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With Diabetes Screening, One Size Does Not Fit All

New study finds that even "skinny" Asian Americans, with a low Body Mass Index, should be screened for diabetes.

Asian Americans who are not overweight might still be at risk for diabetes, according to a new study published by the American Diabetes Association.

To date, pre-diabetes testing was recommended for anyone with a Body Mass Index (BMI) level of 25 or above. But now researchers are saying Asian Americans in particular should test for diabetes, even when BMI levels are as low as 23.

The new recommendations come after investigators tried to find the lowest BMI cutoff point for identifying previously undiagnosed Asian-American adults over age 45.

They looked at data from four university and study groups to get a broad cross section of the community, including 1,663 participants, and found that by limiting screening to BMIs of 25 or higher, 36 percent of Asian Americans with type 2 diabetes would be missed. More importantly, the study found that screening at BMI levels of 23.5 and above identified 80 percent of those with undiagnosed diabetes.

Japanese Americans, who have been found to be at greater risk than other Asian-American groups, reached 80 percent sensitivity at BMI levels greater than 22.8.

According to the study, one reason Asian-American BMI numbers are different from the general population’s threshold is partly because the index doesn’t measure where fat is distributed; belly fat, for example, is a known risk factor for diabetes. It suggests the need for even more ethnic specific studies on diabetes.

"We've never differentiated based on ethnicity because frankly, in the past, we haven't done a good job evaluating different ethnicities," said Dr. Jane Chiang, senior vice president of medical and community affairs at the ADA and one of the authors of the statement in a media report. "We used to think that one size fits all, but now we know that that's not true."