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A second issue the authors noted is that Asian-Americans start developing diabetes at lower weights. “Overweight and obesity are not one-size-fits-all. If you’re Asian-American, a body mass index (BMI) of 23 is overweight,” Abrahamson said.
Body mass index is a rough estimate of body fat that is based on height and weight. In general, a BMI of 25 is considered overweight, according to the U.S. Centers for Disease Control and Prevention.
The authors said the reason Asian-Americans have a greater risk of diabetes at a lower weight is because their fat tends to deposit around their internal organs. This is known as visceral fat, and it increases the risk of insulin resistance, a precursor to type 2 diabetes. For this reason, the ADA recommended that type 2 diabetes screening in Asian-Americans should start if their BMI is 23 or higher, rather than at 25.
The final recommendation highlighted dealt with heart disease risk. People with both type 1 and type 2 diabetes have a significantly increased risk of developing heart disease. Because of this, the ADA recommended that doctors should begin cholesterol-lowering medications called statins in anyone over 40 with diabetes, even if they don’t have high cholesterol.
“If you have diabetes, you’re already at risk for heart disease. The ADA guidelines say if you have diabetes and you’re between 40 and 75, you should be on a statin,” Abrahamson noted.
Dr. Sam Altstein, a family medicine doctor and medical director of the Mount Sinai Beth Israel Medical Group in New York City, said none of the recommendations would be difficult to incorporate into practice.
“Doctors are very good at tailoring treatment to specific individuals. Patients don’t always fit into algorithms — they may be elderly or very sick — so, we have to make adjustments,” Altstein said.
Altstein said the biggest challenge in treating people with type 2 diabetes is that “when someone comes in with type 2, they often have 10 to 20 years of unhealthy living under their belt. It’s easy to figure out which medications they should be one, but getting people to change how they live is a lot like asking someone to change their religion. People have a hard time changing. It’s very hard to undo a lifetime of habits,” he said, adding that a referral to a dietician is often helpful.
He also recommended that patients “connect with your doctor and ask what your doctor feels a realistic goal is for you.” For example, someone who’s very overweight may not be able to lose 100 pounds, but they might feel 20 pounds is possible. “And, from a physiologic perspective, modest decreases in weight can lead to substantial changes in diabetes,” Altstein said.
More information
Learn more about the management of type 2 diabetes from the .
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