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June 7, 2026Diabetes

Asian American and Pacific Islander groups show higher A1c than Whites across most BMI categories.

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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?

Population

792,905 AANHPI members aged ≥30 years without prior cardiovascular disease

Comparison

AANHPI subpopulations vs Non-Hispanic White populations across age and BMI categories

Design

Observational cohort study

Key result

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.

Authors

YDY.G. DaidaRPRishi ParikhJLJoan C. Lo

Discussion

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Member takes

Overview

May support ethnicity-specific A1c thresholds in AANHPI; leaves open whether targeted screening improves outcomes.

Key Points

  • This study aims to analyze A1C levels across different AANHPI subpopulations, considering the effects of age and BMI.
  • Identified 792,905 AANHPI members from Kaiser Permanente Northern California and Hawaii between 2012-2022, aged ≥30 years with no prior cardiovascular disease.
  • Calculated mean predicted A1C values stratified by diabetes status, age, sex, and BMI, adjusting for various factors.
  • Examined interactions between race/ethnicity, age, sex, and BMI.
  • NHPI adults exhibited the highest rates of obesity (58%) and dyslipidemia (51%).
  • Among those with diabetes, A1C levels were highest in NHPIs across all age and BMI groups.
  • All AANHPI subpopulations showed higher adjusted mean A1C than NHW at normal, overweight, and obese BMIs, particularly for ages 30-84.

Study Design

Type

Observational (n=792,905)

Multicenter

Yes

Structured PICO

Does A1c level vary among AANHPI subpopulations compared to NHW populations across different age and BMI categories?

P
Population
792,905 Asian American, Native Hawaiian, and Pacific Islander adults aged ≥30 years without prior cardiovascular disease, evaluated for A1c variation between 2012-2022.
C
Comparator
Non-Hispanic White (NHW) populations
O
Outcome
Mean predicted A1c values across race/ethnicity, stratified by diabetes status, age, sex, and BMIsurrogate

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.

Cite This Study

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.

synapsesocial.com/papers/6a250b707def13d035e1b671https://doi.org/10.2337/db26-2337-p
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 12086-P: Marked Heterogeneity in Type 2 Diabetes among Disaggregated Asian American and Pacific Islander Adolescents and Young Adults: Predictors of Adverse Cardiometabolic Problems in Adolescents and Young Adults (PAPAYA) Study2026
  2. 244-PUB: Evaluation and Care of Double Diabetes in Asian American Patients2026
  3. 3Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study2019 · 233 citations
  4. 42468-P: Insulin Resistance and β-Cell Function in South vs. East Asians and Caucasians2026
  5. 51610-P: Heterogeneity in Diabetes across Socioeconomic Subgroups of Asian-Americans in the U.S.2020