Heterogeneity of Diabetes Outcomes Among Asians and Pacific Islanders in the U.S.

The Diabetes Study of Northern California (DISTANCE)

  1. Andrew J. Karter, PHD3
  1. 1Division of General Internal Medicine, Women’s Health Clinical Research Center, University of California, San Francisco, California
  2. 2Center for Health and Communities, University of California, San Francisco, California
  3. 3Division of Research, Kaiser Permanente Northern California, Oakland, California
  4. 4Division of General Internal Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, California
  5. 5California Diabetes Program, California Department of Public Health, San Francisco, California
  1. Corresponding author: Alka M. Kanaya, alka.kanaya{at}


OBJECTIVE Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated.

RESEARCH DESIGN AND METHODS We performed a prospective cohort study (1996–2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites (n = 40,286), blacks (n = 8,668), Latinos (n = 7,763), Filipinos (n = 3,572), Chinese (n = 1,823), Japanese (n = 951), Pacific Islanders (n = 593), and South Asians (n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA1c, hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted.

RESULTS Pacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites.

CONCLUSIONS Incidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research.


  • Received October 15, 2010.
  • Accepted January 16, 2011.


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  1. Diabetes Care vol. 34 no. 4 930-937
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