Compared to White adults at a BMI of 25 kg/m2, equivalent diabetes prevalence in 35-year-olds occurred at BMIs of 20 for Asian, <18.5 for Black, and 18.5 kg/m2 for Hispanic Americans.
Cross-Sectional (n=19,335)
What are the equivalent BMI thresholds for diabetes screening in racial/ethnic minority populations compared to the standard threshold of 25 kg/m2 in White adults?
Implementing lower, race/ethnicity-specific BMI thresholds for diabetes screening in Asian, Black, and Hispanic Americans could reduce disparities in diabetes diagnosis compared to a universal threshold.
Background: Racial/ethnic minority populations in the United States have increased rates of diabetes compared with White populations. The 2021 guidelines from the U.S. Preventive Services Task Force recommend diabetes screening for adults aged 35 to 70 years with a body mass index (BMI) of 25 kg/m2 or greater. Objective: To determine the BMI threshold for diabetes screening in major racial/ethnic minority populations with benefits and harms equivalent to those of the current diabetes screening threshold in White adults. Design: Cross-sectional study. Setting: NHANES (National Health and Nutrition Examination Survey), 2011 to 2018. Participants: Nonpregnant U.S. adults aged 18 to 70 years (n = 19 335). Measurements: A logistic regression model was used to estimate diabetes prevalence at various BMIs for White, Asian, Black, and Hispanic Americans. For each racial/ethnic minority group, the equivalent BMI threshold was defined as the BMI at which the prevalence of diabetes in 35-year-old persons in that group is equal to that in 35-year-old White adults at a BMI of 25 kg/m2. Ranges were estimated to account for the uncertainty in prevalence estimates for White and racial/ethnic minority populations. Results: Among adults aged 35 years with a BMI of 25 kg/m2, the prevalence of diabetes in Asian Americans (3.8% 95% CI, 2.8% to 5.1%), Black Americans (3.5% CI, 2.7% to 4.7%), and Hispanic Americans (3.0% CI, 2.1% to 4.2%) was significantly higher than that in White Americans (1.4% CI, 1.0% to 2.0%). Compared with a BMI threshold of 25 kg/m2 in White Americans, the equivalent BMI thresholds for diabetes prevalence were 20 kg/m2 (range, <18.5 to 23 kg/m2) for Asian Americans, less than 18.5 kg/m2 (range, <18.5 to 23 kg/m2) for Black Americans, and 18.5 kg/m2 (range, <18.5 to 24 kg/m2) for Hispanic Americans. Limitation: Sample size limitations precluded assessment of heterogeneity within racial/ethnic groups. Conclusion: Among U.S. adults aged 35 years or older, offering diabetes screening to Black Americans and Hispanic Americans with a BMI of 18.5 kg/m2 or greater and Asian Americans with a BMI of 20 kg/m2 or greater would be equivalent to screening White adults with a BMI of 25 kg/m2 or greater. Using screening thresholds specific to race/ethnicity has the potential to reduce disparities in diabetes diagnosis. Primary Funding Source: Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
Aggarwal et al. (Mon,) conducted a cross-sectional in Diabetes (n=19,335). Racial/ethnic minority status (Asian, Black, Hispanic) vs. White Americans was evaluated on Equivalent BMI threshold for diabetes screening (BMI at which diabetes prevalence in 35-year-old minority adults equals that of 35-year-old White adults at BMI 25 kg/m2). Compared to White adults at a BMI of 25 kg/m2, equivalent diabetes prevalence in 35-year-olds occurred at BMIs of 20 for Asian, <18.5 for Black, and 18.5 kg/m2 for Hispanic Americans.