Methods and Prevalence of Non-Insulin-Dependent Diabetes Mellitus in a Biethnic Colorado Population

Hamman, Richard F.; Marshall, Julie A.; Baxter, Judith; Kahn, Louise B.; Mayer, Elizabeth J.; Orleans, Miriam; Murphy, James R.; Lezott, Dennis C.

doi:10.1093/oxfordjournals.aje.a115134

Cited by 213 publications

(127 citation statements)

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“…Clinical centres in Oakland and Los Angeles, California, studied non-Hispanic whites and African Americans recruited from Kaiser Permanente, a nonprofit health maintenance organization. Clinical centres in San Antonio, Texas, and San Luis Valley, Colorado, studied non-Hispanic whites and Hispanics recruited from two ongoing population-based studies (the San Antonio Heart Study [20] and the San Luis Valley Diabetes Study [21]). Recruitment was tailored to yield approximately equal numbers of participants by ethnicity, sex, and glucose tolerance categories [Type II diabetes, impaired glucose tolerance (IGT) and normal glucose tolerance].…”

Section: Methodsmentioning

confidence: 99%

The relation of proinsulin and insulin to insulin sensitivity and acute insulin response in subjects with newly diagnosed Type II diabetes: the Insulin Resistance Atherosclerosis Study

et al. 1999

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Simultaneously with insulin and C peptide, beta cells also secrete a small amount of proinsulin and its conversion intermediates [1]. Insulin and proinsulin cross-react in conventional insulin radioimmunoassays. Plasma proinsulin concentrations are considerably increased in patients with Type II (non-insulindependent) diabetes mellitus and constitute a substantial proportion of the total insulin-containing molecules [2±7]. Also subjects with impaired glucose tolerance (IGT) have higher proinsulin concentrations than normoglycaemic subjects [4±6, 8, 9]. Furthermore, high fasting proinsulin concentrations or proinsulin:insulin ratios have been shown to be associated with the development of Type II diabetes within 2±5 years [10±12].The reasons for hyperproinsulinaemia are largely unknown. In subjects with IGT and overt Type II dia- Diabetologia (1999) Abstract Aims/hypothesis. Proinsulin concentrations are increased relative to insulin concentrations in subjects with Type II (non-insulin-dependent) diabetes mellitus. This could be secondary to hyperglycaemia or insulin resistance or due to a defect in insulin secretion. Methods. We investigated the association between fasting insulin, intact proinsulin and the intact proinsulin: insulin ratio with insulin sensitivity, estimated by a frequently sampled intravenous glucose tolerance test and the minimal model and with acute insulin response (AIR) in 182 newly diagnosed Type II diabetic subjects aged 40 to 69 years. None of the subjects was receiving hypoglycaemic medication. Results. Insulin sensitivity correlated inversely with fasting insulin (r s = ±0.42) and intact proinsulin (r s = ±0.32) (p < 0.001). The intact proinsulin:insulin ratio was not correlated with insulin sensitivity. AIR correlated positively with intact proinsulin (r s = 0.23) and inversely with the intact proinsulin:insulin ratio (r s = ±0.29, p < 0.001). Fasting glucose correlated positively with intact proinsulin (r s = 0.34) and the intact proinsulin:insulin ratio (r s = 0.24, p < 0.001). The intact proinsulin:insulin ratio increased by decreasing AIR (quartiles of AIR from high to low: 7.8, 8.2, 9.7 and 12.1 %, p < 0.001). This association was independent of age, sex, ethnicity, body mass index, fasting glucose, and insulin sensitivity. Conclusion/interpretation. Insulin resistance (low insulin sensitivity) was not related to the intact proinsulin:insulin ratio in subjects with Type II diabetes. In contrast, both low AIR and high fasting glucose concentrations were associated with a disproportionate increase in proinsulin concentration. These results suggest that increased intact proinsulin:insulin ratio is a marker of a defect in insulin secretion in Type II diabetic subjects. [Diabetologia (1999[Diabetologia ( ) 42: 1060± 1066

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Section: Methodsmentioning

confidence: 99%

The relation of proinsulin and insulin to insulin sensitivity and acute insulin response in subjects with newly diagnosed Type II diabetes: the Insulin Resistance Atherosclerosis Study

et al. 1999

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“…18–22 Because Latino immigrants constitute the largest proportion of immigrants to the United States by far, there has been interest in understanding whether acculturation to US lifestyles contributes to their heightened diabetes risk. The evidence on whether the risk of type 2 diabetes in Latino immigrant populations increases with greater time in the United States or acculturation, however, is mixed.…”

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Immigrant Generation and Diabetes Risk Among Mexican Americans: The Sacramento Area Latino Study on Aging

et al. 2014

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Objectives We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population. Methods We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. Results Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. Conclusions Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

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Metabolic factors have been shown to be important risk factors for the development of NIDDM.

