Sex differences in insulin sensitivity and insulin response with increasing age in black South African men and women

Goedecke, Julia H.; George, Cindy; Veras, Katherine; Peer, Nasheeta; Lombard, Carl; Victor, Hendriena; Steyn, Krisela; Levitt, Naomi

doi:10.1016/j.diabres.2016.11.005

Cited by 26 publications

(40 citation statements)

References 29 publications

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“…People of African and South Asian ancestry consistently display a greater risk for diabetes when compared with Europeans [ 1 ]. Many studies have shown greater insulin resistance in black Africans [ 15 ] and Indians [ 3 , 16 ], and higher insulin release to maintain normoglycaemia in black Africans compared with whites [ 15 ], which likely contributes to their greater susceptibility to diabetes.…”

Section: Discussionmentioning

confidence: 99%

Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa

et al. 2018

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AimsTo describe the distribution and examine the associations of diabetes, hypertension and hypercholesterolaemia across and within population groups, gender and body mass index (BMI) categories.MethodsThis national cross-sectional study was conducted in 2013 among ≥18-year-old black African, coloured, white and Indian adults self-selected for screening. Data collection included self-reported behavioural risk factors and clinical measurements comprising blood pressure, anthropometry and point-of-care random blood glucose and cholesterol assessments.ResultsAmong the 7711 participants, 2488 men and 5223 women, the prevalence of diabetes and hypertension increased by BMI category across population groups. Compared with white men and women, black African men (odds ratio: 2.66, 95% confidence interval: 1.70–4.16) and women (2.10, 1.49–2.96), coloured men (2.28, 1.44–3.60) and women (2.15, 1.52–3.05) and Indian men (4.38, 2.65–7.26) and women (3.64, 2.50–5.32) were significantly more likely to have diabetes. The odds for hypertension were significantly higher only in coloured men compared with white men (1.37, 1.02–1.83), while it was significantly higher in black African, coloured and Indian women compared with white women. The odds for hypercholesterolaemia were significantly lower in black African men (0.64, 0.49–0.84) and women (0.52, 0.43–0.62) compared with white men and women, and significantly higher in Indian men (1.47, 1.05–2.08) compared with white men. Black African women compared with their male counterparts were less likely to have diabetes (0.64, 0.46–0.89). Black African (0.66, 0.54-.082), coloured (0.65, 0.50–0.84) and white (0.69, 0.53–0.88) women were significantly less likely to have hypertension compared with their male counterparts. The odds for hypercholesterolaemia were higher in coloured (1.44, 1.16–1.80) and white (1.47, 1.18–1.84) women compared with their counterparts.ConclusionsThe cardio-metabolic diseases of diabetes, hypertension and hypercholesterolaemia were differentially associated with population groups and gender in South Africa. The insights obtained highlight the need for multi-disciplinary targeted management approaches in high-risk populations.

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Section: Discussionmentioning

confidence: 99%

Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa

et al. 2018

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“…In fact, the susceptibility to develop insulin resistance and the insulin response to stimuli that physiologically improve or compromise insulin sensitivity are different in the two sexes [ 52 ]. Women show a tendency to have lower insulin sensitivity than their male counterpart but increase their insulin response to maintain normoglycemia ( Table 1 ) [ 53 , 54 ]. It can suggest that these differences in insulin action may explain that in prediabetic state women are more prone to develop impaired glucose tolerance whereas their male counterparts are more susceptible to develop impaired fasting glycemia [ 55 , 56 ].…”

Section: Sex Hormones In Endocrine Gender-related Differencesmentioning

confidence: 99%

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Lauretta

Sansone

et al. 2018

International Journal of Endocrinology

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Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, “gender” refers to a sociocultural sphere of the individual, whereas “sex” only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how they can affect the human pathophysiology. The path to a tailored medicine in which every patient is able to receive early diagnosis, risk assessments, and optimal treatments cannot exclude the importance of gender. In this review, we have focused our attention on the involvement of sex hormones and gender on different endocrine diseases.

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“…Sex differences in body composition have shown women to express greater central and overall body fat [ 21 ]. Accordingly, a sex distinction in the type 2 diabetes phenotype has been shown in black Africans, whereby men display greater insulin sensitivity compared with women [ 22 ]. The inconsistences in the findings from adolescent and female populations likely stem from differences in methods and participant body composition.…”

Section: Introductionmentioning

confidence: 99%

Black African men with early type 2 diabetes have similar muscle, liver and adipose tissue insulin sensitivity to white European men despite lower visceral fat

et al. 2019

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Aims/hypothesis Type 2 diabetes is more prevalent in black African than white European populations although, paradoxically, black African individuals present with lower levels of visceral fat, which has a known association with insulin resistance. Insulin resistance occurs at a tissue-specific level; however, no study has simultaneously compared whole body, skeletal muscle, hepatic and adipose tissue insulin sensitivity between black and white men. We hypothesised that, in those with early type 2 diabetes, black (West) African men (BAM) have greater hepatic and adipose tissue insulin sensitivity, compared with white European men (WEM), because of their reduced visceral fat. Methods Eighteen BAM and 15 WEM with type 2 diabetes underwent a two-stage hyperinsulinaemic–euglycaemic clamp with stable glucose and glycerol isotope tracers to assess tissue-specific insulin sensitivity and a magnetic resonance imaging scan to assess body composition. Results We found no ethnic differences in whole body, skeletal muscle, hepatic or adipose tissue insulin sensitivity between BAM and WEM. This finding occurred in the presence of lower visceral fat in BAM (3.72 vs 5.68 kg [mean difference −1.96, 95% CI −3.30, 0.62]; p = 0.01). There was an association between skeletal muscle and adipose tissue insulin sensitivity in WEM that was not present in BAM ( r = 0.78, p < 0.01 vs r = 0.25 p = 0.37). Conclusions/interpretation Our data suggest that in type 2 diabetes there are no ethnic differences in whole body, skeletal muscle, hepatic and adipose tissue insulin sensitivity between black and white men, despite differences in visceral adipose tissue, and that impaired lipolysis may not be contributing to skeletal muscle insulin resistance in men of black African ethnicity.

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Sex differences in insulin sensitivity and insulin response with increasing age in black South African men and women

Cited by 26 publications

References 29 publications

Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa

Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Black African men with early type 2 diabetes have similar muscle, liver and adipose tissue insulin sensitivity to white European men despite lower visceral fat

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