Screening Black, Hispanic, and Asian American patients for diabetes at lower body
mass index (BMI) thresholds and earlier ages may improve health equity and reduce
disparities in diabetes rates, according to a cross-sectional study.

Researchers used data from the National Health and Nutrition Examination Survey to
determine the BMI and age thresholds for diabetes screening in major racial/ethnic minority populations.

The study included 19,335 nonpregnant U.S. adults ages 18 to 70 years, including 6,319
White Americans, 2,658 Asian Americans, 4,597 Black Americans, 4,998 Hispanic Americans,
and 763 Americans from other racial/ethnic populations. The equivalent BMI threshold
for each racial/ethnic minority group was defined as the BMI at which the prevalence
of diabetes in 35-year-old people equaled that in 35-year-old White adults at a BMI
of 25 kg/m². The findings were published May 10 by Annals of Internal Medicine.

Significant differences in diabetes prevalence were found by racial/ethnic group among
35- to 70-year-old Americans with normal weight (BMI, 18.5 to 24.9 kg/m²). In this group, 3.5% of White Americans had diabetes, compared with 13.0% of Asian
Americans (odds ratio [OR], 4.14; 95% CI, 2.49 to 6.88), 10.0% of Black Americans
(OR, 3.07; 95% CI, 1.87 to 5.04), 12.2% of Mexican Americans (OR, 3.86; 95% CI, 2.10
to 7.08), and 7.0% of other Hispanic Americans (OR, 2.09; 95% CI, 1.20 to 3.65). Rates
of undiagnosed diabetes were also higher in all racial/ethnic minority groups than
in White patients: 12.5% compared with 27.6% in Asian Americans (OR, 2.61; 95% CI,
1.71 to 4.00), 22.8% in Black Americans (OR, 2.02; 95% CI, 1.42 to 2.88), 21.2% in
Mexican Americans (OR, 1.81; 95% CI, 1.25 to 2.62), and 23.5% in other Hispanic Americans
(OR, 2.19; 95% CI, 1.37 to 3.49).

The authors calculated that to identify the same proportion of patients with diabetes
as White Americans, clinicians would need to screen 35- to 70-year-old Asian Americans
starting at a BMI of 20 kg/m² and Black and Hispanic Americans starting at a BMI of 18.5 kg/m². Among those with a BMI of 25 kg/m² or greater, it would be equitable to begin diabetes screening in individuals from
racial/ethnic minorities starting at younger ages: Asian Americans at 23 years, Black
Americans at 21 years, and Hispanic Americans at 25 years.

An accompanying editorial called on the U.S. Preventive Services Task Force (USPSTF) to update its recommendation on diabetes
screening and preventive services to reflect the differential risk for diabetes among different
racial/ethnic groups. “Screening is only the first step in the prevention and
treatment continuum,” the editorial stated. “The USPSTF already recommends
risk-based preventive services for other conditions, including cancer, cardiovascular
disease, and infectious disease. To address the current inequity in diabetes screening,
the USPSTF should apply the same consideration to its diabetes screening recommendation.”