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confidence: 99%

“…The Mexican American population is characterized by increased adiposity [1][2][3][4]6], a more centralized distribution of body fat [6,7], hyperinsulinaemia [8][9][10] and insulin resistance [11,12].Metabolic factors have been shown to be important risk factors for the development of NIDDM. Both insulin resistance [13,14] and hyperinsulinaemia [13,[15][16][17][18][19] have been shown to predict NIDDM.…”

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Are risk factors for conversion to NIDDM similar in high and low risk populations?

1997

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Numerous studies have shown that Mexican Americans have an increased prevalence [1][2][3][4] and incidence [5] of non-insulin-dependent diabetes mellitus (NIDDM) relative to non-Hispanic whites. The Mexican American population is characterized by increased adiposity [1][2][3][4]6], a more centralized distribution of body fat [6,7], hyperinsulinaemia [8][9][10] and insulin resistance [11,12].Metabolic factors have been shown to be important risk factors for the development of NIDDM. Both insulin resistance [13,14] and hyperinsulinaemia [13,[15][16][17][18][19] have been shown to predict NIDDM. Likewise, decreased insulin secretion in response to various stimuli may predict NIDDM. A low acute insulin response has been found to predict NIDDM in Pima Indians [13], but not in children of two Caucasian diabetic parents [14]. A low 30-min increment in insulin relative to the 30-min increment in glucose (DI 30 /DG 30 ) during an oral glucose tolerance test predicts conversion to NIDDM, especially in subjects with impaired glucose tolerance [20][21][22][23]. A low insulin response 60 min after an intravenous glucose challenge also predicted NIDDM [24,25]. A low 2-h insulin in response to an oral glucose load also Diabetologia (1997) 40: 62-66 Are risk factors for conversion to NIDDM similar in high and low risk populations? Summary Mexican Americans have an increased risk of non-insulin-dependent diabetes mellitus (NIDDM) relative to non-Hispanic whites which is only partially explained by their excess overall obesity and unfavourable body fat distribution. Non-diabetic Mexican Americans have hyperinsulinaemia and insulin resistance relative to non-Hispanic whites. We therefore hypothesized that the insulin resistance might be a more important predictor of NIDDM in high-risk populations characterized by obesity and insulin resistance, while compromised insulin secretion might be a more important risk factor for NIDDM in low-risk populations. We assessed the ability of ethnicity (Mexican American vs non-Hispanic white), age, overall adiposity (body mass index [BMI]), unfavourable body fat distribution (as assessed by waist-to-hip ratio [WHR]), glucose tolerance (impaired glucose tolerance vs normal glucose tolerance), fasting insulin and compromised insulin secretion (as assessed by increment in insulin to the increment in glucose over the first 30 min of an oral glucose tolerance test (DI 30 /DG 30 )) to predict future NIDDM. In the 8-year follow-up of the San Antonio Heart Study, NIDDM developed in 11.7 % (107/914) of Mexican Americans and in 5.0 % (18/362) of nonHispanic whites (p < 0.001). Multivariate predictors of NIDDM by multiple logistic regression analysis included increased age, BMI, WHR, fasting insulin and impaired glucose tolerance and decreased insulin secretion. The strongest independent predictors of NIDDM were high fasting insulin and decreased insulin secretion. These risk factors predicted NIDDM equally well in high and low-risk populations. [Diabetologia (1997) 40: 62-66]

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Methods and Prevalence of Non-Insulin-Dependent Diabetes Mellitus in a Biethnic Colorado Population

Cited by 213 publications

References 0 publications

The relation of proinsulin and insulin to insulin sensitivity and acute insulin response in subjects with newly diagnosed Type II diabetes: the Insulin Resistance Atherosclerosis Study

The relation of proinsulin and insulin to insulin sensitivity and acute insulin response in subjects with newly diagnosed Type II diabetes: the Insulin Resistance Atherosclerosis Study

Immigrant Generation and Diabetes Risk Among Mexican Americans: The Sacramento Area Latino Study on Aging

Are risk factors for conversion to NIDDM similar in high and low risk populations?

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