Diabetes treatment tailored to Asians

After 20 years with Type 2 diabetes, San Francisco resident Andy Chu has become mostly used to the diet restrictions required to manage the disease. He's just never going to stop missing white rice.

Chu, 61, gets one tablespoon of brown rice with dinner. A couple of times a year he might attend a formal banquet dinner and allow himself a taste of white rice. Just thinking about it brings a sad, wistful smile to his face.

"I'm so happy to just have a spoonful," Chu said. "The feeling is so nice. And brown rice is terrible."

Rice, most people are well aware, is a key component of the Asian diet. It's also a carbohydrate that is particularly unhealthy in large quantities for people with diabetes. So when someone like Chu is diagnosed with Type 2 diabetes, one of the first orders they hear is cut out the rice - and that just isn't an option for many Asians.

That's why doctors and other health care providers are increasingly trying to develop culturally sensitive ways to treat Asians with diabetes - programs that take into account Asian diets, exercise preferences and even personality traits.

"Diabetes is primarily a self-managed disease, and you have to try multiple approaches with different patients. But many of those are not culturally appropriate for Asians," said Catherine Chesla, a professor at the UCSF School of Nursing who is studying ways to cater diabetes care to Chinese patients.

Asians at particular risk

Treatment is especially important because Asians have a higher risk for Type 2 diabetes than the general population. Statistics vary and aren't always reliable, researchers say, but studies indicate Asians may have twice the rate of diabetes as white people in the United States.

Part of the reason is genetics, said Dr. William Hsu, co-director of the Asian American Diabetes Initiative at the Joslin Diabetes Center in Boston. White people are more likely to be overweight or obese - obvious indicators of Type 2 diabetes. But Asians tend to carry more visceral fat deep in the abdominal cavity. That fat, Hsu said, can release hormones that create multiple metabolic complications, including diabetes, although researchers don't yet understand why.

"Generally, Asians will present with much lower body weight, but have a riskier metabolic profile," Hsu said.

There are drugs to treat diabetes, but much of the primary care involves the patient - in other words, behavioral changes like diet and exercise. For years, the advice that doctors gave patients was geared toward a white, middle-class patient.

Dr. Danny Sam, a Chinese American who created the diabetes center at Kaiser Permanente in Santa Clara, discovered that firsthand when he diagnosed himself with Type 2 diabetes in 1997. Sam immediately began researching the disease and asking nutritionists for advice. What he found was that most of the diet recommendations didn't apply to an Asian diet.

For example, nutrition pamphlets might tell people to substitute wheat bread for white bread, or turkey for bologna. There was nothing that told Asian Americans what to substitute for rice.

Diet isn't "one size fits all," Sam said.

"If the patient needs 1,800 calories, how do you translate that to their ethnic diet?" he said. "If they don't eat bread and bologna, instead they eat tortillas or noodles, you have to translate that."

A growing recognition

Sam said a lot has changed since he was diagnosed. Kaiser has multiple classes for various ethnic groups, and doctors used to dealing with a diverse patient population will consider cultural differences when doling out advice.

Part of the reason for the study of Chinese Americans in San Francisco is to figure out what some of those cultural differences are. It's not as simple as recognizing that rice is a key part of the Asian diet, said Kevin Chun, a professor of psychology at the University of San Francisco who is working with Chesla on the Chinese diabetes study.

For starters, Chinese families often equate eating plenty with overall good health and might have a hard time accepting that a key part of diabetes management is eating less, Chun said. Telling an Asian patient to join a gym or pick up jogging for exercise might not work as well as suggesting a tai chi class.

"The whole idea of doing strenuous physical activity, like weight-lifting or running, that doesn't make sense to some families," Chun said. "That feels like it taxes the body and it's not a healthy activity."

Doctors aren't the only ones who need to be culturally sensitive, Chun said. In the new clinical trial, patients will learn techniques for talking to doctors and dealing with problems that come up with their friends and family.

Asian patients often are reluctant to ask their doctor questions - they might believe it's disrespectful, or there might be a language problem and they don't quite understand what the doctor is saying, Chun said. The class teaches patients the importance of being assertive with their health care.

Chu, a San Francisco resident, said classes have taught him to speak up to his doctor and ask questions. He's also learned to be more open with his family and friends.

"I learned to listen to what the doctor was saying," Chu said. "And I know how to communicate with people who do not have diabetes. I used to not speak up because I thought my friends wouldn't understand. But I know if I don't speak up, they might think I'm normal, that I can eat anything I want. I've learned how to express myself."

About the UCSF/University of San Francisco diabetes study

Participants will attend classes to learn behavioral changes that can help them manage their Type 2 diabetes. The classes will be held at the Donaldina Cameron House in Chinatown and be conducted in Cantonese.

Participants must be Chinese and born outside the United States. They must have been diagnosed with Type 2 diabetes, and must be at least 21 years old.

The study will last four years and is being paid for by a grant from the National Institutes of Health.

For more information on the study, call (415) 476-3889.