Edeoga Chimaroke, Asuzu Peace, Wan Jim, Dagogo-Jack Samuel
Department of Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA.
The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA.
BMJ Open Diabetes Res Care. 2024 Dec 23;12(6):e004545. doi: 10.1136/bmjdrc-2024-004545.
Ethnic disparities in the prevalence and pathophysiology of type 2 diabetes are well documented, but prospective data on insulin dynamics vis-à-vis pre-diabetes/early dysglycemia risk in diverse populations are scant.
We analyzed insulin secretion, sensitivity, and clearance among participants in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study. The POP-ABC study followed initially normoglycemic offspring of parents with type 2 diabetes for 5.5 years, the primary outcome being incident dysglycemia. Assessments included anthropometry, oral glucose tolerance test, insulin sensitivity (hyperinsulinemic euglycemic clamp, HEC), insulin secretion (intravenous glucose tolerance test, IVGT), and disposition index (DI). Insulin clearance was derived as the molar ratio of plasma C peptide to insulin and by calculating the metabolic clearance rate during HEC.
POP-ABC participants who completed IVGT and HEC at baseline (145 African American, 123 European American; 72% women; mean age 44.6±10.1 years) were included in the present analysis. The baseline fasting plasma glucose was 91.9±6.91 mg/dL (5.11±0.38 mmol/L) and 2-hour plasma glucose was 123±25.1 mg/dL (6.83±1.83 mmol/L). African American offspring of parents with type 2 diabetes had higher insulin secretion and DI, and lower insulin sensitivity and clearance, than their European American counterparts. During 5.5 years of follow-up, 91 of 268 participants developed incident dysglycemia and 177 maintained normoglycemia. In Cox proportional hazards models, insulin secretion (HR 0.997 (95% CI 0.996 to 0.999), p=0.005), insulin sensitivity (HR 0.948 (95% CI 0.913 to 0.984), p=0.005), DI (HR 0.945 (95% CI 0.909 to 0.983), p=0.005) and basal insulin clearance (HR 1.030 (95% CI 1.005 to 1.056), p=0.018) significantly predicted incident dysglycemia.
Insulin sensitivity, secretion, and clearance differ significantly in normoglycemic African American versus European American offspring of parents with type 2 diabetes and are associated with the risk of incident dysglycemia.
2型糖尿病患病率和病理生理学方面的种族差异已有充分记录，但关于不同人群中胰岛素动态与糖尿病前期/早期血糖异常风险关系的前瞻性数据却很少。
我们在一项混血队列糖尿病前期病理生物学（POP - ABC）研究中分析了参与者的胰岛素分泌、敏感性和清除率。POP - ABC研究对2型糖尿病患者的正常血糖后代进行了5.5年的随访，主要结局为新发血糖异常。评估内容包括人体测量、口服葡萄糖耐量试验、胰岛素敏感性（高胰岛素正常血糖钳夹试验，HEC）、胰岛素分泌（静脉葡萄糖耐量试验，IVGT）和处置指数（DI）。胰岛素清除率通过血浆C肽与胰岛素的摩尔比以及计算HEC期间的代谢清除率得出。
本分析纳入了在基线时完成IVGT和HEC的POP - ABC参与者（145名非裔美国人，123名欧裔美国人；72%为女性；平均年龄44.6±10.1岁）。基线空腹血糖为91.9±6.91mg/dL（5.11±0.38mmol/L），2小时血糖为123±25.1mg/dL（6.83±1.83mmol/L）。2型糖尿病患者的非裔美国后代比欧裔美国后代具有更高的胰岛素分泌和DI，以及更低的胰岛素敏感性和清除率。在5.5年的随访期间，268名参与者中有91人出现新发血糖异常，177人维持正常血糖水平。在Cox比例风险模型中，胰岛素分泌（HR 0.997（95%CI 0.996至0.999），p = 0.005）、胰岛素敏感性（HR 0.948（95%CI 0.913至0.984），p = 0.005）、DI（HR 0.945（95%CI 0.909至0.983），p = 0.005）和基础胰岛素清除率（HR 1.030（95%CI 1.005至1.056），p = 0.018）均显著预测了新发血糖异常。
2型糖尿病患者的非裔美国和欧裔美国正常血糖后代在胰岛素敏感性、分泌和清除率方面存在显著差异，且与新发血糖异常风险相关。
