FROM DIABETES CARE
The American Diabetes Association has issued a new recommendation stating that all Asian American adults who present with a body mass index of at least 23 kg/m2 should be tested for type 2 diabetes.
In its latest position statement, the ADA cites increasing evidence that body mass index (BMI) is more indicative than just body weight for determining a patient’s likelihood of developing type 2 diabetes, along with data on the higher predisposition for diabetes among Asian Americans, as the main reasons for lowering the cut point from 25 kg/m2, which is the established BMI at which all adults should be tested for diabetes (Diabetes Care 2015;38:1-9 [ doi:10.2337/dc14-2391 ]).
“Given that established BMI cut points indicating elevated diabetes risk are inappropriate for Asian Americans, establishing a specific 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 said in the statement.
According to the ADA, Asian Americans – who currently make up the fastest-growing ethnic group in the United States – are prone to developing diabetes at a lower BMI because, instead of gathering in the thighs, their weight gains tend to accumulate around the waist, an area that is known for being the most harmful from the standpoint of adiposity and disease. The ADA also highlights lifestyle and dietary habits inherent to Asian cultures as reasons for why Asian Americans are more predisposed to the disease.
“Clinicians have known this intuitively for quite some time,” said Dr. William C. Hsu, lead author of the position statement. “They can see that Asian Americans are being diagnosed with diabetes when they do not appear to be overweight or obese according to general standards. But if you use the previous association 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,” said Dr. Hsu of Harvard Medical School in Boston, who is vice president of international programs at Joslin Diabetes Center.
According to the ADA, most studies tend to group Asian Americans along with Native Hawaiian and Pacific Islander demographics, although the groups differ significantly in terms of physiology and body composition. By focusing more on Asian American populations specifically, the ADA aims to have more reliable data that can lead to earlier and more accurate diagnosis of type 2 diabetes within the demographic.
“This paper is a significant step in the right direction of widely recognizing the diabetes disparity that exists in our populations and communities,” said Dr. Ho Luong Tran, president of the National Council of Asian Pacific Islander Physicians and lead coordinator of the Asian American Native Hawaiian and Pacific Islanders Diabetes Coalition . “The next steps are to increase the amount of clinical research and data on this diverse population, while simultaneously pushing for policy change that will positively impact health outcomes.”
