Racial/ethnic disparities in diabetes remain a persistent public health concern. We aimed to examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by body mass index (BMI) category, in a large racial/ethnically and regionally diverse cohort of overweight and obese insured adults in the U.S. Data were from the Patient Outcomes Research to Advance Learning (PORTAL) network-Overweight and Obese Cohort, a consortium of 3 integrated health care systems. A total of 4,490,649 members (50% white, 22.7% Hispanic, 11.3% black, 10.6% Asian, 1.4% Native Hawaiian/Other Pacific Islander, 0.6% American Indian/Alaskan Native, and 4.3% other/unknown) aged ≥18 years during 2012 or 2013, with a BMI ≥23.0 kg/m2 were included. Ascertainment of diabetes and prediabetes were based on diagnosis codes, medication use, and laboratory results according to the ADA criteria. Age-adjusted prevalence was derived by BMI and racial/ethnic groups. Overall, the age-standardized prevalence of diabetes and prediabetes was 17.5% and 34.5%, respectively. A linear increasing trend was observed in prevalence of diabetes and prediabetes across BMI categories within racial/ethnic groups (all P-for-trend <0.001), except for prediabetes among Asian and Native Hawaiian/Other Pacific Islander, who tended to have a higher prevalence of diabetes and prediabetes compared to white across BMI categories, even more pronounced at a lower BMI. At BMI 23.0-24.9 kg/m2, the age-standardized prevalence of diabetes among Asians was 16.9%, comparable to that among white at BMI 30.0-34.9 kg/m2; the age-standardized prevalence of prediabetes was 37.3% among Asians at BMI 23.0-24.9 kg/m2, even higher than that among white at BMI ≥50.0 kg/m2.

In conclusion, disproportional impact of BMI on diabetes and prediabetes among minority groups highlight the importance of tailored screening, prevention, and intervention strategies to mitigate the risk of diabetes and prediabetes.


Y. Zhu: None. D. Arterburn: None. M.F. Daley: None. J.R. Desai: None. S.L. Fitzpatrick: None. M.A. Horberg: None. C. Koebnick: None. E.V. Mccormick: None. C. Oshiro: None. D.R. Young: None. A. Ferrara: None.

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