Being overweight or obese is commonly associated with diabetes, but a new Kaiser Permanente study finds the connection differs widely by race or ethnicity. Members of racial and ethnic minority groups were much more likely to have diabetes or prediabetes at lower weights, even at normal or below-normal body mass index (BMI), according to research published in Diabetes Care.
Normal-weight Hawaiians and Pacific Islanders were three times more likely to have diabetes than normal-weight white people. Diabetes prevalence at normal BMI was 18% for Hawaiians/Pacific Islanders versus just 5% for whites; prevalence was also high for blacks (13.5%), Hispanics (12.9%), Asians (10.1%) and American Indians/Alaskan Natives (9.6%).
Disparities were also found in prediabetes, but were not as pronounced. Results also differed by gender. Asians, Hispanics, and Hawaiians/Pacific Islanders had a higher prevalence of prediabetes at lower BMIs than other groups, particularly among women.
For primary care clinicians, the findings could signal a change in how they screen racial and ethnic minority patients for diabetes and prediabetes, said senior author Assiamira Ferrara, MD, PhD, a senior research scientist with the Kaiser Permanente Division of Research in Oakland, California. "This study suggests that along with screening patients who are overweight and obese, minorities should probably be screened even if they have a normal BMI, particularly as they get older," Ferrara said.
The authors speculated that there could be physiological differences among people of varying races and ethnicities relating to diabetes, citing the example of Asians having a higher share of body fat and visceral fat at the same BMI as other groups, which could lead to insulin resistance, prediabetes, and diabetes.
Lead author Yeyi Zhu, PhD, also noted that the analysis identified a group of people at risk who don't get as much attention for diabetes risk: those who are underweight. The study found significant differences in diabetes prevalence among underweight men, ranging from 7.3% in whites to 16.8% in American Indians/Alaskan Natives.
Diabetes isn't on the radar for many average and underweight Americans, but minorities should be made aware of their increased risk of developing the disease, even at a healthy weight. Last year, Diabetics took action after receiving direct mail advertisements (56.9%), seeing TV commercials (53.8%), receiving email ads (43%) and either seeing ads on their mobile smartphone apps or receiving an ad via text (40.5%). They're also 12% more likely than other consumers to be willing to sacrifice some privacy to get ads that are relevant to them.
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