Louise Bennet1, Leif Groop2, Paul W Franks3. 1. Department of Clinical Sciences, Lund University, Skåne University Hospital, Sweden; Genetic & Molecular Epidemiology, Lund University, Malmö, Sweden. Electronic address: Louise.Bennet@med.lu.se. 2. Department of Clinical Sciences, Lund University, Skåne University Hospital, Sweden; Department of Diabetes and Endocrinology/Lund University Diabetes Centre, Skåne University Hospital, Malmö, Sweden. 3. Department of Clinical Sciences, Lund University, Skåne University Hospital, Sweden; Genetic & Molecular Epidemiology, Lund University, Malmö, Sweden; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Abstract
AIMS: We investigated insulin action (insulin sensitivity index, ISI) and insulin secretion (oral disposition indices, DIo) and studied metabolic, demographic and lifestyle-related risk factors for type 2 diabetes and insulin action, in the largest non-European immigrant group to Sweden, immigrants from Iraq and native Swedes. METHODS: Population-based, cross-sectional study conducted 2010-2012 including residents 30-75 years of age born in Iraq or Sweden, in whom oral glucose tolerance tests were performed and sociodemography and lifestyle behaviors were characterized. RESULTS: In Iraqis compared to Swedes, ISI was more impaired (76.9 vs. 102.3, p<.001) whereas corrected insulin response CIR was higher (226.6 vs. 188.6, p=.016). However, insulin secretion was inadequate given the substantial insulin resistance, as indicated by lower DIo indices in Iraqis than in Swedes (DIo 12,712.9 vs. 14,659.2, p<.001). The crude ethnic difference in ISI was not offset by traditional risk factors like waist circumference, body mass index or family history of diabetes. In Iraqis, ISI conveyed somewhat higher odds of type 2 diabetes than in Swedes (odds ratio OR 0.98, 95% CI 0.97-0.99) vs. OR 0.95, 0.92-0.99), as indicated by an interaction between country of birth and ISI (Pinteraction=.044). CONCLUSION: This study reports ethnic differences in the contribution of insulin action to type 2 diabetes. Our data suggests that the impaired insulin action observed in immigrants from the Middle East to Sweden is not fully explained by established risk factors.
AIMS: We investigated insulin action (insulin sensitivity index, ISI) and insulin secretion (oral disposition indices, DIo) and studied metabolic, demographic and lifestyle-related risk factors for type 2 diabetes and insulin action, in the largest non-European immigrant group to Sweden, immigrants from Iraq and native Swedes. METHODS: Population-based, cross-sectional study conducted 2010-2012 including residents 30-75 years of age born in Iraq or Sweden, in whom oral glucose tolerance tests were performed and sociodemography and lifestyle behaviors were characterized. RESULTS: In Iraqis compared to Swedes, ISI was more impaired (76.9 vs. 102.3, p<.001) whereas corrected insulin response CIR was higher (226.6 vs. 188.6, p=.016). However, insulin secretion was inadequate given the substantial insulin resistance, as indicated by lower DIo indices in Iraqis than in Swedes (DIo 12,712.9 vs. 14,659.2, p<.001). The crude ethnic difference in ISI was not offset by traditional risk factors like waist circumference, body mass index or family history of diabetes. In Iraqis, ISI conveyed somewhat higher odds of type 2 diabetes than in Swedes (odds ratio OR 0.98, 95% CI 0.97-0.99) vs. OR 0.95, 0.92-0.99), as indicated by an interaction between country of birth and ISI (Pinteraction=.044). CONCLUSION: This study reports ethnic differences in the contribution of insulin action to type 2 diabetes. Our data suggests that the impaired insulin action observed in immigrants from the Middle East to Sweden is not fully explained by established risk factors.
Authors: Mats Martinell; Ronnie Pingel; Johan Hallqvist; Mozhgan Dorkhan; Leif Groop; Anders Rosengren; Petter Storm; Jan Stålhammar Journal: BMJ Open Diabetes Res Care Date: 2017-05-08