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


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.

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We thank Dr. Tran Quang Binh, Dr. Silver Bahendeka, Dr. David Guwatudde, and Dr. R.M Anjana and the team at the Madras Diabetes Research Foundation for contributing additional data for our review article.


Mary Beth Weber and K.M. Venkat Narayan were supported by the National Institute of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health under award number P30DK111024.

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Correspondence to Unjali P. Gujral.

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Unjali P. Gujral, Mary Beth Weber, Lisa R. Staimez, and K.M. Venkat Narayan declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Diabetes Epidemiology

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Gujral, U.P., Weber, M.B., Staimez, L.R. et al. Diabetes Among Non-Overweight Individuals: an Emerging Public Health Challenge. Curr Diab Rep 18, 60 (2018).

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  • Type 2 diabetes
  • Underweight
  • Normal weight
  • BMI