Diabetes susceptibility in ethnic minority groups from Turkey, Vietnam, Sri Lanka and Pakistan compared with Norwegians - the association with adiposity is strongest for ethnic minority women

<p>Abstract</p> <p>Background</p> <p>The difference in diabetes susceptibility by ethnic background is poorly understood. The aim of this study was to assess the association between adiposity and diabetes in four ethnic minority groups compared with Norwegians, and take into account confounding by socioeconomic position.</p> <p>Methods</p> <p>Data from questionnaires, physical examinations and serum samples were analysed for 30-to 60-year-olds from population-based cross-sectional surveys of Norwegians and four immigrant groups, comprising 4110 subjects born in Norway (n = 1871), Turkey (n = 387), Vietnam (n = 553), Sri Lanka (n = 879) and Pakistan (n = 420). Known and screening-detected diabetes cases were identified. The adiposity measures BMI, waist circumference and waist-hip ratio (WHR) were categorized into levels of adiposity. Gender-specific logistic regression models were applied to estimate the risk of diabetes for the ethnic minority groups adjusted for adiposity and income-generating work, years of education and body height used as a proxy for childhood socioeconomic position.</p> <p>Results</p> <p>The age standardized diabetes prevalence differed significantly between the ethnic groups (women/men): Pakistan: 26.4% (95% CI 20.1-32.7)/20.0% (14.9-25.2); Sri Lanka: 22.5% (18.1-26.9)/20.7% (17.3-24.2), Turkey: 11.9% (7.2-16.7)/12.0% (7.6-16.4), Vietnam: 8.1% (5.1-11.2)/10.4% (6.6-14.1) and Norway: 2.7% (1.8-3.7)/6.4% (4.6-8.1). The prevalence increased more in the minority groups than in Norwegians with increasing levels of BMI, WHR and waist circumference, and most for women. Highly significant ethnic differences in the age-standardized prevalence of diabetes were found for both genders in all categories of all adiposity measures (<it>p </it>< 0.001). The Odds Ratio (OR) for diabetes adjusted for age, WHR, body height, education and income-generating work with Norwegians as reference was 2.9 (1.30-6.36) for Turkish, 2.7 (1.29-5.76) for Vietnamese, 8.0 (4.19-15.14) for Sri Lankan and 8.3 (4.37-15.58) for Pakistani women. Men from Sri Lanka and Pakistan had identical ORs (3.0 (1.80-5.12)).</p> <p>Conclusions</p> <p>A high prevalence of diabetes was found in 30-to 60-year-olds from ethnic minority groups in Oslo, with those from Sri Lanka and Pakistan at highest risk. For all levels of adiposity, a higher susceptibility for diabetes was observed for ethnic minority groups compared with Norwegians. The association persisted after adjustment for socioeconomic position for all minority women and for men from Sri Lanka and Pakistan.</p

Designing an e-Health Program for Lifestyle Changes in Diabetes Care A Qualitative Pre-Study in Norway

Type 2 diabetes mellitus (T2D) and prediabetes prevalence rates are high. Consequences are serious, but current treatment is often not efficient for achieving remission. Remission may be achieved through lifestyle intervention. Frequent follow-up is necessary, and health care personnel (HCP) lack resources, time, and often adequate knowledge. Self-management of T2D can benefit from better use of Information and Communication Technologies (ICT), which may improve patient involvement and follow-up, and can provide new tools for lifestyle change. Virtual follow-up through ICT with HCP may reduce costs and reach more patients. An electronic health (e-health) program for T2D and prediabetes will be developed in collaboration with users, as part of a plan for a large randomized controlled trial (RCT)

Potential Mechanisms for How Long-Term Physical Activity May Reduce Insulin Resistance

