Asians should be screened at a lower BMI

jwongcsp said:

Hello Asian Brothers & Sisters:
Here is an article from a group at Harvard. They feel the need to screen Asian people at 23 BMI for diabetes. European folks are currently screened at 25 BMI for diabetes, here in the USA. I think we Asians are Thin On The Outside, Fat On The Inside. This leads to insulin resistance hence Type 2 Diabetes.

https://mg.mail.yahoo.com/d/folders/1/messages/ADOG1woAACi4WmeadgOGWNF1HlQ

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Actually, they need to stop thinking that fat = diabetic and thin = healthy metabolism.
I am not Asian. My BMI runs 19-20, as does my sister’s, and we were both recently diagnosed T2D. Her full and me pre because after her diagnosis, I read up, insisted on the tests, and paid out of pocket for them. Imagine my doctor’s surprise when the results came back as positive. She never would have looked. My father and one grandparent on each side were also diagnosed many years ago. Only one was over weight when diagnosed.
More and more research is showing that a growing percent of people diagnosed as diabetic are normal weight or TOFI when diagnosed. Yes, Asian countries have brought this issue to better light as they don’t tend to be over weight as a group, yet have increasing percentages of diagnosed T2D.
Why don’t we get diagnosed early? We don’t get diagnosed because they just don’t look beyond a fasting glucose and for most, not all, the fasting glucose is the last to go. I think diabetic screening should be done on everyone, no matter what they weigh. Maybe not every year, but throw in a HgbA1C every 5 or so years with labs. Yes, the lab costs increase, but if people were diagnosed earlier and educated appropriately, think of all the long term health benefits and financial savings from diverting the cost of complications. Fewer sick days, fewer disabilities, fewer cardiac events, .....
Yes, this has become one of my soap boxes.

From what I have read, diabetes rates are skyrocketing throughout Asia. The consumption of processed rice is huge, even just the minimal amount of processing dramatically elevates its glycemic score, but how can those countries affected afford to screen so many people, regardless of BMI status?

Tophat1900 said:

From what I have read, diabetes rates are skyrocketing throughout Asia. The consumption of processed rice is huge, even just the minimal amount of processing dramatically elevates its glycemic score, but how can those countries affected afford to screen so many people, regardless of BMI status?

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I’m not thinking of just Asia, when I talk about screening. I’m talking about any and everywhere that they do labs as part of a wellness check. BTW, when my doctor ordered repeat labs and added the 3 hr OGTT with insulin assay at my insistence, the lab cost was $1,308. The insurance company discount was $1188. This makes the actual cost about $120. A lot different than what they say the labs cost.


You go for a check up. Routine labs are a comprehensive metabolic panel, complete blood count with differential, lipid panel, urinalysis. These are very basic. They alert the physician to early signs of disease so early treatment can be started to hopefully prevent or reverse progression of the problem

Well, how often does the metabolic panel show up an imbalance when there have been no signs or symptoms of a problem? Not that often, but the consequence of missing early kidney or liver disease or electrolyte imbalances is high, so the testing is routine. How often does the blood count show up as anemic when the person isn’t tired or rundown feeling, or an infection when the person is not feeling sick, or leukemia when there have not been symptoms? Not too often, but the consequences when missing these are too high, so the testing is routine. How often does the urinalysis come back abnormal without signs of infection proceeding it? Actually often, because of poor cleaning before giving the sample. So it is repeated and usually fine. Otherwise it is more of a back up test for kidney problems or infections whose source is questionable. But, as before, high consequences if not identified and treated in a timely manner.


So why is it OK to ignore diabetes screening until the overt signs and symptoms of a metabolic imbalance are staring the doctor in the face? Kraft’s data with insulin levels showed that diabetic metabolism was in place 10 or more years before early diagnosis! By this time the elevated glucose and insulin levels have already started damaging our organs, blood vessels, and nerve pathways. To my thinking, it is morally and ethically irresponsible to not be screening for diabetes before it is symptomatic. Unfortunately, it is seen as fiscally irresponsible to spend the money. My point is that it is a short term expense with potential long term savings. Of course this assumes intelligent education and implementation of lifestyle/dietary changes appropriate to T2D.

Wow.....just reread this.........maybe I should buy a lottery ticket today.....from that tooth fairy I saw fluttering about.

