Ethnic differences in the contribution of insulin action and secretion to type 2 diabetes in immigrants from the Middle East compared to native Swedes

Bennet, Louise; Groop, Leif; Franks, Paul W.

doi:10.1016/j.diabres.2014.04.025

Cited by 34 publications

(67 citation statements)

References 23 publications

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“…Malmö is a multicultural city with a third of its population born abroad, with the majority being born in Iraq [2]. As previously reported, citizens of Malmö, which were born in Iraq (Middle Eastern ethnicity) or born in Sweden (Caucasian ethnicity), aged 30 to 75 years were randomly selected from the census register and invited by post and phone to participate in the MEDIM population-based study [7]. Our aim was to recruit Iraqi-born and Swedish-born groups, matched for gender and age distribution.…”

Section: Methodsmentioning

confidence: 99%

“…Blood samples were collected prior to glucose loading and at 30, 60, 90 and 120 min thereafter; glucose was measured in fresh plasma from venous whole blood immediately after sampling using a photometer (HemoCue AB, Ängelholm, Sweden) as described previously [11]. Plasma insulin, cholesterol, triglyceride (p-TG), high-density lipoprotein (p-HDL) and low-density-lipoprotein (p-LDL), C-peptide and high-sensitive c-reactive protein were determined as previously described [7, 11]. …”

Section: Methodsmentioning

confidence: 99%

“…during the glucose load. Insulin sensitivity index (ISI), corrected insulin response (CIR) and oral disposition index (DIo) were assessed using the Matsuda indices calculated from the OGTT results as described previously [7]. ISI provides an estimate of insulin action, CIR provides an estimate of beta cell function and DIo provides an estimate of beta-cell function adjusted for insulin resistance, and is calculated as CIR multiplied by ISI [12].…”

Section: Methodsmentioning

confidence: 99%

“…Insulin sensitivity, together with insulin secretion, are the main determinants of type 2 diabetes [6], but the MEDIM study previously reported that insulin sensitivity (assessed as insulin sensitivity index, ISI) rather than insulin secretion, contributes to the high diabetes risk in the Iraqi immigrant population. Thus, ISI is a main target in the prevention of type 2 diabetes in this population [7]. Dysfunctional insulin sensitivity, or insulin resistance, is dependent on ectopic fat accumulation in liver, visceral adipose tissue, and skeletal muscle [8].…”

Section: Introductionmentioning

confidence: 99%

“…Dysfunctional insulin sensitivity, or insulin resistance, is dependent on ectopic fat accumulation in liver, visceral adipose tissue, and skeletal muscle [8]. Although the Iraqi immigrant population is generally more obese (BMI > 30 kg/m 2 ) than the native Swedish population (37.5% vs 23.0%, p < 0.001) [9], the reduced insulin sensitivity in this population is not fully explained by BMI or other cardiometabolic risk factors [7]. These findings are consistent with other studies reporting different fat distributions across ethnicities and consequently highlight the limitation of BMI as a measure of adiposity [10].…”

Section: Introductionmentioning

confidence: 99%

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BMI and waist circumference cut-offs for corresponding levels of insulin sensitivity in a Middle Eastern immigrant versus a native Swedish population – the MEDIM population based study

et al. 2016

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BackgroundThe aim of this study was to identify corresponding body mass index (BMI) and waist circumference cut-offs for equivalent levels of insulin sensitivity in a Middle Eastern immigrant population compared with native Swedes.MethodsCitizens of Malmö, Sweden aged 30 to 75 years, who were born in Iraq or Sweden, were in 2010–2012 invited to participate in a health examination including anthropometrics, oral glucose tolerance test, fasting samples and interviews concerning sociodemographic factors and lifestyle behaviours.ResultsIn total, 1176 individuals born in Iraq and 688 born in Sweden, without previously diagnosed type 2 diabetes, participated in the study. In normal weight participants (BMI < 25 kg/m2), 21.2% of Iraqis vs 9.3% of Swedes were insulin resistant. Corresponding figures in participants without abdominal obesity (waist circumference, men < 94 cm, women < 80 cm) were 28.2% of Iraqis vs 9.4% of Swedes.The age-adjusted insulin sensitivity index (ISI) for obese Swedes (BMI 30 kg/m2) corresponded in Iraqi men with BMI of 28.5 kg/m2, and in Iraqi women with BMI of 27.5 kg/m2. The ISI level in abdominally obese Swedes corresponded with waist circumference cut-offs of 84.0 cm and 71.0 cm in Iraqi men and women, respectively.In men only, larger waist circumference (P interaction = 0.026) presented a stronger association with impaired ISI in Iraqis as compared to Swedes.ConclusionsOur data shows that the impact of BMI and waist circumference on ISI is ethnic- and gender-specific, indicating a disturbed fat metabolism in Iraqi males in particular. Our data suggests that 10 cm lower cut-off values for abdominal obesity, than is currently recommended by major organisations, should be considered when estimating diabetes risk in Middle Eastern populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3892-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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BMI and waist circumference cut-offs for corresponding levels of insulin sensitivity in a Middle Eastern immigrant versus a native Swedish population – the MEDIM population based study

et al. 2016

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Adult‐onset diabetes in Middle Eastern immigrants to Sweden: Novel subgroups and diabetic complications—The All New Diabetes in Scania cohort diabetic complications and ethnicity

