Diabetes in Asian Americans: 5 Things That May Affect Your Risk and What You Can Do About It

Experts are raising the alarm bell on diabetes in the U.S. It is estimated that more than 8 million Americans have diabetes and don’t even know it. 

Previous research, however, suggests that some diagnoses are missed because of racial and ethnic biases in medical settings. In the case of diabetes, healthcare providers sometimes assume that Asian Americans are not at risk for the condition. In reality, however, nearly half of Asian American adults have diabetes or are prediabetic. And more than half of diabetes cases in Asian Americans go undiagnosed.

Here’s an overview of what the research shows regarding risk factors for diabetes among the Asian American community and what can be done to lower the risk.

Why does the Asian American community have a higher risk of developing diabetes?

Experts are still learning about factors that may put Asian Americans at a higher risk than other groups. Possible factors include the following.

1. Visceral fat

Type 2 diabetes is known to be more common in people who have larger body sizes. Asian Americans tend to have more visceral fat and less muscle than other groups. As a result, they may be more likely to develop diabetes at a younger age and lower body weight. 

Visceral fat is fat that surrounds your internal organs. This is different from the fat stored under your skin, and it’s hard to tell how much visceral fat a person has based on their appearance. Having a large amount of visceral fat increases the risk of heart disease, stroke, and other health conditions. It also makes the body’s tissues more resistant to insulin.

Read more like this

Explore these related articles, suggested for readers like you.

How Do You Know If You Have Diabetes? 10 Early Signs to Watch For

Can You Cure or Reverse Diabetes?

5 Best Foods to Eat When You Have Diabetes, and Some Simple Tips for Success

View more

2. Adopting parts of Western culture

Some research suggests that moving to a new country and taking on some of the beliefs and culture of the new place may affect a person’s health risks. For example, Japanese immigrants living in the U.S. are three times more likely to develop Type 2 diabetes than Japanese people living in Japan. But how assimilating into a new culture is related to the development of Type 2 diabetes in other Asian-American communities is unclear. 

3. Reduced production of insulin

The pancreas produces insulin, which helps control the sugar in our bloodstream. Some research suggests that Asian American people produce less insulin than some other groups, which might contribute to a higher risk of diabetes. 

4. Racial bias

There is a lot of diversity in the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community — both between different parts of the community and between individuals. But stereotypes about Asian Americans may also play a role in Type 2 diabetes risk.

For example, the “model minority myth” — the idea that Asian Americans are more educated and financially better off than other groups — can lead to healthcare providers making false assumptions about Asian Americans and not monitoring their health as closely as they should. For instance, providers might not ask questions they otherwise would about issues like:

• Medical needs, including health screenings 

• Health insurance status

• Healthcare knowledge 

• Diet quality

5. Cultural preferences and barriers

On the flip side, Asian Americans who experience bias and racism may become hesitant to seek medical care. This hesitance may be due to issues such as:

• Lack of trust in healthcare providers

• Potential language barrier

• Preferences for Eastern medicine 

If a person avoids going to the doctor, their risk for diabetes and other health conditions might not get evaluated early enough to catch problems before they become serious.

How do the existing guidelines around diabetes apply to Asian Americans?

It depends on which guidelines you are following. 

The U.S. Preventive Task Force’s 2021 screening recommendations say adults aged 35 to 70 years who have extra body weight or obesity should be screened for diabetes.

The task force does not have any special consideration for the Asian community, but notes that more research is needed to understand the effects of screening on health among AANHPI people and other ethnic communities. This would also allow for a better estimate of how many people have diabetes in the U.S.

A joint CDC and National Institutes of Health (NIH) study, however, found that Asian Americans develop diabetes at a lower BMI compared to the general population. 

The American Diabetes Association now recommends lowering the BMI screening benchmark to 23 for Asian Americans. For other communities, screening is recommended with a BMI of 25 or more. 

How would the existing diabetes guidelines need to change to better apply to Asian Americans?

