https://acpinternist.org/weekly/archives/2022/05/10/1.htm

Tailoring diabetes screening by race, ethnicity may lead to earlier diagnosis

Researchers used data from the National Health and Nutrition Examination Survey to determine the body mass index and age thresholds for diabetes screening in major racial/ethnic minority populations.


Screening Black, Hispanic, and Asian American patients for diabetes at lower body mass index (BMI) thresholds and earlier ages may improve health equity and reduce disparities in diabetes rates, according to a cross-sectional study.

Researchers used data from the National Health and Nutrition Examination Survey to determine the BMI and age thresholds for diabetes screening in major racial/ethnic minority populations.

The study included 19,335 nonpregnant U.S. adults ages 18 to 70 years, including 6,319 White Americans, 2,658 Asian Americans, 4,597 Black Americans, 4,998 Hispanic Americans, and 763 Americans from other racial/ethnic populations. The equivalent BMI threshold for each racial/ethnic minority group was defined as the BMI at which the prevalence of diabetes in 35-year-old people equaled that in 35-year-old White adults at a BMI of 25 kg/m2. The findings were published May 10 by Annals of Internal Medicine.

Significant differences in diabetes prevalence were found by racial/ethnic group among 35- to 70-year-old Americans with normal weight (BMI, 18.5 to 24.9 kg/m2). In this group, 3.5% of White Americans had diabetes, compared with 13.0% of Asian Americans (odds ratio [OR], 4.14; 95% CI, 2.49 to 6.88), 10.0% of Black Americans (OR, 3.07; 95% CI, 1.87 to 5.04), 12.2% of Mexican Americans (OR, 3.86; 95% CI, 2.10 to 7.08), and 7.0% of other Hispanic Americans (OR, 2.09; 95% CI, 1.20 to 3.65). Rates of undiagnosed diabetes were also higher in all racial/ethnic minority groups than in White patients: 12.5% compared with 27.6% in Asian Americans (OR, 2.61; 95% CI, 1.71 to 4.00), 22.8% in Black Americans (OR, 2.02; 95% CI, 1.42 to 2.88), 21.2% in Mexican Americans (OR, 1.81; 95% CI, 1.25 to 2.62), and 23.5% in other Hispanic Americans (OR, 2.19; 95% CI, 1.37 to 3.49).

The authors calculated that to identify the same proportion of patients with diabetes as White Americans, clinicians would need to screen 35- to 70-year-old Asian Americans starting at a BMI of 20 kg/m2 and Black and Hispanic Americans starting at a BMI of 18.5 kg/m2. Among those with a BMI of 25 kg/m2 or greater, it would be equitable to begin diabetes screening in individuals from racial/ethnic minorities starting at younger ages: Asian Americans at 23 years, Black Americans at 21 years, and Hispanic Americans at 25 years.

An accompanying editorial called on the U.S. Preventive Services Task Force (USPSTF) to update its recommendation on diabetes screening and preventive services to reflect the differential risk for diabetes among different racial/ethnic groups. “Screening is only the first step in the prevention and treatment continuum,” the editorial stated. “The USPSTF already recommends risk-based preventive services for other conditions, including cancer, cardiovascular disease, and infectious disease. To address the current inequity in diabetes screening, the USPSTF should apply the same consideration to its diabetes screening recommendation.”