Bennet

Nilsson

Mansour-Aly

et al. 2020

Diabetes Metabolism Res

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Background Middle Eastern immigrants to Europe represent a high risk population for type 2 diabetes. We compared prevalence of novel subgroups and assessed risk of diabetic macro‐ and microvascular complications between diabetes patients of Middle Eastern and European origin. Methods This study included newly diagnosed diabetes patients born in Sweden (N = 10641) or Iraq (N = 286), previously included in the All New Diabetes in Scania cohort. The study was conducted between January 2008 and August 2016. Patients were followed to April 2017. Incidence rates in diabetic macro‐ and microvascular complications were assessed using cox‐regression adjusting for the confounding effect of age at onset, sex, anthropometrics, glomerular filtration rate (eGFR) and HbA1c. Findings In Iraqi immigrants versus native Swedes, severe insulin‐deficient diabetes was almost twice as common (27.9 vs. 16.2% p < 0.001) but severe insulin‐resistant diabetes was less prevalent. Patients born in Iraq had higher risk of coronary events (hazard ratio [HR] 1.84, 95% CI 1.06–3.12) but considerably lower risk of chronic kidney disease (CKD) than Swedes (HR 0.19; 0.05–0.76). The lower risk in Iraqi immigrants was partially attributed to better eGFR. Genetic risk scores (GRS) showed more genetic variants associated with poor insulin secretion but lower risk of insulin resistance in the Iraqi than native Swedish group. Interpretation People with diabetes, born in the Middle East present with a more insulin‐deficient phenotype and genotype than native Swedes. They have a higher risk of coronary events but lower risk of CKD. Ethnic differences should be considered in the preventive work towards diabetes and its complications.

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Insulin action and secretion independent of traditional risk factors predict new‐onset type 2 diabetes in Iraqi and Swedish born citizens – The MEDIM cohort study

Pikkemaat

Lönn

Bennet

2021

Diabetes Metabolism Res

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Aims Our aim was to study the incidence of type 2 diabetes in a population‐based cohort of Swedish and Iraqi born individuals, focussing on traditional risk factors, insulin action, insulin secretion and ethnicity. Materials and Methods The cohort consisted of 1164 Iraqi and 693 Swedish‐born citizens. We investigated the association between new‐onset type 2 diabetes and the predictors including lifestyle factors, metabolic risk markers, country of birth, insulin sensitivity and secretion assessed by Matsuda index with Cox regression. Results Eighty‐nine individuals were diagnosed with type 2 diabetes with a mean follow‐up of 7.5 years. Both lower insulin sensitivity (ISI, HR 0.02 [0.01–0.08]) as well as insulin secretion (CIR, HR 0.13 [0.07–0.24]) at baseline predicted type 2 diabetes onset, independent of traditional risk factors. Our results were not modified by country of birth. Regarding traditional risk factors, WHR (1.05 [1.00–1.09]), blood glucose (3.27 [2.35–4.55]), LDL/HDL (1.46 [1.20–1.78]) and diastolic blood pressure (1.04 [1.00–1.07]) predicted diabetes incidence in the full model. Conclusions Both impaired insulin sensitivity index and corrected insulin response predicted type 2 diabetes onset, independent of traditional risk factors. We conclude that insulin secretion and action might be useful additional predictors for type 2 diabetes in populations of European and Middle Eastern ethnicities.

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Ethnic differences in the contribution of insulin action and secretion to type 2 diabetes in immigrants from the Middle East compared to native Swedes

Abstract: 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.

Cited by 34 publications

References 23 publications

BMI and waist circumference cut-offs for corresponding levels of insulin sensitivity in a Middle Eastern immigrant versus a native Swedish population – the MEDIM population based study

BMI and waist circumference cut-offs for corresponding levels of insulin sensitivity in a Middle Eastern immigrant versus a native Swedish population – the MEDIM population based study

Adult‐onset diabetes in Middle Eastern immigrants to Sweden: Novel subgroups and diabetic complications—The All New Diabetes in Scania cohort diabetic complications and ethnicity

Insulin action and secretion independent of traditional risk factors predict new‐onset type 2 diabetes in Iraqi and Swedish born citizens – The MEDIM cohort study

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