Experts suggest using other measures besides BMI as screening tools for diabetes in Asian Americans. Measuring waist circumference, for instance, can help assess if someone has excess visceral fat. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches are at higher risk of diabetes.

To get an accurate waist measurement, place a tape measure around the middle of your waist — right above your hip bones. It’s best to measure right after you exhale.

Tips to lower your risk for diabetes if you’re Asian American

It’s not easy to fight genetics. But there are simple steps you can take that may help lower your risk of diabetes. Here are six recommendations.

1. Limit your sugar intake

Take an inventory of the things you normally eat and decrease foods that are high in sugar, such as:

• Refined grain products, such as cereal

• Alcoholic beverages

• Fruit juice

• Flavored yogurt

• Ultra-processed foods, such as cake, cookies, and candy

2. Optimize your nutrition

Improving your diet doesn’t mean eliminating foods you enjoy or that are traditionally part of your family’s diet. Instead, you can make adjustments:

• Eat more foods that are high in fiber and low in fat. Fruits and vegetables are great examples, along with beans, nuts, and seeds.

• Practice portion control. This can look like getting in the habit of keeping your portion sizes to approximately 2 fistfuls for non-starchy vegetables, 1 fistful for whole grains or starchy vegetables, and 1 palm’s worth for lean protein. 

• Adding a healthy fat or source of protein to carbohydrate-rich foods that you normally eat. For example, if you eat rotis, you can try mixing avocado into the dough or adding hemp or chia seeds. 

3. Physical Activity

Being active is an important part of maintaining a healthy weight. For people in the Asian community with a BMI of 23 or higher, losing 7% to 10% of their body weight may help prevent Type 2 diabetes. Experts recommend staying physically active to help reduce your risk. Even everyday activities like gardening, cleaning the house, or taking the stairs instead of the elevator can be helpful.

4. Sleep

Remember to get a good night’s sleep. For most adults, this means getting 7 to 9 hours of sleep per night. A lack of sleep can lead to insulin resistance, along with many other health problems. 

5. Limit alcohol intake

If you drink, limit your alcoholic beverages to 1 per day for women or 2 per day for men. Alcohol lowers sugar production in the liver. This can lead to low blood sugar in people who take medication to manage their diabetes — and without treatment, this is dangerous. On the other hand, alcoholic drinks like beer can spike sugar levels.

Also keep in mind that an increasing body of research has shown that no amount of alcohol is safe to drink. So if you don’t drink, don’t start.

6. Smoking

Although the connection between smoking and diabetes may not be apparent, research shows that people who smoke have a 30% to 40% higher risk of developing diabetes. Aside from that, smoking also increases the risk of cancers and a shortened life span. 

Resources on diabetes management for Asian Americans

If you are Asian American and looking for ways to lower your diabetes risk, here are some resources that can help: 

1. Drag 'n Cook: Access recipes and nutritional breakdowns for Asian meals as part of a diet study from the Joslin Diabetes Center’s Asian American Diabetes Initiative (AADI).

2. Asian Smokers’ Quitline: This organization offers resources to help you quit smoking, including phone counseling in four languages, online reading material, and free nicotine patches.

3. AADI’s Diabetes Resources: Learn how to lower your risk for diabetes with videos, reading materials, and tools like a BMI calculator designed specifically for Asians.

4. Joslin's Asian Clinic: Talk with a healthcare provider who is familiar with Asian American culture and understands the diversity that exists within the community. 

Why trust our experts?

Written by:

Shiv Sudhakar, MD

Shiv Sudhakar, MD, is a fellow of the Infectious Disease Society of America and works as a physician in California. He has co-authored over 10 peer-reviewed research articles, published several short stories, had a script recently optioned, and presented 20 scientific presentations, two of which placed in the top 3 at the American College of Physicians.

Edited by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Reviewed by:

Sanjai Sinha, MD

Sanjai Sinha, MD, is a board-certified physician with over 20 years of experience. He specializes in internal medicine.

Our editorial standards

Meet our experts