Premium
Tale of two Indians: Heterogeneity in type 2 diabetes pathophysiology
Author(s) -
Staimez Lisa R.,
Deepa Mohan,
Ali Mohammed K.,
Mohan Viswanathan,
Hanson Robert L.,
Narayan K.M. Venkat
Publication year - 2019
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.3192
Subject(s) - insulin resistance , type 2 diabetes , medicine , diabetes mellitus , body mass index , glycemic , endocrinology , population , insulin , obesity , asian indian , demography , ethnic group , environmental health , sociology , anthropology
Aims Type 2 diabetes is a heterogeneous disease and may manifest from multiple disease pathways. We examined insulin secretion and insulin resistance across two ethnicities with particularly high risk for diabetes yet with widely different distributions of weight class. Materials and Methods In this population‐based, cross‐sectional study, Pima Indians from Southwestern United States (n = 865) and Asian Indians from Chennai, India (n = 2374) had a 75‐g oral glucose tolerance test. We analysed differences in plasma glucose, plasma insulin, insulin resistance (HOMA‐IR), and insulin secretion (ΔI 0‐30 /ΔG 0‐30 ) across categories of body mass index (BMI) and glycemic status per American Diabetes Association criteria. Results Pima Indians were younger (mean 27.4 ± SD 6.6, Asian: 33.9 ± 6.7 years) and had higher BMI (33.6 ± 8.1, Asian: 25.7 ± 4.9 kg/m 2 ). Among normal weight participants (mean BMI: Pima 22.4 SE 0.2; Asian 22.2 SE 0.06 kg/m 2 ), fasting glucose was higher in Asian Indians (5.2 vs Pima: 4.8 mmol/L, P = .003), adjusted for age and sex. Pima Indians were three times as insulin resistant as Asian Indians (HOMA‐IR: 7.7 SE 0.1, Asian: 2.5 SE 0.07), while Asian Indians had three times less insulin secretion (Pima: 2.8 SE 1.0 vs Asian: 0.9 SE 1.0 pmol/mmol), a pattern evident across age, BMI, and glycemic strata. Conclusions Metabolic differences between Pima and Asian Indians suggest heterogeneous pathways of type 2 diabetes in the early natural history of disease, with emphasis of insulin resistance in Pima Indians and emphasis of poor insulin secretion in Asian Indians.