Ethnic-specific diabetes screening BMI cutoffs proposed
medwireNews: Researchers studying the MESA cohort have proposed BMI cutoffs at which people from ethnic minorities should be screened for type 2 diabetes, all of which are lower than their proposed cutoff for White people.
“Our primary finding showed that in high-risk individuals, who were a majority, with at least one risk factor, screening should be considered at a BMI ≥ 22 kg/m2 for Chinese Americans, ≥ 24 kg/m2 for Hispanics, ≥ 25 kg/m2 for African Americans and ≥ 26 kg/m2 for white participants,” say Luis Rodriguez (University of California, San Francisco, USA) and colleagues.
This was the team’s clinical screening scenario, but they stress that BMI cutoffs varied with ethnicity at different levels of risk.
The clinical screening scenario involved people with at least one diabetes risk factor, which comprised 65% of the 5659 MESA (Multi-Ethnic Study of Atherosclerosis) participants who did not have type 2 diabetes at baseline, rising to 74% among the 5382 for whom family history of diabetes was known.
The study participants were an average age of 62 years at baseline, and during follow-up 12% developed new-onset type 2 diabetes. After accounting for age, sex, and the presence of diabetes risk factors, the risk for type 2 diabetes was increased 1.3-fold in African Americans, 1.6-fold in Hispanics, and 2.6-fold in Chinese Americans, relative to White Americans.
In the clinical screening scenario, White Americans had a 10% risk for developing diabetes over the next 10 years at a BMI of 26.2 kg/m2. But African Americans had this same risk at a BMI of 24.7 kg/m2, Hispanics at 23.8 kg/m2, and Chinese Americans at just 21.7 kg/m2.
Rodriguez and team note that only around half of Americans aged 45 years or older are screened for type 2 diabetes, despite guidelines recommendations.
“Our study […] adds evidence to support including BMI and traditional risk factors as action points to prioritize and identify who among adults aged ≥ 45 should be screened for type 2 diabetes,” they write in Diabetic Medicine.
If White people had no other risk factors, they would reach a 10% risk for developing diabetes in 10 years at a BMI of 30.5 kg/m2, after accounting for age and sex. But again, the same level of risk was observed at lower BMIs for the ethnic minority groups, at 27.9, 26.8, and 24.3 kg/m2 for African Americans, Hispanics, and Chinese Americans, respectively.
“This study adds to the body of literature that underscores the value of using different BMI cut-off points for different racial/ethnic groups, and presents new evidence that the cut-off points may also differ between these groups based on the presence of risk factors,” conclude the researchers.
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