155-OR: Are the American Diabetes Association Screening Guidelines Appropriate for the Racial/Ethnically Diverse U.S. Population? Evidence from the Multiethnic Study of Atherosclerosis

Objective: Current ADA screening guidelines recommend screening adults with a BMI ≥25 (or ≥23 for Asian Americans) who have at least one risk factor (e.g., belonging to a race/ethnic minority group, hypertension, dyslipidemia, physical inactivity) for diabetes. We determined if these guidelines are appropriate when applied to a multi-ethnic cohort of adults free of diabetes at baseline.

Research Design and Methods: We used data from the Multi-Ethnic Study of Atherosclerosis (exams 1-5 every 1.5 to 3 years between 2002-2013). Incident cases of diabetes were defined as fasting glucose ≥ 126 mg/dL and/or use of any diabetes medication. We used multivariable Weibull regression adjusting for age, sex, education, diet, exercise, hypertension, and dyslipidemia to estimate the differential association between BMI and incident diabetes by race/ethnicity.

Results: Among 4,541 MESA participants without prevalent diabetes, 1,860 were white, 539 Chinese American, 1,167 African American, and 975 Hispanic. In a median 9.1 years of follow-up, 557 new cases of diabetes occurred (166 in whites, 66 in Chinese Americans, 169 in African Americans, and 156 in Hispanics). Incidence rates were 11.4 (95% CI 9.8 to 13.2), 15.9 (12.5 to 20.3), 19.9 (17.1 to 23.1) and 22 (18.8 to 25.7) per 1,000 person-years among whites, Chinese Americans, African Americans and Hispanics, respectively. The race/ethnic-specific BMI for participants without any additional diabetes risk factors, compared to whites with a BMI of 25 and one or more diabetes risk factor was 29.2 in whites, 22.8 in Chinese Americans, 26.2 in African Americans and 25.4 in Hispanics.

Conclusions: Our findings show that the current American Diabetes Association diabetes screening guidelines are appropriate for the ethnically and racially diverse populations, and suggest that a higher BMI cut point, such as 29, may be appropriate for screening whites without other risk factors.