in the case of Massachusetts with the Department of Public Health (DPH) itself. We’re hoping that future bills will be able to pass based on the Screen at 23 resolutions, and that in the short term we can help the DPH get the word out. Outside the legislature, in each of these states we have worked with community organizations and ADA chapters who’ve conducted health fairs with diabetes screenings, created online PSAs, and materials for patients.
SoD: How will Screen at 23 improve the health of the Asian American community?
DH: If you don’t know your diabetes status then you don’t get treated, and untreated diabetes can lead to vision loss, foot amputation, kidney failure, etc. It can lead to fatal consequences, so getting diagnosed is critical. If every Asian American who walks into a doctor’s office or clinic with a BMI of 23 or greater is recognized as having one risk factor for diabetes, that will lead to more diagnoses. Then medication and a lifestyle intervention program can be started and they can lead a very healthy life even with diabetes. If they are screened and seen as prediabetic (at increased risk for developing diabetes), the intervention can take place and diabetes avoided altogether. Also, cardiovascular disease and other dangerous conditions are exacerbated by diabetes, so getting screened, diagnosed, and beginning that early intervention can have great preventive benefits there, too.
Click here to buy tickets for the AADI’s 2018 A Taste of Ginger.
For more information on Joslin’s AADI, visit aadi.joslin.org.
For more information on Screen at 23, visit http://screenat23.org/.