Optimum BMI cut points to screen asian americans for type 2 diabetes

Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabete...

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Published in:	Diabetes care Vol. 38; no. 5; p. 814
Main Authors:	Araneta, Maria Rosario G, Kanaya, Alka M, Hsu, William C, Chang, Healani K, Grandinetti, Andrew, Boyko, Edward J, Hayashi, Tomoshige, Kahn, Steven E, Leonetti, Donna L, McNeely, Marguerite J, Onishi, Yukiko, Sato, Kyoko K, Fujimoto, Wilfred Y
Format:	Journal Article
Language:	English
Published:	United States 01.05.2015
Subjects:	Aged Aged, 80 and over Asian Americans - ethnology Body Mass Index Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - ethnology Early Diagnosis Epidemiologic Methods Female Glucose Tolerance Test Glycated Hemoglobin A - metabolism Humans Male Middle Aged Residence Characteristics United States - epidemiology
ISSN:	1935-5548, 1935-5548
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Abstract	Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis. We consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c). Mean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes. The BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical.
AbstractList	Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis.OBJECTIVEAsian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis.We consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c).RESEARCH DESIGN AND METHODSWe consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c).Mean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes.RESULTSMean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes.The BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical.CONCLUSIONSThe BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical. Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis. We consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c). Mean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes. The BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical.
Author	Hsu, William C Onishi, Yukiko Leonetti, Donna L Kahn, Steven E Araneta, Maria Rosario G McNeely, Marguerite J Chang, Healani K Hayashi, Tomoshige Boyko, Edward J Fujimoto, Wilfred Y Kanaya, Alka M Grandinetti, Andrew Sato, Kyoko K
Author_xml	– sequence: 1 givenname: Maria Rosario G surname: Araneta fullname: Araneta, Maria Rosario G email: haraneta@ucsd.edu organization: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA haraneta@ucsd.edu – sequence: 2 givenname: Alka M surname: Kanaya fullname: Kanaya, Alka M organization: Department of Medicine, University of California, San Francisco, San Francisco, CA – sequence: 3 givenname: William C surname: Hsu fullname: Hsu, William C organization: Joslin Diabetes Center, Harvard Medical School, Boston, MA – sequence: 4 givenname: Healani K surname: Chang fullname: Chang, Healani K organization: University of Hawaii at Manoa, Honolulu, HI – sequence: 5 givenname: Andrew surname: Grandinetti fullname: Grandinetti, Andrew organization: University of Hawaii at Manoa, Honolulu, HI – sequence: 6 givenname: Edward J surname: Boyko fullname: Boyko, Edward J organization: Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington, Seattle, WA – sequence: 7 givenname: Tomoshige surname: Hayashi fullname: Hayashi, Tomoshige organization: Department of Preventive Medicine and Environmental Health, Osaka City University, Graduate School of Medicine, Osaka, Japan – sequence: 8 givenname: Steven E surname: Kahn fullname: Kahn, Steven E organization: Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington, Seattle, WA – sequence: 9 givenname: Donna L surname: Leonetti fullname: Leonetti, Donna L organization: Department of Anthropology, University of Washington, Seattle, WA – sequence: 10 givenname: Marguerite J surname: McNeely fullname: McNeely, Marguerite J organization: Department of Medicine, University of Washington, Seattle, WA – sequence: 11 givenname: Yukiko surname: Onishi fullname: Onishi, Yukiko organization: The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan – sequence: 12 givenname: Kyoko K surname: Sato fullname: Sato, Kyoko K organization: Department of Preventive Medicine and Environmental Health, Osaka City University, Graduate School of Medicine, Osaka, Japan – sequence: 13 givenname: Wilfred Y surname: Fujimoto fullname: Fujimoto, Wilfred Y organization: Department of Medicine, University of Washington, Seattle, WA
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Copyright	2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
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SubjectTerms	Aged Aged, 80 and over Asian Americans - ethnology Body Mass Index Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - ethnology Early Diagnosis Epidemiologic Methods Female Glucose Tolerance Test Glycated Hemoglobin A - metabolism Humans Male Middle Aged Residence Characteristics United States - epidemiology
Title	Optimum BMI cut points to screen asian americans for type 2 diabetes
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