Key result
Asian American and Pacific Islander groups show higher A1c than Whites across most BMI categories.
Why the study?
Although A1c increases with age and BMI, patterns vary by race/ethnicity.
Does A1c level vary among AANHPI subpopulations compared to NHW populations across different age and BMI categories?
Observational (n=792,905)
Yes
Does A1c level vary among AANHPI subpopulations compared to NHW populations across different age and BMI categories?
A1c levels are higher in AANHPI subpopulations compared to Non-Hispanic Whites independent of diabetes status, age, sex, and BMI, highlighting the need for targeted screening and interventions.
Answers are grounded in this paper and cite their sources.
May support ethnicity-specific A1c thresholds in AANHPI; leaves open whether targeted screening improves outcomes.
Introduction and Objective: A1c increases with age and BMI, but patterns vary by race/ethnicity. We examined A1c in US AANHPI and Non-Hispanic White (NHW) populations by age and BMI categories. Methods: We identified 792,905 AANHPI members in Kaiser Permanente Northern California and Hawaii from 2012-2022, aged ≥30 years and no prior cardiovascular disease. We calculated mean predicted A1c values across race/ethnicity, stratified by diabetes (DM) status, age, sex, and BMI, after adjustment for education, income, hypertension, dyslipidemia, smoking, and glucose-lowering medications (diabetes model only), and possible interactions between race/ethnicity, age, sex and BMI. Results: NHPI adults had the highest prevalence of obesity (58%) and dyslipidemia (51%), while Filipinos had the highest prevalence of hypertension (52%) and DM (35%). In adjusted analyses (Figure) among those with DM, A1c was highest in NHPIs across all age groups and BMI groups. When stratified by BMI, the largest racial variation in A1c was seen in underweight men with DM. In those without DM, all AANHPI subpopulations had higher adjusted mean A1c than NHW at normal, overweight, and obese BMI and for ages 30-84y, with the highest A1c seen in NHPI, Filipino, and South Asian adults. Conclusion: A1c level differs in AANHPI subpopulations independent of DM status, age, sex and BMI, highlighting the need for targeted screening and interventions. Disclosure Y.G. Daida: Research Support; Current; Gilead Sciences, Inc. Research Support; Ended; Sanofi. R.V. Parikh: None. J.C. Lo: None. S. Alexeeff: None. T. Tan: None. C.K. Howick: None. A.P. Ambrosy: Consultant; Current; Bayer AG, Novo Nordisk. Research Support; Current; Boehringer Ingelheim International GmbH, Bayer AG, Johnson & Johnson, BridgeBio Pharma, Inc. Consultant; Current; Pfizer Inc. A. Go: Research Support; Ended; Novartis AG. Research Support; Current; Bristol-Myers Squibb Company. Advisory Panel; Current; Bristol-Myers Squibb Company, Janssen Pharmaceuticals, Inc. Research Support; Ended; Edwards Lifesciences Corporation.
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Daida et al. (2026) conducted an observational in Diabetes and A1c variation (n=792,905). Asian American, Native Hawaiian, and Pacific Islander (AANHPI) race/ethnicity vs. Non-Hispanic White (NHW) race/ethnicity was evaluated on Mean predicted A1c values. Asian American, Native Hawaiian, and Pacific Islander subpopulations had higher adjusted mean A1c levels than Non-Hispanic Whites across most BMI categories, independent of diabetes status.
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