Recent trends in the U.S. refugee population have confirmed increased numbers of refugees with the diagnosis of diabetes. Despite some correlations seen with increasing rates of diabetes in obese individuals, certain ethnic groups have demonstrated an increased prevalence of diabetes at a lower body mass index. [1] As part of their acculturation to the U.S., refugees may adopt dietary and lifestyle behaviors that are known to increase their risk for diabetes. [2] Delays in the diagnosis and treatment of diabetes can lead to complications and unnecessary costs. All immigrant populations, including refugees, should be screened appropriately and treated in a timely manner to prevent the development of diabetes and its associated complications.

Diabetes affects over 25 million children and adults in the U.S. each year, accounting for over 8% of the U.S. population. Another 79 million Americans have pre-diabetes, placing many more individuals at high risk for developing the disease. [3] Diabetes is found in both genders and across all ages, races, and ethnic groups, although some are at higher risk than others.

Type 1 and Type 2 Diabetes
The two main types of diabetes are Type 1 (5% of diabetics) and Type 2 (95% of diabetics). Individuals with Type 1 diabetes do not produce insulin. This type is usually diagnosed in childhood or early adulthood. In Type 2 diabetes, individuals either do not make enough insulin or the body’s cells ignore the insulin. This type of diabetes is more common in obese individuals, the elderly population, and some racial and ethnic groups.

Screening and Risk Factors
All refugees at risk for diabetes should be screened shortly after their arrival to the U.S. Based on the recommendations of the American Diabetes Association (ADA), these risks include:

  • Age 45 years or older
  • Overweight (BMI > 25) and other factors: Inactivity, hypertension, dyslipidemia, vascular disease, polycystic ovarian syndrome (PCOS), gestational diabetes, family history of diabetes, or membership in a high-risk ethnic group [4]

Associated Conditions
Studies have shown that at-risk individuals can delay the progression of disease with a healthy lifestyle of diet and exercise. If left untreated, poorly controlled diabetes can lead to increased rates of morbidity, mortality, and medical expenditures. The following conditions have all been associated with diabetes:

  • Heart disease
  • Stroke
  • Hypertension
  • Blindness
  • Kidney disease
  • Neuropathy

Contributed by Marc Altshuler, M.D. and Kevin Scott, M.D.

1. American Diabetes Association. http://www.diabetes.org
2. Centers for Disease Control and Prevention. General Refugee Health Guidelines.
3. The Southeast Asian Subcommittee of the Asian American/Pacific Islander Work Group National Diabetes Education Program. Silent Trauma: Diabetes, Health Status, and the Refugee Southeast Asians in the United States. 2006.
4. American Diabetes Association. American Diabetes Association Clinical Practice Recommendations 2007. Diabetes Care: January 2007.