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Race/ethnicity and challenges for optimal insulin therapy

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do Vale Moreira, Nayla Cristina, Ceriello, Antonio, Basit, Abdul, Balde, Naby, Mohan, V., Gupta, Ritesh, Misra, Anoop, Bhowmik, Bishwajit +9 more·2021·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2021.108823
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Abstract

AIMS: We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. METHODS: We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: "ethnicity", "diabetes", "insulin", "history of insulin", "insulin therapy", "food/rice", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "insulin sensitivity", "insulin response", "glycaemic index", "glycaemic response", "efficacy and safety", with interposition of the Boolean operator "AND".In addition, we reviewed the reference lists of the articles found. RESULTS: The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. CONCLUSIONS: Race/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.

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  • East Asian populations are characterized by distinct metabolic and anthropometric profiles compared to Western populations, including lower body mass index, differences in body composition, and unique dietary patterns.

    “East Asian populations are characterized by distinct metabolic and anthropometric profiles compared to Western populations, including lower body mass index (BMI), differences in body composition, and unique dietary patterns 11 , 12 .”

    From A study of changes in insulin requirements related to the menstrual cycle in Japanese women with type 1 diabetes using the advanced hybrid closed‐loop system (2026) · cites this paper as [12]

    Section 2.5 reports that East Asians have lower mean BMI and less visceral fat than Caucasians, supporting the anthropometric and body-composition comparisons. The section on glycaemic response to carbohydrates contrasts Asian and Western diets, but describes Asian diets broadly rather than establishing a dietary pattern specific to East Asian populations. No page numbers are available in our copy. (LLM, conf=0.82)

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  • Population-specific differences in body composition and insulin sensitivity among Asian individuals, together with dietary carbohydrate patterns, may contribute to higher insulin requirements.

    “Additionally, population‐specific differences in body composition and insulin sensitivity among Asian individuals 12 , together with dietary carbohydrate patterns 18 , 19 , may also contribute.”

    From A study of changes in insulin requirements related to the menstrual cycle in Japanese women with type 1 diabetes using the advanced hybrid closed‐loop system (2026) · cites this paper as [12]

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Authors
do Vale Moreira, N. C., Ceriello, A., Basit, A., Balde, N., Mohan, V., Gupta, R., Misra, A., Bhowmik, B., Lee, M. K., Zuo, H., Shi, Z., Wang, Y., Montenegro, R. M., Fernandes, V. O., Colagiuri, S., Boulton, A. J. M., & Hussain, A.
Affiliations
  • MultiMedica (IT)
  • Baqai Medical University (PK)
  • Donka Hospital (GN)
  • Dr. Mohan's Diabetes Specialities Centre (IN)
  • Fortis C-DOC Hospital (IN)
  • Eulji University (KR)
  • Soochow University (CN)
  • Qatar University (QA)
  • Xi'an Jiaotong University (CN)
  • Universidade Federal do Ceará (BR)
  • The University of Sydney (AU)
  • University of Manchester (GB)
Corresponding author
Hussain, Akhtar
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2021-05
Volume
175
Pages
108823
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2021.108823
OpenAlex
W3156316855
Cited by
37
References
9
Citations by year
2026: 5 · 2025: 12 · 2024: 4 · 2023: 5 · 2022: 9 · 2021: 2
FWCI
3.74
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Qatar University QSpace (Qatar University) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
race and ethnicity, insulin therapy, insulin dose, insulin resistance, insulin sensitivity, glycemic index, body mass index, glucose metabolism, insulin regulation
MeSH terms
Adult, Aged, Blood Glucose, Female, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Young Adult

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