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Mediation of the Relationship of Acculturation With Glycemic Control in Asian Americans With Diabetes

Purpose To assess the role of physical activity and healthcare access in mediating the association of acculturation with cardiometabolic health in Asian American adults with diabetes. Design Cross-sectional study. Setting National Health and Nutrition Examination Survey (NHANES) 2011–2018. Subjects Non-pregnant Asian American adults with doctor diagnosed diabetes. Measures Participants were classified into low, moderate, and high acculturation status. Self-reported leisure-time, work, and transportation-based physical activity were summed for overall physical activity. Health insurance, frequency of healthcare receipt, and glycohemoglobin (HbA1c) check in the past year indicated healthcare access. Cardiometabolic health indicators included HbA1c, total and high density lipoprotein-cholesterol, and systolic and diastolic blood pressure. Analysis Linear and logistic regression estimates, standardized using y-standardization, and assessed mediation of acculturation with cardiometabolic health. Results Low acculturation was significantly related to greater leisure-time inactivity odds [OR (95% CI) = 2.25 (1.05, 4.82)], overall insufficient activity [OR (95% CI) = 2.30 (1.12, 4.74)], and uninsured status [OR (95% CI) = 5.62 (1.55, 20.41)]. Asian Americans with low acculturation had significantly higher log HbA1c than those with high acculturation (β ± SE = .078 ± .038); however, this association was not significant after adjusting for leisure-time activity. Leisure-time activity mediated 48.9% of acculturation and HbA1c association, and the indirect effect was statistically significant [estimate (95% CI) = .021 (.002, 0.047)]. Conclusions Results suggest that promoting sufficient leisure-time activity could improve glycemic control in least acculturated Asian Americans with diabetes.