Grip strength is something many people don’t think about. Does it really matter whether or not you have a firm handshake? While that may be up for debate, researchers have found a link between how strong your grip is and your chances of developing diabetes.

In a study conducted at the University of Florida, researchers found that the strength of your grip could provide clues to undetected diabetes or high blood pressure, especially if you’re “skinny fat.” That means you’re within the normal range on the body mass index (BMI) but your fat-to-lean muscle ratio leans more toward the fat part. In other words, about 25 percent body fat in men and 35 percent body fat in women.

The folks that fit inside these categories would be less likely to get screened for high blood pressure or diabetes, since they tend to not consider themselves overweight or obese. “We’ve had a significant amount of interest and focus on obesity, and rightfully so,” said Arch G. Mainous, chair of the Department of Health Services Research, Management and Policy at the University of Florida College of Public Health and Health Professions, in a statement. “But there is a concern that health problems in people who have decreased muscle mass, but don’t fit the criteria of being overweight, are being missed because these people aren’t targeted by screening programs.”

People who are “skinny fat” are four times more likely to develop problems, like increased blood pressure, high blood sugar, and abnormal cholesterol levels, than people who have lower body fat. As many as 30 million Americans are “skinny fat” and many don’t even know it.

For the study, researchers analyzed the grip strength measurements, blood pressure readings, and blood sugar levels of nearly 1,500 adults age 20 and older, who had a BMI within 18.5 to 24.9 — the healthy range. The people with undiagnosed high blood pressure or diabetes had a weaker grip strength than those who didn’t.

“In our study, grip strength was able to identify people with undiagnosed hypertension and diabetes relatively easily, even after we adjusted the analyses for age, sex, and whether or not they had a family history of disease,” Mainous said.

Grip strength is certainly a valuable, non-invasive and low-cost tool that can help identify people who may have diabetes or hypertension. However, researchers believe that more studies need to be done before it can be implemented as a screening tool. Age, gender, and height are all variables that need to be assessed when it comes to grip strength.

Source: Mainous A, Tanner R, Anton S, Jo A. Grip Strength as a Marker of Hypertension and Diabetes in Healthy Weight Adults. American journal of Preventive Medicine. 2015.