title: Optimum BMI cut points to screen asian americans for type 2 diabetes.
abstract: OBJECTIVE
  Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis.
  
  
  METHODS
  We consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c).
  
  
  RESULTS
  Mean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes.
  
  
  CONCLUSIONS
  The BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical.
authors: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA haraneta@ucsd.edu.
authors: Maria Rosario G
authors: MR
authors: Araneta
authors: Department of Medicine, University of California, San Francisco, San Francisco, CA.
authors: Alka M
authors: AM
authors: Kanaya
authors: Joslin Diabetes Center, Harvard Medical School, Boston, MA.
authors: William C
authors: WC
authors: Hsu
authors: University of Hawaii at Manoa, Honolulu, HI.
authors: Healani K
authors: HK
authors: Chang
authors: University of Hawaii at Manoa, Honolulu, HI.
authors: Andrew
authors: A
authors: Grandinetti
authors: Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington, Seattle, WA.
authors: Edward J
authors: EJ
authors: Boyko
authors: Department of Preventive Medicine and Environmental Health, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Tomoshige
authors: T
authors: Hayashi
authors: Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington, Seattle, WA.
authors: Steven E
authors: SE
authors: Kahn
authors: Department of Anthropology, University of Washington, Seattle, WA.
authors: Donna L
authors: DL
authors: Leonetti
authors: Department of Medicine, University of Washington, Seattle, WA.
authors: Marguerite J
authors: MJ
authors: McNeely
authors: The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
authors: Yukiko
authors: Y
authors: Onishi
authors: Department of Preventive Medicine and Environmental Health, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Kyoko K
authors: KK
authors: Sato
authors: Department of Medicine, University of Washington, Seattle, WA.
authors: Wilfred Y
authors: WY
authors: Fujimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000208:ethnology*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin