A recent study in the December 2019 Issue of Diabetes Care Journal explains why patients who do not have obesity should be tested for diabetes and prediabetes. Overweight and obesity are well-established risk factors for diabetes; however, evidence suggests that the relationship between body weight and diabetes risk may differ by race/ethnicity, which has implications for the prevention, screening, and treatment of individuals who develop diabetes with a BMI below the overweight or obesity range.  In this study, racial/ethnic disparities in the prevalence of diabetes by BMI category in a large, racially/ethnically and geographically diverse cohort of 4.9 million adults were examined. Individuals enrolled in the cohort were from six racial/ethnic groups, including white, black, Hispanic, Asian, Hawaiian/Pacific Islander, and American Indian/Alaskan Native. Compared with whites, all other racial/ethnic groups had a higher prevalence of diabetes at any given BMI, and these differences were more pronounced in lower BMI categories. Strikingly, in those with a normal weight, the prevalence of diabetes was 5.0% in whites, 10.1% in Asians and American Indians/Alaskan Natives, 13.0% in Hispanics, 13.5% in Blacks, and 18.0% in Hawaiians/Pacific Islanders.

Obesity-driven insulin resistance may not be sufficient to explain the high prevalence of diabetes in nonobese people, and other factors, such as poor insulin secretion, may be at play in the early natural history. It is, therefore, important to acknowledge the elevated risk of diabetes at low BMI in many large populations. Diagnosing prediabetes earlier can save billions and improve the quality of life for your patients. Therefore, not only should screening practices be tailored to identify high-risk individuals in the absence of obesity better, but additional research focusing on more effective interventions in this population is warranted, as are mechanistic studies to identify pathophysiological pathways contributing to the natural history of diabetes incidence in normal-weight individuals.

Diabetes Care 2019 Dec; 42(12): 2164-2166. https://doi.org/10.2337/dci19-0046