Black, Asian, and Hispanic adults in the United States were found to have an increased risk for developing diabetes at lower weights and younger ages compared with White Americans, suggesting that screening recommendations for the disease should be altered to reflect this difference.
Although excess body weight is a known risk factor for diabetes, a study published in Annals of Internal Medicine found that Americans who are Asian, Hispanic, or Black are at an increased risk for developing diabetes at lower weights and at younger ages than White Americans.
The authors suggested that their findings support the need for more Asian, Hispanic, and Black Americans to get screened at a lower body mass index (BMI) and at younger ages compared with their White counterparts.
“If the current thresholds are universally applied, without accounting for differential risk in racial/ethnic groups, clinicians may underdiagnose diabetes in Asian, Hispanic, and Black Americans. On the other hand, applying a more tailored approach may allow reduce rates of undiagnosed diabetes and produce population wide improvements in diabetes care,” said Dhruv Kazi, MD, MSc, MS, senior author of the study, the associate director of the Smith Center, and an associate professor of medicine at Harvard Medical School, in a statement.
Diabetes impacts over 34 million adults and is a leading cause of death and disability in the United States. Diabetes care costs about $330 billion in annual health care expenditures, and federal guidelines recommend that overweight adults, defined as those with a BMI of 25 or higher, should start being screened for diabetes at age 35 years.
The team of physicians and scientists at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC) used statistical modeling to detect the BMI levels and age at which racial and ethnic minority populations experiences the same prevalence of diabetes compared with White populations. The data for the modeling stemmed from a long-running, nationally representative survey conducted by the CDC.
The researchers recommended that diabetes screening should be offered to people between the ages of 35 and 70 with a BMI of 20.0 kg/m2 for those who are Asian American and 18.5 kg/m2 for those who are Hispanic or Black American. According to the CDC website, a BMI of 18.5 kg/m2 is considered the lower threshold for the normal weight range, meaning that any Black or Hispanic individual that is not underweight should be recommended for diabetes screening.
Additionally, they recommended that Black, Hispanic, and Asian Americans should begin screening in their early 20s instead of waiting until they are 35 years old. The study authors noted that delaying diagnosis and inadequate treatment could lead to significant damage to their heart, kidneys, eyes, and limbs.
“But it doesn’t affect all of us equally – there are striking disparities that are largely the legacy of structural racism. Fixing the health disparities for Americans with diabetes will require a range of strategic investments in health care and efforts to reduce structural inequities. Making screening more equitable is a place to start, as it ensures that individuals with diabetes can receive preventive care and treatment in a timely manner and avert the most catastrophic consequences of diabetes,” said Rahul Aggarwal, MD, another study author and an internal medicine resident at BIDMC.
In an interview with The American Journal of Managed Care®, Kazi noted that the current “one-size-fits-all” approach to diabetes screening misses patients who may be at increased risk for diabetes at a lower BMI and younger age, an issue that their newly proposed thresholds would directly address. In addition to screening, he emphasized the importance of connecting patients with adequate behavioral and pharmacological care to reduce the risk of diabetes and disease-related complications.
Kazi mentioned the inability for him and his colleagues to fully dissect the diabetes risk profiles of subracial and ethnic groups, such as individuals with Indigenous or Pacific Islander ancestry or South Asian communities within the Asian American population, saying that the study was limited by data available in nationally representative surveys.
“I think we make the case that we'd love to see more granular data on diabetes risk in these subgroups. But at the same time, we shouldn't shy away from making recommendations about health equity until we have better data. The more I look at the data, the more the current status quo seems unacceptable. We shouldn't let perfect be the enemy of the good. We can do better than what we have right now.”
Screening some sooner may reduce racial and ethnic disparities in diabetes diagnosis, researchers show. News release. Beth Israel Deaconess Medical Center; May 9, 2020. Accessed May 6, 2022. https://www.eurekalert.org/news-releases/951828?