Comparison of different aspects of BMI history to identify undiagnosed diabetes in Japanese men and women: Toranomon Hospital Health Management Center Study 12 (TOPICS 12)




To examine current BMI and various aspects of BMI history as pre-screening tools for undiagnosed diabetes in Japanese individuals.


This cross-sectional study included 16 226 men and 7026 women aged 30–75 years without a self-reported history of clinician-diagnosed diabetes. We estimated the probability of having undiagnosed diabetes (fasting glucose ≥ 7.0 mmol/l and/or HbA1c ≥ 48 mmol⁄mol (≥ 6.5%) for the following variables: current BMI, BMI in the early 20s (BMI20y), lifetime maximum BMI (BMImax), change between BMI in the early 20s and current BMI (ΔBMI20y−cur), change between BMI in the early 20s and maximum BMI (ΔBMI20y−max), and change between lifetime maximum and current BMI (ΔBMImax−cur).


The prevalence of undiagnosed diabetes was 3.3% (771/23252) among participants. BMImax, ΔBMI20y–max and current BMI (1-sd increments) were more strongly associated with diabetes than the other factors (multivariate odds ratio 1.58 [95% CI 1.47–1.70] in men and 1.65 [95% CI 1.43–1.90] in women for BMImax; multivariate odds ratio 1.47 [95% CI 1.37–1.58] in men and 1.61 [95% CI 1.41–1.84] in women for ΔBMI20y–max; multivariate odds ratio 1.47 [95% CI 1.36–1.58] in men and 1.63 [95% CI 1.40-1.89] in women for current BMI). The probability of having diabetes was markedly higher in those with both the highest tertile of BMImax and greatest ΔBMI20y-max; however, a substantially lower likelihood of diabetes was observed among individuals with the lowest and middle tertiles of current BMI (< 24.62 kg/m2 in men and < 22.54 kg/m2 in women).


Lifetime maximum BMI and BMI changes from early adulthood were strongly associated with undiagnosed diabetes. Adding BMI history to people's current BMI would improve the identification of individuals with a markedly higher probability of having undiagnosed diabetes.