ADA releases position statement on new BMI screening cut points for diabetes in Asian Americans

The American Diabetes Association (ADA) is lowering the Body Mass Index (BMI) cut point at which it recommends screening Asian Americans for type 2 diabetes, aligning its guidelines with evidence that many Asian Americans develop the disease at lower BMI levels than the population at large. The new recommendation appears in a position statement recently published in Diabetes Care.

“The position statement highlights, for the first time, the physiologic differences seen between Asian Americans and other populations affected by diabetes,” says Jane Chiang, the Association’s Senior Vice President for Medical Affairs and Community Information. “Asian Americans are a heterogeneous group and have historically been underrepresented in studies, so it is important to keep in mind that this is just the beginning. Clearly, we need more research to better understand why these distinctions exist.”

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, it is now recommending that for Asian Americans screening be done at 23 kg/m2 or higher. It is believed that Asian Americans develop diabetes at lower BMI levels because of differences in their body composition: weight gain tends to accumulate around the waist in Asian Americans, rather than in other parts of the body. The waist is the area in which adiposity is considered most harmful from a disease standpoint.

“Clinicians have known this intuitively for quite some time,” says William C. Hsu, MD, Vice President, International Programs, Joslin Diabetes Center and Assistant Professor, Harvard Medical School, who was lead author of the position 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. 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.”