medwireNews: Researchers recommend using different BMI or age thresholds for type 2 diabetes screening in ethnic minority groups, on finding that a single threshold may miss many cases in non-White Americans.
“[U]sing a single BMI threshold to determine eligibility for screening in all U.S. adults may contribute to the substantial racial/ ethnic disparities in diabetes diagnosis in the United States,” say Dhruv Kazi (Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA) and study co-authors.
They add that the differences in diabetes rates by race “is particularly true in adults with normal weight, among whom the prevalence of diabetes is 2 to 4 times higher in racial/ethnic minority populations than in White populations.”
The researchers used data from 19,335 adults aged 18 to 70 years who participated in NHANES 2011–2018, among whom were 6319 White Americans, 2658 Asian Americans, 4597 Black Americans, and 4998 Hispanic Americans.
Among people aged 35–70 years (ie, the ages eligible for diabetes screening in the USA), the rates of diagnosed diabetes ranged from 12.4% in White Americans to 20.7% in Black Americans. The rates of undiagnosed diabetes were considerably higher, particularly in ethnic minority groups, at 21.2–27.6% compared with 12.4% in White Americans.
Of note, among people with a BMI in the normal range, the rate of diagnosed diabetes was just 3.5% in White Americans, but rose to as high as 13.0% in Asian Americans.
Using a logistic regression model, the researchers calculated that to detect diabetes at the same rate in all ethnic groups it would be necessary to lower either the BMI threshold or age at screening in the non-White groups relative to White Americans.
Specifically, at a screening age of 35 years and a BMI threshold of 25 kg/m2 in White people, the equivalent would be 20 kg/m2 for Asian Americans and 18.5 kg/m2 for both Black and Hispanic Americans.
Alternatively, at a screening BMI threshold of 25 kg/m2, the screening age of 35 years in White Americans would decrease to 25 years for Hispanic Americans, 23 years for Asian Americans, and 21 years for Black Americans.
The report is published in the Annals of Internal Medicine, with a linked editorial by Quyen Ngo-Metzger (Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA).
She writes: “Whether the increased diabetes prevalence in persons in underrepresented racial/ethnic groups at lower BMIs and younger ages compared with White persons is a result of biological, social, economic, or structural factors (or a combination of factors) warrants further research.”
However, she also stresses that screening “is only the first step” in diabetes management, and points to research showing that “racial/ethnic disparities in quality of diabetes care exist across all groups.”
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