Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, USA.
Diabetes Care. 2010 Mar;33(3):614-9. doi: 10.2337/dc09-1220. Epub 2009 Dec 10.
OBJECTIVE Insulin resistance is greater in racial/ethnic minorities than in non-Hispanic whites (NHWs) for those with and without type 2 diabetes. Because previous research on insulin resistance in type 1 diabetes was limited to NHWs, racial/ethnic variation in an estimated measure of insulin resistance in type 1 diabetes was determined. RESEARCH DESIGN AND METHODS The sample included 79 individuals with type 1 diabetes diagnosed at age <18 years (32.9% NHWs, 46.8% non-Hispanic black [NHB], 7.6% other/mixed, and 12.7% Hispanic) and their families. Estimated glucose disposal rate (eGDR) (milligrams per kilogram per minute; a lower eGDR indicates greater insulin resistance) was calculated using A1C, waist circumference, and hypertension status. RESULTS Mean current age was 13.5 years (range 3.2-32.5) and diabetes duration was 5.7 years (0.1-19.9). eGDR was inversely associated with age. Compared with that in NHWs, age-adjusted eGDR was significantly lower among nonwhites (NHB, other/mixed, and Hispanic: Delta = -1.83, P = 0.0006). Age-adjusted eGDR was negatively associated with body fat, triglycerides, urinary albumin/creatinine, acanthosis nigricans, parental obesity, and parental insulin resistance and positively related to HDL and sex hormone-binding globulin. In multivariable analysis, lower eGDR was significantly associated with older age, nonwhite race/ethnicity, acanthosis, and lower HDL. CONCLUSIONS Minorities with type 1 diabetes are significantly more insulin resistant, as measured by eGDR, than NHWs. Exploring potential mechanisms, including disparities in care and/or physiological variation, may contribute to preventing racial/ethnic differences in insulin resistance-associated outcomes.
在患有 2 型糖尿病和不患有 2 型糖尿病的人群中，与非西班牙裔白人（NHW）相比，种族/民族少数群体的胰岛素抵抗更为严重。由于之前对 1 型糖尿病胰岛素抵抗的研究仅限于 NHW，因此确定了 1 型糖尿病中估计的胰岛素抵抗测量值的种族/民族差异。
该样本包括 79 名在 18 岁以下（32.9%为 NHW、46.8%为非西班牙裔黑人 [NHB]、7.6%为其他/混合、12.7%为西班牙裔）确诊为 1 型糖尿病的个体及其家属。使用 A1C、腰围和高血压状态计算估计的葡萄糖处置率（eGDR）（每公斤每分钟毫克数；eGDR 越低表示胰岛素抵抗越严重）。
当前的平均年龄为 13.5 岁（范围为 3.2-32.5），糖尿病病程为 5.7 年（0.1-19.9）。eGDR 与年龄呈反比。与 NHW 相比，非白人（NHB、其他/混合和西班牙裔）的年龄调整后 eGDR 明显较低（Delta = -1.83，P = 0.0006）。年龄调整后的 eGDR 与体脂、甘油三酯、尿白蛋白/肌酐、黑棘皮病、父母肥胖和父母胰岛素抵抗呈负相关，与高密度脂蛋白和性激素结合球蛋白呈正相关。在多变量分析中，较低的 eGDR 与年龄较大、非白人种族/民族、黑棘皮病和较低的高密度脂蛋白显著相关。
与 NHW 相比，通过 eGDR 测量，1 型糖尿病的少数群体的胰岛素抵抗明显更为严重。探讨潜在的机制，包括护理方面的差异和/或生理差异，可能有助于预防与胰岛素抵抗相关的结果中的种族/民族差异。
