Diabetes prevalence varies between and within US ethnic subgroups
medwireNews: The prevalence of diabetes is elevated in non-White US ethnic groups, but varies markedly within those groups, show data from the NHANES survey.
Yiling Cheng (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues used data from the 2011–2016 surveys, which included 7575 people with diagnosed diabetes or available blood glucose measurements. Of these, 2266 had diagnosed diabetes, 377 had previously undiagnosed diabetes, and 2384 had prediabetes.
After accounting for age and sex, the prevalence of diabetes (both diagnosed and undiagnosed) was highest in Hispanic people, at 22.1%, followed by non-Hispanic Black, Asian, and other non-White ethnicities, at 20.4%, 19.1%, and 18.5%, respectively.
The prevalence of diabetes in non-Hispanic White people was a notably lower 12.1%, the researchers report in JAMA.
But further adjustment for BMI changed this picture, with Asians now having the highest prevalence of diabetes, at 27.0%, compared with 20.3–17.7% for the other non-White groups.
There were also marked variations within the Asian group, with adjusted rates of 33.4% for Southeast Asians, 27.7% for South Asians, and 21.3% for East Asians.
Likewise, within the Hispanic group adjusted diabetes rates were highest for Mexicans, at 21.6%, followed by 19.4–20.1% for Central Americans, Puerto Ricans, and Cuban/Dominicans, and just 14.9% for South Americans.
Kunihiro Matsushita (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and co-authors of a linked editorial say: “The most novel and important aspects of this study are the nationally representative estimates of both diagnosed and undiagnosed diabetes as well as prediabetes within Hispanic and Asian subgroups.”
However, they note that the measures used to define impaired glucose metabolism varied within the study and were based on a single positive result, and so may have overstated the prevalence of both prediabetes and undiagnosed diabetes.
The editorialists highlight the effect of BMI on diabetes prevalence in Asians, noting that they “have greater visceral adiposity and increased insulin resistance” than White people at a given BMI, underlining the need for an Asian-specific BMI threshold to trigger blood glucose testing.
They note that although the ADA guidelines recommend a lower diabetes screening threshold of 23 kg/m2 for Asians, this “is not widely implemented,” and say the current findings support use of this lower cutoff, which “may help identify additional cases of undiagnosed diabetes in clinical practice.”
Matsushita and co-authors also highlight the need for data on diabetes prevalence in people who identify as having multiple ethnicities, “who represent rapidly growing populations in the United States.”
And they conclude: “[M]ost important, the social determinants that underlie racial/ethnic disparities in diabetes need to be better characterized and confronted.”
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