More than 40% of diabetes (DM) is undetected in Asian Americans. The ADA recommends glucose testing for Asian Americans at BMI≥23 kg/m2 and BMI≥25 for all others. However, if clinicians screen using BMI cutpoints, they may miss a substantial number of cases. We used the National Health Examination and Nutrition Surveys (NHANES) 2011-2016 and examined young adults (aged 20-44) without self-reported DM. We estimated for each race/ethnic group: a) the total prevalence of undetected prediabetes and DM using all three glucose tests (fasting plasma glucose [FPG] ≥100 mg/dl, 2-hour glucose ≥140 mg/dl, HbA1c ≥5.7%), b) the prevalence of undetected prediabetes and DM when only persons meeting ADA screening criteria (BMI criterion plus one additional risk factor for whites) are tested using FPG and HbA1c, c) the prevalence from (b) but removing BMI from ADA criteria. The total prevalence of undetected prediabetes and DM ranged from 35% in whites to 47% in Hispanics. Using ADA criteria and only FPG and HbA1c, prevalence was 17% in whites, 25% in Asians, 35% in blacks, and 36% in Hispanics. Dropping the BMI criterion, prevalence was 20% in whites, 35% in Asians, 42% in blacks, and 43% in Hispanics. Removing the BMI criterion for screening improved detection of prediabetes and DM to a greater extent in Asians vs. others; the more stringent criteria and use of FPG and HbA1c were associated with lower detection in whites.
A.K. Lee: None. U. Gujral: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. N.R. Kandula: None. A.M. Kanaya: None.
National Institutes of Health (T32AG000212)