Turns out, you can’t outrun diabetes with a low BMI.
In a sweeping study of nearly 45,000 participants, researchers set out to determine what drives the progression from prediabetes to diabetes — and weight is only one facet.
They found that factors like age, sex, and fasting plasma glucose (FPG) levels, or the amount of sugar in your blood, all play a significant role as well.
“The study highlights that the prevalence of diabetes is increasing in the world and that we need to highlight the importance of prevention, regardless of medical history, because we see that the risk is increased across all types of patients, including lower BMI patients,” Dr. Danielle Brooks, an endocrinologist at North Shore University Hospital who was not involved with the study, told The Post.
In the study, published Thursday in the journal JAMA Network Open, the average age of participants was 43.7 years, with an average BMI of 28.9, which is considered overweight.
Their fasting plasma glucose levels ranged from normal (70-100 mg/dL) to impaired (100-125 mg/dL), placing the latter group in the prediabetes zone, where blood sugar is elevated but not yet in the diabetic range.
Over a median follow-up of 6.8 years, 8.6% of participants developed diabetes — and the researchers estimated that number would be 12.8% chance within 10 years.
A particularly eye-popping finding was that any FPG level outside of the narrow range of 80 to 94 mg/dL — even if still considered normal — was linked to a heightened risk of developing diabetes.
Abnormal BMI categories, including those considered underweight, were also associated with increased risk.
“The authors postulate that there was an increased risk for this section of individuals based on potentially having a malnourished state as an individual increased risk factor for insulin resistance and development of diabetes, which is not something that we typically think about,” Brooks added.
Researchers also found that men were more likely to develop diabetes than women, while older age was similarly linked to a higher risk.
Notably, the study revealed a significant additive relationship between key variables, especially between FPG levels and BMI.
For example, a woman aged 55 to 59 years with a BMI of 18.5 to 24.9 and an FPG level of 95-99 mg/dL had a 7% chance of developing diabetes within 10 years.
But if her BMI increased to 30-34.9, her risk almost doubled to 13%. If her FPG level also rose to 205-209 mg/dL, her risk shot up to 28%.
One limitation of the study was that more than 87% of participants were Caucasian, leaving questions about how race and ethnicity might interact with other factors to either increase or decrease the risk of developing diabetes.
“We do know that there are increased risks of diabetes development in patients with particular ethnicities,” said Brooks. “I think further research is definitely needed in that area to further individualize patient care and patient prevention for diabetes development.
What you can do now
As the US grapples with an obesity epidemic, the number of people with diabetes continues to rise. According to the CDC, nearly 98 million Americans have prediabetes, and over 38 million have type 2 diabetes.
Brooks says the study underscores the need for doctors to be hyper-aware of increased diabetes risk in every patient — not just those who are overweight or have a history of the disease.
“We need to be hyper aware of this trend in our health,” she said.
Researchers believe the findings could help guide both doctors and patients in implementing lifestyle and pharmacologic interventions for those at the highest risk, ultimately aiming to reduce future morbidity and mortality from the disease.
In 2022, 101,209 Americans died from diabetes, which was the eighth leading cause of death.
Currently, metformin is the primary option for delaying or preventing type 2 diabetes with medication. But new research shows that next-generation weight-loss drugs, like tirzepatide, could also reduce the risk of developing the disease in overweight or obese individuals.
If you’re not ready to reach for the medicine cabinet just yet, there are still plenty of everyday steps you can take to lower your diabetes risk.
“Leading a healthy lifestyle in terms of achieving the general recommended amount of exercise per week is one of the foundations of diabetes prevention,” said Brooks, who recommended aiming for 150 minutes of exercise per week.
Managing your food choices is just as crucial, especially at a time when 60% of the average U.S. diet consists of ultra-processed foods, like sugary cereals, frozen pizzas, and potato chips.
Brooks advises focusing on a low-carb, high-protein diet to maintain a healthy weight over time and help prevent diabetes.
