The American Diabetes Association announced today that they are lowering the Body Mass Index (BMI) cut point for which they recommend screening Asian Americans for type 2 diabetes. These new guidelines derives from a position statement that will be published in the January issue of Diabetes Care, showing that many Asian Americans develop type 2 diabetes at lower BMI levels than the population at large.
"Clinicians have known this intuitively for quite some time," said William C. Hsu, M.D., Vice President of International Programs at Joslin Diabetes Center and Assistant Professor at Harvard Medical School and lead author of the paper. "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."
For members of the general population, the Association now recommends testing for diabetes when BMI reaches 25 kg/m2 or higher. Based upon an extensive review of the literature using studies conducted in North America, for Asian Americans, it is now recommending that screening be done at 23 kg/m2 or higher.
Using the previous Association standard for diabetes screening of being age 45 or older with a BMI of 25 kg/m2 or above, resulted in providers overlooking many people of Asian American descent who are at risk, according to Dr. Hsu.
The paper also concludes that the previous BMI guidelines for screening for diabetes were inappropriate for Asian Americans and it was necessary to reestablish a specific BMI cut point to better identify Asian Americans with or at risk for future diabetes. The new guidelines will be beneficial to the potential health of millions of Asian American individuals worldwide.
"Based on unique features of diabetes in the Asian American population, the American Diabetes Association is pleased to collaborate with key academic and community leaders, such as Joslin Diabetes Center, to define the standard of care for the Asian American community with diabetes," said Jane L. Chiang, M.D., Senior Vice President for Medical Affairs and Community Information, American Diabetes Association.
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 than Caucasian Americans despite having lower rates of obesity under current federal BMI standards, following a 2011 State of the Science Scientific Symposium on Diabetes in Hawaii.
"The ADA's announcement that they are changing the BMI cut point used to screen Asian Americans for diabetes represents a major shift in screening guidelines, which Joslin's Asian American Diabetes Initiative and many other Asian American health organizations have been advocating for years," commented George King, M.D., Chief Scientific Officer and Senior Vice President at Joslin, Professor of Medicine at Harvard Medical School and Advisory Council member of the AANHPI. "These new guidelines are important since they are critical for making timely diagnoses of type 2 diabetes in Asian American populations. However, it should be noted that additional research and support are needed to understand the differences of the causes and manifestations of diabetes in the Asian community."
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.
"What this does is to help us, as a society, identify those who are at risk for type 2 diabetes who might otherwise not have been identified because of their lack of appearance of obesity," said Dr. Hsu, adding that the growing prevalence of diabetes and its economic impact in the United States heighten the need for early detection and prevention.