Celebrating Asian American and Pacific Islander Heritage Month: Addressing Unique Diabetes Challenges

by | May 14, 2025 | Cultural Nutrition

Blog header featuring the title 'Celebrating Asian American and Pacific Islander Heritage Month: Addressing Unique Diabetes Challenges' with a professional photo of Karen Lau, Asian American diabetes dietitian, against a teal background.

May is Asian American and Pacific Islander (AAPI) Heritage Month—a time to celebrate cultural richness while addressing healthcare disparities that impact our community.

Why This Matters to Me

As an Asian living in the United States and a diabetes dietitian with 15 years of experience at a diabetes center focusing on helping Asian Americans manage diabetes, AAPI Heritage Month holds special significance. Throughout my career, I’ve been passionate about advocating for equitable, culturally responsive care for Asian Americans living with diabetes and prediabetes.

This isn’t just professional for me—it’s deeply personal. I’ve witnessed firsthand how cultural disconnects in healthcare can impact outcomes for our community. When diabetes education and management strategies aren’t culturally informed, they simply don’t work as effectively for Asian Americans.

Why This Matters to Asian Americans

While the prevalence of elevated blood sugar among each Asian subgroup differs, Asian Americans as a collective group have a higher risk for diabetes. According to the latest statistics in the United States, 1 in 2 Asian American adults have prediabetes or diabetes. Even more concerning, 1 in 3 Asian American adults with diabetes don’t know they have the condition.

Asian Americans also experience the highest rate of gestational diabetes, particularly among Asian Indians. These conditions often silently affect many Asian Americans, increasing the risk for diabetes-related complications such as stroke and heart disease.

The Unique Diabetes Challenges Facing Asian Americans

Asian Americans face several distinct challenges when it comes to diabetes management that often go unrecognized in standard diabetes care:

1. The “Lean Paradox”: High Risk at Lower Body Weight

One of the most misunderstood aspects of diabetes risk in Asian Americans is what I call the “lean paradox”: 

  • Lower BMI Threshold: Asian Americans develop type 2 diabetes at significantly lower body weights than the general population. While the standard BMI threshold for increased diabetes risk is 25 kg/m² for the general population, for Asian Americans, that risk begins at just 23 kg/m².
  • Invisible Risk Factors: Many Asian Americans appear “lean and healthy” by conventional standards, which means healthcare providers often don’t recommend diabetes screening until symptoms become apparent or when their BMI reaches the usual threshold—missing crucial early intervention opportunities. 

Here is a BMI calculator that is tailored based on Asian American guidelines, which can help you assess diabetes risk based on more accurate guidelines for the Asian body composition.

nfographic comparing body composition between Asian and non-Asian individuals at the same BMI of 23. Shows that Asians typically have less muscle mass, higher percentage of body fat, and more visceral fat but less subcutaneous fat, resulting in higher diabetes risk at the same BMI.

2. Asian Americans as a Diverse Group

Asian Americans represent over 20 countries of origin with distinct cultures, languages, dietary patterns, and health beliefs. This diversity is often overlooked in healthcare settings where “Asian” is treated as a monolithic category.

  • Varying Risk Profiles: Research shows significant differences in diabetes risk among Asian subgroups. For instance, South Asians (Indians, Pakistanis, Bangladeshis) tend to have higher rates of insulin resistance at lower BMI levels compared to East Asians (Chinese, Japanese, Korean).
  • Dietary Diversity: While rice is a staple across many Asian cultures (but not all), cooking methods, accompaniments, and proportions vary dramatically. Vietnamese cuisine features fresh herbs; Korean meals often incorporate fermented foods; Indian diets may be rich in dairy and legumes; and Filipino cuisine is frequently influenced by various cultures – Spanish, Chinese, indigenous cuisines and more.
  • Regional Medical Traditions: Traditional medicine systems vary significantly across Asia – from Traditional Chinese Medicine to Ayurveda in South Asia to Jamu in Indonesia. Each brings different perspectives on disease causation, treatment, and prevention that influence how people approach diabetes management.
  • Immigration Patterns: First-generation immigrants often maintain stronger ties to traditional practices, while second and third generations may adopt more Western approaches. This creates generational diversity within families that healthcare providers must navigate.
  • Socioeconomic Factors: There are significant socioeconomic differences among Asian American subgroups that affect healthcare access. While some Asian American communities have high rates of health insurance and regular medical care, others face substantial barriers to accessing diabetes education and treatment.
  • Healthcare Implications: This diversity renders one-size-fits-all diabetes education ineffective and necessitates approaches tailored to specific cultural backgrounds, family dynamics, and individual circumstances.

3. Cultural Barriers to Diabetes Education

Standard diabetes education in the United States rarely addresses the unique cultural factors that impact diabetes management for Asian Americans: 

 

Food-Related Challenges

  • Limited Culturally Relevant Resources: Few diabetes education materials provide nutritional information for traditional Asian foods. How do you count the carbohydrates in congee, sticky rice, or various noodle dishes? What about the numerous regional variations of these foods?
  • Carb-Rich Foods as Staples: For many Asian Americans, carbohydrate-rich foods (such as rice, noodles, millet, or buns) are not just side dishes—they’re cultural cornerstones. Traditional advice to “cut out carbs” is particularly challenging and may be perceived as culturally insensitive. 
  • Family-Style Dining: Many Asian meals are served family-style, with shared dishes in the center of the table. This makes portion management particularly challenging compared to individually plated Western meals.
Traditional Asian family-style dining table with lazy Susan, showing multiple shared dishes including rice bowls, vegetables, noodles, and meat dishes, with hands using chopsticks to reach for food from communal plates.

