Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites. The Insulin Resistance Atherosclerosis Study
Abstract
The etiology of NIDDM is still controversial, with both insulin resistance and decreased insulin secretion postulated as potential important factors. African-Americans and Hispanics have a two- to threefold excess risk of developing NIDDM compared with non-Hispanic whites. Yet little is known concerning the prevalence of insulin resistance and secretion defects in minorities, especially in African-Americans in population-based studies. Fasting and 2-h post-glucose load glucose and insulin levels, insulin-mediated glucose disposal (insulin sensitivity index) (S(I)), glucose effectiveness (S(G)), and first-phase insulin response (acute insulin response [AIR]) were determined in nondiabetic African-Americans (n= 288), Hispanics (n= 363), and non-Hispanic whites (n= 435) as part of the Insulin Resistance Atherosclerosis Study. Subjects received a standard 2-h oral glucose tolerance test on the first day and an insulin-modified frequently sampled intravenous glucose tolerance test on the second day. African-Americans and Hispanics were more obese than non-Hispanic whites. Both African-Americans and Hispanics had higher fasting and 2-h insulin concentrations and AIR but lower S(I) than non-Hispanic whites. No ethnic difference was observed in S(G). After further adjustments for obesity, body fat distribution, and behavioral factors, African-Americans continued to have higher fasting and 2-h insulin levels and AIR, but lower S(I) than non-Hispanic whites. In contrast, after adjustment for these covariates, no significant ethnic differences in S(I) or fasting insulin levels were observed between Hispanics and non-Hispanic whites. Hispanics continued to have higher 2-h insulin levels and AIRs than those in non-Hispanic whites. In this report, the association between S(I) and upper body adiposity (waist-to-hip, ratio) was similar in each ethnic group. Both nondiabetic African-Americans and Hispanics have increased insulin resistance and higher AIR than nondiabetic non-Hispanic whites, suggesting that greater insulin resistance may be in large part responsible for the higher prevalence of NIDDM in these minority groups. However, in Hispanics. the greater insulin resistance may be due to greater adiposity and other behavioral factors.
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African Americans, Mexican Americans, and Native Americans secrete a greater amount of insulin than European Americans for a given amount of exposure to oral or intravenous glucose.
“African Americans (AAs), Mexican Americans, and Native Americans secrete a greater amount of insulin than do European Americans (EAs) for a given amount of exposure to oral or intravenous glucose (19)(20)(21).”
From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [20]
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“Differences in insulin resistance according to race/ethnicity cannot be fully explained by obesity, but nondiabetic African Americans tend to have lower SI and higher AIR than their non-Hispanic white counterparts (15,16).”
BackgroundSelf-citationGower, B. A., Granger, W. M., Franklin, F., Shewchuk, R. M., & Goran, M. I. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.5.8498 · Cited by 114 · see citing works
Orchestration of Glucose Homeostasis
Bergman, R. N. (2007) · Diabetes · doi:10.2337/db07-9903 · Cited by 114 · see citing works
Self-citationDolan, L., Bean, J., D'Alessio, D., Cohen, R., Morrison, J., Goodman, E., & Daniels, S. (2005) · Jornal de Pediatria · doi:10.1016/j.jpeds.2005.01.045 · Cited by 108 · see citing works
Efficacy and safety of rosiglitazone plus metformin in Mexicans with type 2 diabetes
Gomez-Perez, F. J., Fanghänel‐Salmón, G., Barbosa, J. A., Montes‐Villarreal, J., Berry, R. A., Warsi, G. M., & Gould, E. M. (2002) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.264 · Cited by 113 · see citing works
“A study in healthy patients suggested that, compared with non-Hispanic whites, Mexican Americans have greater insulin resistance and a higher acute insulin response – a strong predictor of type 2 diabetes [12].”
ResultDagogo-Jack, S. E. (2003) · PubMed Central · Cited by 112 · see citing works
Multi-Ethnic Study of Atherosclerosis (MESA)
Blaha, M. J., & DeFilippis, A. P. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.05.006 · Cited by 121 · see citing works
Correlates and Heritability of Nonalcoholic Fatty Liver Disease in a Minority Cohort
Wagenknecht, L. E., Scherzinger, A. L., Stamm, E. R., et al. (2009) · Obesity · doi:10.1038/oby.2009.4 · Cited by 108 · see citing works
“Paradoxically, central obesity, insulin resistance, and diabetes were similar or more frequent in African Americans than Hispanics in this study and others (30), yet African Americans had a dramatically lower prevalence of NAFLD.”
BackgroundSelf-citationKu, C., Gower, B. A., Hunter, G. R., & Goran, M. I. (2000) · Obesity Research · doi:10.1038/oby.2000.63 · Cited by 108 · see citing works
“Our findings are consistent with previous findings in adults and adolescents, indicating that African Americans have higher insulin secretion and lower SI than whites (1,2,6,35,36).”
ResultSumner, A. E., Vega, G. L., Genovese, D. J., Finley, K. B., Bergman, R. N., & Boston, R. C. (2005) · Metabolism · doi:10.1016/j.metabol.2005.03.001 · Cited by 109 · see citing works
“African Americans have a disproportionately high prevalence of insulin resistance and conditions associated with insulin resistance, such as type 2 diabetes, obesity, hypertension, and heart disease [1-4].”