Maybe you should buy a lottery ticket, won't hurt.

I think there are a lot of doctors who ignore the results sitting in front of them anyway. For example, my father had all those tests you mentioned done and his FBG was close to diabetic, but because it wasn't... just sitting below it, doctor told him you're fine and off you go. Nothing to worry about. To me this is a problem as much as not screening. Inability to recognise insulin resistance when it is right in front of them.

It would be great if everyone could be regularly screened.

The use of the term "labs" instead of "tests" suggests a Left Pondian

As far as I know, outside of private health care, there is no routine screening in the UK which involves comprehensive blood tests.

There is screening for breast cancer, cervical cancer, I've even seen mobile laboratories for glaucoma screening. I've also been screened for aortic aneurysm.

Wouldn't it be nice if there was a screening program to identify insulin resistance coupled with an EFFECTIVE strategy to reverse IR. As far as I know, NICE has neither.

In the UK we are screened for diabetes only by a FBG test and HbA1c. In England most surgeries now offer a general health check including diabetes for everyone over 40 that doesn't already have regular checks due to chronic health issues. (In other words the ones that might otherwise slip through the net) This health check was initially for the over 60's but has been extended. The BMI , ethnicity, and weight of the person is irrelevant. It is for everyone.

This recommendation has been in the NICE guidelines since 2013 (Public health guideline [PH46] Published date: July 2013):


https://www.nice.org.uk/guidance/ph...s#recommendation-1-preventing-type-2-diabetes

And in the US guidelines since 2014:


http://www.diabetes.org/newsroom/pr...t-points-for-diabetes-in-asian-americans.html

In my opinion bmi isn`t a credible or reliable indicator, weight could be accounted for by muscle just as easily as fat. I suspect if we went purely on bmi then a good proportion of the England rugby squad would be obese if not morbidly so.

Tophat1900 said:

From what I have read, diabetes rates are skyrocketing throughout Asia. The consumption of processed rice is huge, even just the minimal amount of processing dramatically elevates its glycemic score, but how can those countries affected afford to screen so many people, regardless of BMI status?

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A tax on sugar, all drinks that contain sugar and "western" fast food would go a long way towards paying for the screening, as well as reducing the need for the screening.

Bluetit1802 said:

The BMI , ethnicity, and weight of the person is irrelevant.

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The NHS health checks, if someone is borderline are more likely to result in them being retested every year instead of every 5 years if their BMI is higher.

In the UK there is a body called the National Screening Committee (NSC) which evaluates whether screening for a particular condition is recommended based on cost/benefit of screening versus not screening. Screening programmes are expensive so the NHS needs to be sure that spending is targeted in the most effective areas. Currently, the NSC do not recommend systematic screening for diabetes but they review the evidence every 3 years and the next review is due 2017/2018.
https://legacyscreening.phe.org.uk/diabetes

The NSC do recommend screening for diabetic retinopathy, however, which is why UK residents get regular retinal photography from their local Diabetic Eye Screening Programme.

This blog explains a bit more about why screening for a particular condition may not be recommended:-
https://phescreening.blog.gov.uk/2015/07/08/why-saying-no-to-screening-can-be-a-good-thing/

There is a list of all the conditions that the NSC has considered for screening and for which ones screening is recommended:-
https://legacyscreening.phe.org.uk/screening-recommendations.php

Biggles2 said:

This recommendation has been in the NICE guidelines since 2013 (Public health guideline [PH46] Published date: July 2013):

BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups​

https://www.nice.org.uk/guidance/ph...s#recommendation-1-preventing-type-2-diabetes

And in the US guidelines since 2014:

American Diabetes Association Releases Position Statement on New BMI Screening Cut Points for Diabetes in Asian Americans​

http://www.diabetes.org/newsroom/pr...t-points-for-diabetes-in-asian-americans.html

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My point is that BMI should not be used to determine if you are screened or not.
I am not of Asian descent, my BMI is lower than the Asian criteria for screening, I was only diagnosed when I had the labs run myself after my sister was diagnosed. She has a non-healing wound on her foot. Would she still have it if she had been screened and diagnosed years ago? If she had been guided as to how to eat appropriately for her diabetes? I will never know, but the fear that she may someday have to lose that foot to diabetes really makes me angry, wondering if the situation could have been prevented. It’s a position I don’t feel anyone should have to be in.

