Diabetes Screening by Race and Ethnicity in the United States: Equivalent Body Mass Index and Age Thresholds

Abstract

Background: Racial/ethnic minority populations in the United States have increased rates of diabetes compared with White populations. The 2021 guidelines from the U.S. Preventive Services Task Force recommend diabetes screening for adults aged 35 to 70 years with a body mass index (BMI) of 25 kg/m² or greater.

Objective: To determine the BMI threshold for diabetes screening in major racial/ethnic minority populations with benefits and harms equivalent to those of the current diabetes screening threshold in White adults.

Design: Cross-sectional study.

Setting: NHANES (National Health and Nutrition Examination Survey), 2011 to 2018.

Participants: Nonpregnant U.S. adults aged 18 to 70 years (n = 19 335).

Measurements: A logistic regression model was used to estimate diabetes prevalence at various BMIs for White, Asian, Black, and Hispanic Americans. For each racial/ethnic minority group, the equivalent BMI threshold was defined as the BMI at which the prevalence of diabetes in 35-year-old persons in that group is equal to that in 35-year-old White adults at a BMI of 25 kg/m². Ranges were estimated to account for the uncertainty in prevalence estimates for White and racial/ethnic minority populations.

Results: Among adults aged 35 years with a BMI of 25 kg/m², the prevalence of diabetes in Asian Americans (3.8% [95% CI, 2.8% to 5.1%]), Black Americans (3.5% [CI, 2.7% to 4.7%]), and Hispanic Americans (3.0% [CI, 2.1% to 4.2%]) was significantly higher than that in White Americans (1.4% [CI, 1.0% to 2.0%]). Compared with a BMI threshold of 25 kg/m² in White Americans, the equivalent BMI thresholds for diabetes prevalence were 20 kg/m² (range, <18.5 to 23 kg/m²) for Asian Americans, less than 18.5 kg/m² (range, <18.5 to 23 kg/m²) for Black Americans, and 18.5 kg/m² (range, <18.5 to 24 kg/m²) for Hispanic Americans.

Limitation: Sample size limitations precluded assessment of heterogeneity within racial/ethnic groups.

Conclusion: Among U.S. adults aged 35 years or older, offering diabetes screening to Black Americans and Hispanic Americans with a BMI of 18.5 kg/m² or greater and Asian Americans with a BMI of 20 kg/m² or greater would be equivalent to screening White adults with a BMI of 25 kg/m² or greater. Using screening thresholds specific to race/ethnicity has the potential to reduce disparities in diabetes diagnosis.

Primary funding source: Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.