Diabetes in Normal-Weight Individuals: High Susceptibility in Nonwhite Populations.

Abstract

Type 2 diabetes is one of the most prevalent diseases of our time. There are an estimated 425 million people with diabetes worldwide, and 625 million people are projected to have the disease by 2045 (1). Over the next three decades, the largest increases in diabetes prevalence and overall numbers of people with the disease are expected to occur in low- and middle-income countries and among nonwhite ethnic minorities living in high-income nations (1). Overweight and obesity are well-established risk factors for diabetes; however, evidence suggests that the relationship between body weight and diabetes risk may differ by race/ethnicity (2–4), which has implications for the prevention, screening, and treatment of individuals who develop diabetes with a BMI below the overweight or obesity range. In their article in this issue of Diabetes Care , Zhu et al. (5) examined racial/ethnic disparities in the prevalence of diabetes by BMI category in a large, racially/ethnically and geographically diverse cohort of 4.9 million adults. Individuals enrolled in the cohort were members of three integrated health care systems in the U.S. in the years 2012–2013 and were from six racial/ethnic groups including white, black, Hispanic, Asian, Hawaiian/Pacific Islander, and American Indian/Alaskan Native. They found that the age-standardized prevalence of diabetes increased across BMI categories among all racial/ethnic groups. However, compared with whites, all other racial/ethnic groups had a higher prevalence of diabetes at any given BMI, and these differences were more pronounced in lower BMI categories. Strikingly, in those with a normal weight, the prevalence of diabetes was 5.0% in whites, 10.1% in Asians and American Indians/Alaskan Natives, 13.0% in …