Kailee56 said:

I think diabetic screening should be done on everyone, no matter what they weigh. Maybe not every year, but throw in a HgbA1C every 5 or so years with labs. Yes, the lab costs increase, but if people were diagnosed earlier and educated appropriately, think of all the long term health benefits and financial savings from diverting the cost of complications. Fewer sick days, fewer disabilities, fewer cardiac events, ......

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Where I work at the VA hospital and outpatient clinics we screen everyone with an A1C periodically. I was kinda surprised. It's like a PSA and TSH.

LittleGreyCat said:

The use of the term "labs" instead of "tests" suggests a Left Pondian

As far as I know, outside of private health care, there is no routine screening in the UK which involves comprehensive blood tests.

There is screening for breast cancer, cervical cancer, I've even seen mobile laboratories for glaucoma screening. I've also been screened for aortic aneurysm.

Wouldn't it be nice if there was a screening program to identify insulin resistance coupled with an EFFECTIVE strategy to reverse IR. As far as I know, NICE has neither.

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Guilty as charged . I’m an ICU nurse in the USA.

Over here, I can’t recall ever seeing a physician for a general check up without them demanding labs first. I believe it is actually built into their standards of Care.

You mention the mobile screening. Over here, over 50% of the population ( don’t recall off hand where I saw the data) is diabetic or pre-diabetic. More and more of these are children and youths. To me, that is just the tip of the iceberg. I think the screening should be available for everyone at minimal cost.

Maybe when I win that mega lottery I can help fund such a program. The clash between ideal and reality.......so frustrating.

I expect that if the NHS had a good "low carb" training program to put people on who were at risk of Type2 then more screening would be of great benefit, otherwise, how much good would it do?

PS a A1C costs the NHS about £3 (lab door price), there is also the GP's costs of taking blood and transporting it to the lab. But adding a A1C when other tests are being done is close to free of charge.

Two important aspects are what is consumed and socio-economic circumstances, when these are changed so does the persons metabolic health markers. I read that it takes circa 300 years for changes in food to be adapted by mass populations. Diabetes rates are soaring even in the Asian populations that are Vegetarian, due increases in carbs, this is no different to say my ethnicity (Afro- Caribbean).

The below for example is completely normal in a Jamaican family for a serving of rice and peas (yes the entire plate if filled, and seconds would be a possibility)



In addition to this some yam and green banana starch would have been added in my household with the chicken. Very scary to consider the total carb content, along with the glass of orange, pineapple or mango juice. There is a double whammy as West Indians are doing this and the "worst" of the modern diets - I see this all the time, mac and cheese, pizza, biscuits, cakes, crisps the whole 9 yards.

I experienced a food ghetto recently in Ilford which really surprised me, I could not find on Ilford high street somewhere where I could easily low carb, even in the shopping mall everything was super processed, I walked for around 30 minutes and eventually found somewhere that had a grill where I could see my food prepared. I have read a lot about Blacks and Hispanics and poor Whites in the US living in areas where it is near impossible to find a supermarket, and where convenience stores don't have fruit and veg (astonishing), on top of this all of the fast food outlets are concentrated with cheap high carb offers.

jwongcsp said:

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Hi Kailee: I still think BMI can be used as one of many criteria to test for Diabetes or considered a goal to achieve. I know chri5 and many others feel body builders, rugby players and many professional athletes have more muscle mass than the normal person and they would be "obese" on the chart. That's just it. Body builders, Rugby players do not have "normal" body compositions. My guess is professional athletes make up less than 1% of the population. What about the other 99%? We don't get paid to work out and lift weights. Instead we sit more than we should. Here is a helpful hint. I told my GP here in California my mother is diabetic. Because, of the close genetic connection, I was able to get FBG & HbA1c test once every year without additional cost. Now that I am diagnosed pre-diabetic I get tested once every 6 months. I have 2 daughters around 30 years of age. They both get the HbA1c test once every year without additional cost. Both are below BMI of 23 but because of the close genetic connection they qualify for testing.

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Actually, I am part of the 3rd generation, which my physician knew, am now in my 60’s, and this was the first year she tested. Thank you, however, for the suggestion of asking my daughter if her physician is testing her regularly. I think I will also ask her to keep track of any trends since there really is no magic number.