Insulin became available for the treatment of patients with diabetes 100 years ago, and soon thereafter it became evident that the biological response to its actions differed markedly between individuals. This prompted extensive research into insulin action and resistance (IR), resulting in the universally agreed fact that IR is a core finding in patients with type 2 diabetes mellitus (T2DM). T2DM is the most prevalent form of diabetes, reaching epidemic proportions worldwide. Physical activity (PA) has the potential of improving IR and is, therefore, a cornerstone in the prevention and treatment of T2DM. Whereas most research has focused on the acute effects of PA, less is known about the effects of long-term PA on IR. Here, we describe a model of potential mechanisms behind reduced IR after long-term PA to guide further mechanistic investigations and to tailor PA interventions in the therapy of T2DM. The development of such interventions requires knowledge of normal glucose metabolism, and we briefly summarize an integrated physiological perspective on IR. We then describe the effects of long-term PA on signaling molecules involved in cellular responses to insulin, tissue-specific functions, and whole-body IR

Glucose and fat metabolism in Nordic and South Asian subjects with type 2 diabetes.

<p>A) Glucose metabolism per kg fat free mass (FFM). Median [inter-quartile range] values of basal and clamp glucose delivery, both from non-oxidative glucose metabolism (NOGM) and oxidative glucose metabolism (OGM) B) Fat oxidation per kg fat free mass (FFM). Mean (standard error of mean) values in basal and clamp conditions. NOR = Nordic, SA = South Asians. Comparisons beween ethnic groups are Student’s <i>t</i>-tests or Mann-Whitney U tests as appropriate. Comparisons between basal and clamp values are paired samples <i>t</i>-tests, after log-transformation where appropriate.</p

Correlations to endogenous glucose production during clamp.

<p>Data are presented as Spearman’s correlation coefficients (r_s) with corresponding <i>p</i>-values. Significant correlations in bold. NOR: Nordic, SA: South Asians.</p

Basal and Clamp Indirect Calorimetry.

<p>Data are presented as mean ± standard deviation or median [inter-quartile range]. <i>p</i>-values from Student’s <i>t</i>-tests or Mann-Whitney U tests as appropriate. NOR: Nordic, SA: South Asians, FFM: fat free mass, REE: resting energy expenditure, EE_clamp: energy expenditure during clamp, RQ: respiratory quotient, ΔRQ: change in respiratory quotient from basal to clamp conditions.</p

Anthropometrical and biochemical characteristics.

<p>Data are presented as mean ± standard deviation or median [inter-quartile range]. NOR: Nordic, SA: South Asians, BMI: body mass index, TBF: total body fat, FFM: fat free mass, FM: fat mass, 25(OH)vitamin D: 25-hydroxyvitamin D. <i>p-</i>values are from Student's <i>t</i>-test.</p><p>^a = Student's <i>t-</i>test after Log-transformation.</p

Description of patients.

<p>Data are presented as number (percentage) or as mean ± standard deviation. <i>p</i>-values from <i>^a</i>Student's t-test or <i>^b</i>Chi square test. OAD: oral antidiabetic agent, GLP-1: Glucagon-like peptid 1 analogue. Microalb.: microalbuminuria. Other complications include ophthalmopathy, neuropathy, diabetic foot, sexual dysfunction and periodontal disease. NOR = Nordic, SA = South Asians.</p

Inclusion and exclusion criteria.

<p>Main inclusion and exclusion criteria. GAD: glutamic acid decarboxylase, IA2: protein tyrosine phosphatase, GFR: glomerular filtration rate, ASAT: aspartate amino transferase, ALAT: alanine amino transferase, BMI: body mass index.</p

Endogenous glucose production, insulin sensitivity and insulin secretion.

<p>Data are presented as mean ± standard deviation or median [inter-quartile range]. <i>p</i>-values from Student’s <i>t</i>-tests or Mann-Whitney U tests as appropriate. NOR: Nordic, SA: South Asians, EGP: endogenous glucose production, FFM: fat free mass, TGD: total glucose disposal, GIR: glucose infusion rate, AIRg: acute insulin response to glucose, AUC: area under the curve (from 0–8 minutes and 0–30 minutes of the intra-venous glucose tolerance test). For LogAIRg _{0–8 min} n = 36 NOR and 16 SA, and for LogAIRg_{0–30 min} n = 40 NOR and 17 SA.</p