Diabetes Among Non-Overweight Individuals: an Emerging Public Health Challenge

Curr Diab Rep. 2018 Jul 4;18(8):60. doi: 10.1007/s11892-018-1017-1.


Purpose of review: Overweight and obesity are well-established risk factors for type 2 diabetes. However, a substantial number of individuals develop the disease at underweight or normal weight. In this review, we discuss the epidemiology of type 2 diabetes in non-overweight adults; pose questions about etiology, pathophysiology, diagnosis, and prognosis; and examine implications for prevention and treatment.

Recent findings: In population-based studies, the prevalence of type 2 diabetes ranged from 1.4-10.9%. However, the prevalence of type 2 diabetes in individuals with BMI < 25 kg/m2 ranged from 1.4-8.8%. In countries from Asia and Africa, the proportion of individuals with diabetes who were underweight or normal weight ranged from 24 to 66%, which is considerably higher than the US proportion of 10%. Impairments in insulin secretion, in utero undernutrition, and epigenetic alterations to the genome may play a role in diabetes development in this subgroup. A substantial number of individuals with type 2 diabetes, particularly those with recent ancestry from Asia or Africa, are underweight or normal weight. Future research should consist of comprehensive studies of the prevalence of type 2 diabetes in non-overweight individuals; studies aimed at understanding gaps in the mechanisms, etiology, and pathophysiology of diabetes development in underweight or normal weight individuals; and trials assessing the effectiveness of interventions in this population.

Keywords: BMI; Normal weight; Type 2 diabetes; Underweight.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Body Mass Index
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / physiopathology
  • Humans
  • Overweight / complications*
  • Prevalence
  • Public Health*
  • Risk Factors