BackgroundSelf-citationAshraf, A. P., Alvarez, J. A., Saenz, K. H., Gower, B. A., McCormick, K. L., & Franklin, F. A. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0445 · Cited by 106 · see citing works
The Triglyceride Paradox in People of African Descent
Yu, S. S. K., Castillo, D. C., Courville, A. B., & Sumner, A. E. (2012) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2011.0108 · Cited by 108 · see citing works
“29,48,49 We suggest that higher insulin concentrations in blacks may lead to greater inhibition of hormone sensitive lipase in adipose tissue and less release of free fatty acids (FFA) from peripheral adipose tissue.”
A Population Perspective on Diabetes Prevention
Burke, J. P., Williams, K., Narayan, K. M. V., Leibson, C. L., Haffner, S. M., & D, M. P. S. M. (2003) · Diabetes Care · doi:10.2337/diacare.26.7.1999 · Cited by 106 · see citing works
“This may be a result of increased insulin resistance in nondiabetic Mexican Americans compared with non-Hispanic whites (30).”
BackgroundSelf-citationDiabetes in the hispanic or latino population: Genes, environment, culture, and more
Caballero, A. E. (2005) · Current Diabetes Reports · doi:10.1007/s11892-005-0012-5 · Cited by 105 · see citing works
Tulloch-Reid, M. K., Hanson, R. L., Sebring, N. G., Reynolds, J. C., Premkumar, A., Genovese, D. J., & Sumner, A. E. (2004) · Obesity Research · doi:10.1038/oby.2004.170 · Cited by 104 · see citing works
Insulin Sensitivity and the Risk of Incident Hypertension
Goff, D. C., Zaccaro, D. J., Haffner, S. M., & Saad, M. F. (2003) · Diabetes Care · doi:10.2337/diacare.26.3.805 · Cited by 100 · see citing works
“The protocol has been previously described in detail (11,14).”
MethodSelf-citationHaffner, S. M., Agostino, R. D., Saad, M. F., O’Leary, D. H., Savage, P. J., Rewers, M., Selby, J. V., Bergman, R. N., & Mykkänen, L. M. (2000) · The American Journal of Cardiology · doi:10.1016/s0002-9149(00)00784-0 · Cited by 101 · see citing works
Self-citationHaffner, S. M., D'Agostino, R., Goff, D. C., Howard, B. V., Festa, A., Saad, M. F., & Mykkänen, L. (1999) · Arteriosclerosis, Thrombosis and Vascular Biology · doi:10.1161/01.atv.19.9.2234 · Cited by 111 · see citing works
Self-citationVelasquez‐Mieyer, P., Cowan, P. A., Arheart, K. L., Buffington, C. K., Spencer, K., Connelly, B. E., Cowan, G., & Lustig, R. H. (2003) · International Journal of Obesity · doi:10.1038/sj.ijo.802227 · Cited by 98 · see citing works
Gower, B. A., & Goss, A. M. (2015) · The Journal of Nutrition · doi:10.3945/jn.114.195065 · Cited by 98 · see citing works
Insulin Response in Relation to Insulin Sensitivity
Goedecke, J. H., Dave, J. A., Faulenbach, M. V., Utzschneider, K. M., Lambert, E. V., West, S. J., Collins, M., Olsson, T., Walker, B. R., Seckl, J. R., et al. (2009) · Diabetes Care · doi:10.2337/dc08-2048 · Cited by 98 · see citing works
“A similar scenario is presented in African Americans, who have a higher prevalence of type 2 diabetes but display a similar or higher disposition index than their Caucasian counterparts (6,7).”
Background
- Authors
- Haffner, S. M., Ralph, D., Saad, M. F., Rewers, M., Mykkänen, L., Selby, J., Howard, G., Savage, P. J., Hamman, R. F., Wegenknecht, L. E., & Bergman, R. N.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Department of Public Health Sciences, Bowman Gray School of Medicine Winston-Salem, North Carolina
- University of Southern California (US)
- University of Colorado Anschutz (US)
- Department of Medicine, University of Texas Health Science Center at San Antonio San Antonio, Texas
- Kaiser Permanente (US)
- Atrium Health Wake Forest Baptist (US)
- National Institutes of Health (US)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1996-06-01
- Volume
- 45
- Issue
- 6
- Pages
- 742-748
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2121083878
- Cited by
- 536
- References
- 0
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 5 · 2023: 9 · 2022: 18 · 2021: 15 · 2020: 19 · 2019: 17 · 2018: 17 · 2017: 16 · 2016: 23 · 2015: 15 · 2014: 20 · 2013: 18 · 2012: 23
- FWCI
- 7.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01hl047890-09, 5u01hl047887-09, 5u01hl047889-09)
- National Heart, Lung, and Blood Institute (HL-47889, HL‐47890, HL47887)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- insulin resistance, insulin secretion, type 2 diabetes, African Americans, Hispanic Americans, ethnic differences, insulin sensitivity index, acute insulin response, glucose effectiveness, obesity, Insulin Resistance Atherosclerosis Study
- MeSH terms
- Insulin Secretion, Africa, Analysis of Variance, Arteriosclerosis, Black or African American, Blood Glucose, Cross-Sectional Studies, Diet, Female, Glucose Tolerance Test, Hispanic or Latino, Humans, Insulin, Insulin Resistance, Male, Mexico, Middle Aged, United States, Black People, White People
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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