Characteristics of Glucose Metabolism in Nordic and South Asian Subjects with Type 2 Diabetes

• Published in: PloS one Vol. 8; no. 12; p. e83983
• Main Authors: Wium, Cecilie, Gulseth, Hanne Løvdal, Eriksen, Erik Fink, Birkeland, Kåre Inge
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.12.2013; Public Library of Science (PLoS)
• Subjects: Absorptiometry; Absorptiometry, Photon; Adult; Asia - ethnology; Biology; Blood glucose test; Body composition; Body composition (biology); Body mass; Calorimetry; Calorimetry, Indirect; Carbohydrates; Comparative analysis; Diabetes mellitus; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - metabolism; Dual energy X-ray absorptiometry; Energy expenditure; Energy Metabolism; Energy resources; Europe - ethnology; Female; Glucose; Glucose - metabolism; Glucose Clamp Technique; Glucose tolerance; Glucose Tolerance Test; Glycated Hemoglobin A - metabolism; Humans; Insulin; Insulin - metabolism; Insulin Resistance; Insulin secretion; Lipid metabolism; Lipid peroxidation; Liver - metabolism; Male; Medicine; Metabolism; Middle Aged; Minority & ethnic groups; Oxidation; Secretion; Studies; Substrates; Type 2 diabetes; Vitamin D; Vitamin D - analysis; Norway
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0083983

Insulin resistance and type 2 diabetes are more prevalent in people of South Asian ethnicity than in people of Western European origin. To investigate the source of these differences, we compared insulin sensitivity, insulin secretion, glucose and lipid metabolism in South Asian and Nordic subjects with type 2 diabetes. Forty-three Nordic and 19 South Asian subjects with type 2 diabetes were examined with intra-venous glucose tolerance test, euglycemic clamp including measurement of endogenous glucose production, indirect calorimetry measuring glucose and lipid oxidation, and dual x-ray absorptiometry measuring body composition. Despite younger mean ± SD age (49.7 ± 9.4 vs 58.3 ± 8.3 years, p = 0.001), subjects of South Asian ethnicity had the same diabetes duration (9.3 ± 5.5 vs 9.6 ± 7.0 years, p = 0.86), significantly higher median [inter-quartile range] HbA1c (8.5 [1.6] vs 7.3 [1.6] %, p = 0.024) and lower BMI (28.7 ± 4.0 vs 33.2 ± 4.7 kg/m(2), p<0.001). The South Asian group exhibited significantly higher basal endogenous glucose production (19.1 [9.1] vs 14.4 [6.8] µmol/kgFFM · min, p = 0.003). There were no significant differences between the groups in total glucose disposal (39.1 ± 20.4 vs 39.2 ± 17.6 µmol/kgFFM · min, p = 0.99) or first phase insulin secretion (AUC0-8 min: 220 [302] vs 124 [275] pM, p = 0.35). In South Asian subjects there was a tendency towards positive correlations between endogenous glucose production and resting and clamp energy expenditure. Subjects of South Asian ethnicity with type 2 diabetes, despite being younger and leaner, had higher basal endogenous glucose production, indicating higher hepatic insulin resistance, and a trend towards higher use of carbohydrates as fasting energy substrate compared to Nordic subjects. These findings may contribute to the understanding of the observed differences in prevalence of type 2 diabetes between the ethnic groups.