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Original Research
Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S.
Yeyi Zhu, Margo A. Sidell, David Arterburn, Matthew F. Daley, Jay Desai, Stephanie L. Fitzpatrick, Michael A. Horberg, Corinna Koebnick, Emily McCormick, Caryn Oshiro, Deborah R. Young, Assiamira Ferrara
Diabetes Care 2019 Sep; dc190532. https://doi.org/10.2337/dc19-0532
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Abstract

OBJECTIVE To examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI category.

RESEARCH DESIGN AND METHODS In a consortium of three U.S. integrated health care systems, 4,906,238 individuals aged ≥20 years during 2012–2013 were included. Diabetes and prediabetes were ascertained by diagnosis and laboratory results; antihyperglycemic medications were also included for diabetes ascertainment.

RESULTS The age-standardized diabetes and prediabetes prevalence estimates were 15.9% and 33.4%, respectively. Diabetes but not prediabetes prevalence increased across BMI categories among all racial/ethnic groups (P for trend < 0.001). Racial/ethnic minorities reached a given diabetes prevalence at lower BMIs than whites; Hawaiians/Pacific Islanders and Asians had a diabetes prevalence of 24.6% (95% CI 24.1–25.2%) in overweight and 26.5% (26.3–26.8%) in obese class 1, whereas whites had a prevalence of 23.7% (23.5–23.8%) in obese class 2. The age-standardized prediabetes prevalence estimates in overweight among Hispanics (35.6% [35.4–35.7%]), Asians (38.1% [38.0–38.3%]), and Hawaiians/Pacific Islanders (37.5% [36.9–38.2%]) were similar to those in obese class 4 among whites (35.3% [34.5–36.0%]), blacks (36.8% [35.5–38.2%]), and American Indians/Alaskan Natives (34.2% [29.6–38.8%]). In adjusted models, the strength of association between BMI and diabetes was highest among whites (relative risk comparing obese class 4 with normal weight 7.64 [95% CI 7.50–7.79]) and lowest among blacks (3.16 [3.05–3.27]). The association between BMI and prediabetes was less pronounced.

CONCLUSIONS Racial/ethnic minorities had a higher burden of diabetes and prediabetes at lower BMIs than whites, suggesting the role of factors other than obesity in racial/ethnic disparities in diabetes and prediabetes risk and highlighting the need of tailored screening and prevention strategies.

Footnotes

  • This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-0532/-/DC1.

  • Received March 15, 2019.
  • Accepted August 6, 2019.
  • © 2019 by the American Diabetes Association.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

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Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S.
Yeyi Zhu, Margo A. Sidell, David Arterburn, Matthew F. Daley, Jay Desai, Stephanie L. Fitzpatrick, Michael A. Horberg, Corinna Koebnick, Emily McCormick, Caryn Oshiro, Deborah R. Young, Assiamira Ferrara
Diabetes Care Sep 2019, dc190532; DOI: 10.2337/dc19-0532

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Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S.
Yeyi Zhu, Margo A. Sidell, David Arterburn, Matthew F. Daley, Jay Desai, Stephanie L. Fitzpatrick, Michael A. Horberg, Corinna Koebnick, Emily McCormick, Caryn Oshiro, Deborah R. Young, Assiamira Ferrara
Diabetes Care Sep 2019, dc190532; DOI: 10.2337/dc19-0532
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