Racial and ethnic disparities in the burden of non-obese type 2 diabetes using different anthropometric measurements

Aims

Compare racial/ethnic disparities in the prevalence of non-obese type 2 diabetes (T2D) and the proportion of non-obese individuals among T2D patients.

Methods

This cross-sectional study used ICD-9/10 codes to ascertain T2D. Participants were classified as non-obese by BMI (<25 kg/m² for normal weight; <23 kg/m² for Asian Americans), waist circumference (<102 cm for males, <88 cm for females), and waist-to-hip ratio (<0.9 for males, <0.85 for females). The statistical analysis used marginal standardization of predicted probabilities from multivariable logistic regression to calculate the prevalence.

Key results

Among 276,736 participants (mean age 51.7, 61.2% female), non-obese T2D prevalence varied: 6.85% (BMI), 4.17% (waist circumference), 3.63% (waist-to-hip ratio). Asian participants had the highest prevalence of normal-weight T2D (2.70% vs. 1.92% in White, OR 1.44, 95% CI: 1.22–1.69) and non-obese T2D by waist circumference (8.04% vs. 3.36%, OR 2.61, 95% CI: 2.35–2.89). Black participants had the highest prevalence using waist-to-hip ratio (5.37% vs. 2.91%, OR 1.91, 95% CI: 1.80–2.03).

Conclusion

Asian Americans showed higher non-obese T2D prevalence by BMI and waist circumference, while Black adults had higher prevalence by waist-to-hip ratio, suggesting different fat distribution patterns.