The American Diabetes Association (ADA) has decided to lower the Body Mass Index (BMI) cut point at which it recommends screening Asian Americans for type 2 diabetes. This change in ADA guidelines is aligned with evidence that many Asian Americans develop the disease at lower BMI levels than the population at large, according to a position statement being published in the January issue of Diabetes Care.
For members of the general population, the Association recommends testing for diabetes when BMI reaches 25 kg/m2 or higher. Based upon an exhaustive review of the literature, for Asian Americans, it is now recommending that screening be done at 23 kg/m2 or higher. It is believed that Asian Americans – the nation’s fastest growing ethnic group – develop diabetes at lower BMI levels because of differences in their body composition: weight gain tends to accumulate around the waist in Asian Americans, the area in which adiposity is considered most harmful from a disease standpoint, rather than in the thighs and other parts of the body.
The Asian Americans Native Hawaiian and Pacific Islander (AANHPI) Diabetes Coalition began drawing attention to the need for changes in clinical management guidelines for Asian Americans, who experience twice the prevalence of type 2 diabetes as Caucasian Americans despite having lower rates of obesity under current federal BMI standards.
“‘A thin Asian person may be at risk for developing diabetes. Research has shown that BMI may not be the best marker in this population. This paper is a significant step in the right direction of widely recognizing the diabetes disparity that exists in our populations and communities,” said Ho Luong Tran, M.D., President of the National Council of Asian Pacific Islander Physicians, and lead coordinator of the AANHPI 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.”
The Association’s position statement does not redefine overweight or obesity for Asian Americans, only the BMI cut point for screening for type 2 diabetes.