Healthy Weight May Not Mean Diabetes-Free

Type 2 diabetes BMI cut point for Asian Americans lowered to increase diabetes detection

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When it comes to determining diabetes risk, one size may not fit all. Asian-Americans in a healthy weight range may still face a risk of diabetes.

A new report from the American Diabetes Association (ADA) advised Asian-Americans that they may be at risk for type 2 diabetes at a lower body mass index (BMI) than other groups. BMI is a measure of body fat based on height and weight.

Lead report author William C. Hsu, MD, medical director of Joslin Diabetes Center’s Asian Clinic in Boston, noted that more doctors are catching on to the fact that Asian-Americans may be slipping through the cracks in terms of diabetes diagnoses.

“Asian Americans are being diagnosed with diabetes when they do not appear to be overweight or obese according to general standards," Dr. Hsu said in a press release. "But if you use the previous [ADA] standard for diabetes screening of being age 45 or older with a BMI of 25 kg/m2 or above, you will miss many Asian Americans who are at risk."

The ADA stated that Asian-Americans have been found to develop type 2 diabetes at lower BMI levels due to differences in body composition compared to other ethnicities.

Asian-Americans include anyone with roots “from the Far East (China, Japan, Korea, and Mongolia), Southeast Asia (Cambodia, Malaysia, the Philippine Islands, Thailand, Vietnam, Indonesia, Singapore, Laos, etc.), or the Indian subcontinent (India, Pakistan, Bangladesh, Bhutan, Sri Lanka, and Nepal),” the ADA says.

The ADA advises most patients to get screened for diabetes when their BMI goes over 25. But the organization advised Asian-Americans to seek screening when their BMI breaches 23.

With type 2 diabetes, patients' bodies do not process insulin properly. Insulin is a hormone that regulates blood sugar.

Past studies found that Asian-Americans tended to gain weight around the waist more so than other groups. Fat accumulation around the waist — versus the thigh or another part of the body — has been found to be most harmful in terms of developing diseases like diabetes.

Asian-Americans had a higher rate of type 2 diabetes at lower BMIs than whites, Dr. Hsu and team found.

Dr. Hsu and colleagues wrote that the “... BMI cut point to identify Asian Americans with or at risk for future diabetes would be beneficial to the potential health of millions of Asian American individuals."

The ADA did not redefine overweight or obesity criteria but simply recommended a lower BMI cut point for type 2 diabetes screening among Asian-Americans.

Dr. Hsu and team noted that there was no standard diabetes diagnosis method used in the studies the ADA reviewed. They also noted a shortage of robust studies for a full review. Other studies either lacked BMI data for patients when first diagnosed with diabetes or data for specific Asian ethnic groups, Dr. Hsu and colleagues noted.

The ADA report was published online Dec. 22 in Diabetes Care.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
December 22, 2014
Last Updated:
December 29, 2014