Research shows that Asian, Hispanic, and Black Americans are at increased risk for diabetes at lower weights and younger ages than White Americans.
Adult-onset diabetes is one of the most common chronic conditions in adults in the United States. According to the Centers for Disease Control’s (CDC) 2021 statistics, 11.3% of the U.S. population has diabetes, and 38% are pre-diabetic1. CDC data statistics also show that minorities have a higher rate of diabetes in the U.S. population1. Prevention can be effective with many chronic diseases; however, early identification is key. Black American beneficiaries of Medicare’s fee for service were 1.98 times more likely to receive a lower limb amputation (LLA) within 1 year of a diabetic foot ulcer (DFU) diagnosis compared with non-Hispanic/White beneficiaries relative to no amputation2.
Based on the U.S. Preventive Services Task Forces’ 2021 guidelines, adults aged 35 to 70 should receive screening for diabetes when they have a body mass index (BMI) of 25 kg/m2 or greater3. However, a team of physician-scientists at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC) found that Asian, Hispanic, and Black Americans are at increased risk for diabetes at lower weights and younger ages than White Americans. Their study, published this year in the Annals of Internal Medicine, concluded that “using screen thresholds specific to race/ethnicity has the potential to reduce disparities in diabetes diagnosis.”4 Their study suggests that Black Americans and Hispanic Americans aged 35 and older should receive screening for diabetes when they have a BMI of 18.5 kg/m2 or greater. Asian Americans with a BMI of 20 kg/m2 or higher should receive a screening. Screening at lower BMIs for these minority groups would be comparable to screening White adults with a BMI of 25 kg/m2 or greater.
Identifying this disease earlier can inform early intervention measures necessary for prevention in minority populations. This may require educating patients to request a screening for diabetes at a lower BMI as well as healthcare providers facilitating screenings at a lower BMI in addition to advocating for screening protocol adjustments that are reflective of a patient’s racial background.
References
National Diabetes Statistics Report. (2022). Retrieved from https://www.cdc.gov/diabetes/data/statistics-report/index.html
Miller, T. A., Campbell, J. H., Bloom, N., & Wurdeman, S. R. (2022). Racial Disparities in Health Care With Timing to Amputation Following Diabetic Foot Ulcer. Diabetes Care, 45(10), 2336-2341. doi:https://doi.org/10.2337/dc21-2693
Prediabetes and Type 2 Diabetes: Screening. (2021). Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
Aggarwal, R., Bibbins-Domingo, K., Yeh, R. W., Song, Y., Chiu, N., Wadhera, R. K., . . . Kazi, D. S. (2022). Diabetes Screening by Race and Ethnicity in the United States: Equivalent Body Mass Index and Age Thresholds. Ann Intern Med, 175(6), 765-773. doi:https://doi.org/10.7326/m20-8079