A clinician told you your BMI is normal and ordered no blood work. That answer depends on who you are. The American Diabetes Association Standards of Care 2026 say testing should be considered at a BMI of 25 or higher for most adults, or 23 or higher for individuals of Asian ancestry, when one or more additional risk factors are present [3]. If you are Asian and your BMI sits at 23 or above, and you have family history of diabetes, high blood pressure, abnormal cholesterol, or physical inactivity, the threshold for screening is different than it is for other groups. This page explains why, what the threshold actually triggers, and what it does not.

Why is the threshold lower for Asian adults?

The data show that diabetes risk rises at lower body weights in Asian populations than in white populations. In Ontario, Canada, Chiu and colleagues followed 59,824 adults without diabetes aged 30 and older and found a BMI of 24 in South Asian adults carried the same diabetes incidence rate as a BMI of 30 in white adults [2]. That is a 6-point difference. The same study found a hazard ratio of 3.40 for developing diabetes among South Asian adults compared with white adults [2]. The risk is not the same at the same weight.

In the United States, the MASALA and MESA studies measured type 2 diabetes prevalence among US South Asian adults aged 44 to 84 at 23%, against 6% in white adults, 18% in African American adults, 17% in Latino adults, and 13% in Chinese American adults [1]. That 23% figure describes a population, not a prediction for any one person. But it shows why screening thresholds exist: when one group carries substantially higher prevalence, the threshold to test moves down.

What does the WHO say about BMI 23?

In 2004, a WHO expert consultation identified potential public health action points at BMI values of 23.0, 27.5, 32.5 and 37.5 along the BMI continuum for Asian populations [4]. The same consultation stated that the proportion of Asian people at high risk of type 2 diabetes and cardiovascular disease is substantial at BMI values lower than the existing WHO cut-off point for overweight of 25 or higher [4]. The 23 threshold is not new. It has been in the international evidence for two decades.

What does the ADA threshold actually trigger?

The ADA Standards of Care 2026 state that testing should be considered in adults with a BMI of 23 or higher in individuals of Asian ancestry who have one or more additional risk factors [3]. The threshold is a trigger to test, not a diagnosis. Testing means blood work, usually an A1C or a fasting glucose, ordered by your clinician.

The additional risk factors the ADA lists are a first-degree relative with diabetes, high-risk race, ethnicity and ancestry including Asian American, a history of cardiovascular disease, hypertension, abnormal cholesterol or triglyceride levels, polycystic ovary syndrome, and physical inactivity [3]. You need the BMI threshold plus at least one of these. If you have a BMI of 23 and no other risk factors, the threshold does not apply to you automatically. Ask your clinician whether testing makes sense for your situation.

What do the test results mean?

An A1C below 5.7% is normal. An A1C of 5.7% to 6.4% is prediabetes. An A1C of 6.5% or higher is diabetes [3]. These are the ADA cut points. Prediabetes means your blood glucose is higher than normal but not high enough to be diagnosed as type 2 diabetes. Most people with prediabetes have no symptoms. About 115 million US adults have prediabetes, and most people who have it do not know.

If your result is prediabetes, you have a high chance of developing type 2 diabetes within 5 to 10 years. That is not a guarantee. It is a probability. What you do next is the part you control. The Diabetes Prevention Program found that losing 5% to 7% of body weight lowered the chance of developing type 2 diabetes. No medication is FDA-approved specifically for preventing type 2 diabetes [5]. The evidence supports lifestyle change, and your clinician can help you plan it.

Where does the BMI 23 threshold already appear in US policy?

Medicare already uses the BMI 23 threshold. To qualify for Medicare coverage of the diabetes prevention program, an individual must have a BMI above 25, or above 23 if they self-identify as Asian [5]. The threshold is not new to US policy. It is already embedded in how the government covers prevention.

How do you know if you meet the screening criteria?

Here is the full picture in one table:

Threshold source BMI number Population What it triggers
ADA Standards 2026 [3] 25 or higher Most adults Consider testing if one or more risk factors present
ADA Standards 2026 [3] 23 or higher Asian ancestry Consider testing if one or more risk factors present
WHO 2004 [4] 23.0 Asian populations Public health action point for risk assessment
WHO 2004 [4] 27.5 Asian populations Public health action point for risk assessment
Medicare coverage [5] 25 or higher Most adults Eligibility for diabetes prevention program
Medicare coverage [5] 23 or higher Self-identify as Asian Eligibility for diabetes prevention program

The threshold is a screening gate, not a diagnosis gate and not a treatment gate. It tells you when to get tested. The test result tells you what to do next.

What to do next

  1. Find out your current BMI. Your clinician can calculate it, or you can use the CDC BMI calculator online.
  2. If your BMI is 23 or higher and you are of Asian ancestry, write down which of these apply to you: family history of diabetes, high blood pressure, abnormal cholesterol or triglyceride levels, polycystic ovary syndrome, physical inactivity less than 3 times a week, or prior cardiovascular disease.
  3. Bring both pieces of information to your next visit and ask your clinician whether an A1C test or fasting glucose test makes sense for you.
  4. If you have had a test result in the past, ask whether it was an A1C or a fasting glucose, and what the number was. Write it down before your appointment.
  5. Ask about your family history: do you have a parent or sibling with type 2 diabetes or prediabetes? If yes, that counts as a risk factor.
  6. If your result is prediabetes, ask your clinician about the Diabetes Prevention Program or a similar lifestyle intervention. The evidence shows that weight loss of 5% to 7% of your body weight lowers your risk.
  7. Learn more about South Asian diabetes risk and family history and diabetes screening in the Sehat guides.

Sources

  1. Kanaya and colleagues, MASALA and MESA diabetes prevalence, type 2 diabetes prevalence in US South Asian adults, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/24705613/
  2. Chiu and colleagues, ethnic-specific BMI cutoff points, BMI equivalence and hazard ratio in South Asian adults in Ontario Canada, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/21680722/
  3. American Diabetes Association, Diagnosis and Classification of Diabetes, Standards of Care in Diabetes 2026, BMI screening thresholds and A1C cut points, accessed 2026-08-06, https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes
  4. WHO expert consultation, appropriate body-mass index for Asian populations, Lancet 2004, BMI action points for Asian populations, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/14726171/
  5. American Diabetes Association, Prevention or Delay of Diabetes, Standards of Care in Diabetes, Medicare coverage thresholds and prevention program eligibility, accessed 2026-08-06, https://pmc.ncbi.nlm.nih.gov/articles/PMC12690170/