Traditional family-style Asian dining presents unique challenges for diabetes management: shared dishes make portion awareness difficult, refusing food can be culturally inappropriate, and carb-rich staples are central to the meal experience. (Illustration generated by DALL-E through ChatGPT)

Worldview Differences

 

  • Collectivistic vs. Individualistic Perspective: Asian cultures typically prioritize group harmony and collective wellbeing over individual needs. This creates unique challenges:
    • Family-Centered is Person-Centered: Personal choices often take into account family dynamics, from food selections to medical decisions.
    • Social Pressure at Meals: Many of my clients struggle with feeling like they’re being “difficult” or “troublemakers” when they need to choose foods differently from others at family gatherings.
    • Food as Love: Refusing food offerings can be interpreted as rejecting love and care from family members, creating emotional tension around diabetes management.

 

  • Traditional Medicine Concepts: Many Asian Americans navigate between Western medical approaches and traditional health beliefs:
    • Medication Hesitancy: There’s often concern that diabetes medications might damage organs, particularly the liver and kidneys. Some may also feel that medications are only treating the symptoms, not the root cause, and hence not providing true healing.
    • Symptom-Based Treatment: The belief that medications are only necessary when symptoms are present can lead to inconsistent medication adherence, especially when blood sugar appears stable.

 

  • Balance of Forces Philosophy: Many Asian cultures embrace concepts of balancing forces, such as “hot” and “cold” energies or the five elements, and should eat foods that help in maintaining this balance:
    • Conflicting Recommendations: Foods that are considered beneficial for balancing these energies may not align with evidence-based recommendations for blood sugar management.
    • Seasonal Adjustments: Dietary choices might change seasonally to maintain this balance, creating additional complexity for consistent diabetes management.

Building Bridges: Culturally Responsive Diabetes Care

Based on my experience working with hundreds of Asian American clients, here are the approaches I’ve found most effective: 

1. Modified Nutritional Strategies

  • Adapting Traditional Dishes: Rather than eliminating cultural staples, I work with clients to modify traditional recipes that my clients (and even their family) agree on. For example, adding more vegetables to a traditionally carb-based dish, such as fried rice.
  • Portion Management Techniques: While the plate method may be helpful for some, it may be less practical for others. Using familiar visual cues like rice bowls or hands to help in portion management are useful alternatives. 
  • Strategic Meal Sequencing: Teaching the importance of consuming vegetables and protein before rice and other carbohydrates to reduce blood sugar spikes.

2. Family-Centered Approach

  • Empowering Communication: Providing scripts and strategies to explain diabetes management needs to family members and loved ones in culturally appropriate ways.
  • Education Sessions for Support Network: Including key members in their care circle in diabetes education to create a supportive home environment. 
  • Collaborative Meal Planning: Developing strategies for navigating family-style meals while respecting cultural traditions, personal preferences, and family dynamics.

3. Bridging Traditional and Modern Perspectives

  • Acknowledging Traditional Practices: Respecting traditional medicine approaches while helping clients integrate evidence-based practices.
  • Finding Alignment: Identifying where traditional health beliefs can support diabetes management goals rather than creating conflict. 
  • Medication Education: Addressing specific cultural concerns about medications with clear, culturally sensitive explanations.
Illustration showing a healthcare provider and older Asian woman working together at a table with family recipe book, diabetes education materials, traditional Asian food items, and glucose meter. A framed picture of a bridge hangs on the wall symbolizing connection between cultural traditions and health management.

Culturally responsive diabetes care bridges traditional Asian practices with evidence-based management strategies, creating personalized approaches that honor both heritage and health needs. (Illustration generated by DALL-E through ChatGPT)

Moving Forward Together

As we celebrate AAPI Heritage Month, I’m reminded that cultural competency & cultural humility in diabetes care isn’t optional—it’s essential. When diabetes education respects and incorporates cultural values and practices, it dramatically improves outcomes.

For healthcare providers working with Asian American clients, I encourage you to:

  • Ask about cultural food practices and preferences
  • Inquire about traditional health beliefs that may influence care
  • Adapt recommendations to work within cultural frameworks
  • Include family members when appropriate

For my fellow Asian Americans living with diabetes or prediabetes:

  • Your cultural background is an asset, not an obstacle, in your health journey
  • You deserve care that respects and incorporates your cultural values
  • You can be true to who you are while managing your blood sugar
  • Small adaptations to traditional practices can make a significant difference
  • Building a support system that understands both your cultural and health needs is key

Join Me in This Important Work

I’m committed to continuing to develop culturally responsive diabetes management strategies for the Asian American community. If you’d like to learn more about managing diabetes while honoring your cultural heritage, I invite you to:

This AAPI Heritage Month, let’s celebrate our cultural heritage while empowering ourselves with the knowledge and strategies to thrive with diabetes.

👋 About the Author

I’m Karen Lau, a Registered Dietitian and Certified Diabetes Care and Education Specialist with over 15 years of experience helping Asian Americans manage diabetes while honoring their cultural traditions. Want to work together? Book a free strategy call or join our community.

Note: This guide provides general education based on current medical guidelines. Always consult your healthcare team for personalized medical advice. This article was authored by me, with my professional expertise, clinical experience, and original ideas forming the foundation of the content. Claude, an AI assistant from Anthropic, helped organize and expand my outline into a comprehensive blog post while maintaining my voice and professional perspective.