Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans: The Southall And Brent REvisited (SABRE) cohort

Therese Tillin; Alun D. Hughes; Ian F. Godsland; Peter Whincup; Nita G. Forouhi; Paul Welsh; Naveed Sattar; Paul M. McKeigue; Nish Chaturvedi

doi:10.2337/dc12-0544

Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans: The Southall And Brent REvisited (SABRE) cohort

Therese Tillin^*, Alun D. Hughes, Ian F. Godsland, Peter Whincup, Nita G. Forouhi, Paul Welsh, Naveed Sattar, Paul M. McKeigue, Nish Chaturvedi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE
To determine the extent of, and reasons for, ethnic differences in type 2 diabetes incidence in the U.K.

RESEARCH DESIGN AND METHODS
Population-based triethnic cohort. Participants were without diabetes, aged 40-69 at baseline (1989-1991), and followed-up for 20 years. Baseline measurements included fasting and postglucose bloods, anthropometry, and lifestyle questionnaire. Incident diabetes was identified from medical records and participant recall. Ethnic differences in diabetes incidence were examined using competing risks regression.

RESULTS
Incident diabetes was identified in 196 of 1,354 (14%) Europeans, 282 of 839 (34%) Indian Asians, and 100 of 335 (30%) African Caribbeans. All Indian Asians and African Caribbeans were first-generation migrants. Compared with Europeans, age-adjusted subhazard ratios (SHRs [95% CI]) for men and women, respectively, were 2.88 (95%, 2.36-3.53; P <0.001) and 1.91 (1.18-3.10; P = 0.008) in Indian Asians, and 2.23 (1.64-3.03; P <0.001) and 2.51 (1.63-3.87; P <0.001) in African Caribbeans. Differences in baseline insulin resistance and truncal obesity largely attenuated the ethnic minority excess in women (adjusted SHRs: Indian Asians 0.77 [0.49-1.42]; P = 0.3; African Caribbeans 1.48 [0.89-2.45]; P = 0.13), but not inmen (adjusted SHRs: Indian Asians 1.98 [1.52-2.58]; P <0.001 and African Caribbeans, 2.05 [1.46-2.89; P <0.001]).

CONCLUSIONS
Insulin resistance and truncal obesity account for the twofold excess incidence of diabetes in Indian Asian and African Caribbean women, but not men. Explanations for the excess diabetes risk in ethnic minority men remains unclear. Further study requires more precise measures of conventional risk factors and identification of novel risk factors. Diabetes Care 36:383-393, 2013

Original language	English
Pages (from-to)	383-393
Number of pages	11
Journal	Diabetes Care
Volume	36
Issue number	2
DOIs	https://doi.org/10.2337/dc12-0544
Publication status	Published - Feb 2013

Keywords / Materials (for Non-textual outputs)

RISK
SENSITIVITY
ATHEROSCLEROSIS
ETHNIC-GROUPS
C-PEPTIDE
BODY-FAT
NON-HISPANIC WHITES
CARDIOVASCULAR-DISEASE
AMERICANS
IMPAIRED GLUCOSE-TOLERANCE

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10.2337/dc12-0544

Insulin resistance and truncal obesity as important determinants of the greater incidence of diabetes in Indian Asians and African Caribbeans compared with Europeans
Copyright © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
Final published version, 1.21 MBLicence: Creative Commons: Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND)

http://care.diabetesjournals.org/content/36/2/383

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Tillin, T., Hughes, A. D., Godsland, I. F., Whincup, P., Forouhi, N. G., Welsh, P., Sattar, N., McKeigue, P. M., & Chaturvedi, N. (2013). Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans: The Southall And Brent REvisited (SABRE) cohort. Diabetes Care, 36(2), 383-393. https://doi.org/10.2337/dc12-0544

@article{62c194f2d560465c9b3b9cd0c23277ec,

title = "Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans: The Southall And Brent REvisited (SABRE) cohort",

abstract = "OBJECTIVE To determine the extent of, and reasons for, ethnic differences in type 2 diabetes incidence in the U.K. RESEARCH DESIGN AND METHODS Population-based triethnic cohort. Participants were without diabetes, aged 40-69 at baseline (1989-1991), and followed-up for 20 years. Baseline measurements included fasting and postglucose bloods, anthropometry, and lifestyle questionnaire. Incident diabetes was identified from medical records and participant recall. Ethnic differences in diabetes incidence were examined using competing risks regression. RESULTS Incident diabetes was identified in 196 of 1,354 (14%) Europeans, 282 of 839 (34%) Indian Asians, and 100 of 335 (30%) African Caribbeans. All Indian Asians and African Caribbeans were first-generation migrants. Compared with Europeans, age-adjusted subhazard ratios (SHRs [95% CI]) for men and women, respectively, were 2.88 (95%, 2.36-3.53; P <0.001) and 1.91 (1.18-3.10; P = 0.008) in Indian Asians, and 2.23 (1.64-3.03; P <0.001) and 2.51 (1.63-3.87; P <0.001) in African Caribbeans. Differences in baseline insulin resistance and truncal obesity largely attenuated the ethnic minority excess in women (adjusted SHRs: Indian Asians 0.77 [0.49-1.42]; P = 0.3; African Caribbeans 1.48 [0.89-2.45]; P = 0.13), but not inmen (adjusted SHRs: Indian Asians 1.98 [1.52-2.58]; P <0.001 and African Caribbeans, 2.05 [1.46-2.89; P <0.001]). CONCLUSIONS Insulin resistance and truncal obesity account for the twofold excess incidence of diabetes in Indian Asian and African Caribbean women, but not men. Explanations for the excess diabetes risk in ethnic minority men remains unclear. Further study requires more precise measures of conventional risk factors and identification of novel risk factors. Diabetes Care 36:383-393, 2013",

keywords = "RISK, SENSITIVITY, ATHEROSCLEROSIS, ETHNIC-GROUPS, C-PEPTIDE, BODY-FAT, NON-HISPANIC WHITES, CARDIOVASCULAR-DISEASE, AMERICANS, IMPAIRED GLUCOSE-TOLERANCE",

author = "Therese Tillin and Hughes, {Alun D.} and Godsland, {Ian F.} and Peter Whincup and Forouhi, {Nita G.} and Paul Welsh and Naveed Sattar and McKeigue, {Paul M.} and Nish Chaturvedi",

note = "The study was funded at baseline by the Medical Research Council, Diabetes UK, and the British Heart Foundation, and at follow-up by the Wellcome Trust and the British Heart Foundation. ",

year = "2013",

month = feb,

doi = "10.2337/dc12-0544",

language = "English",

volume = "36",

pages = "383--393",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "2",

}

Tillin, T, Hughes, AD, Godsland, IF, Whincup, P, Forouhi, NG, Welsh, P, Sattar, N, McKeigue, PM & Chaturvedi, N 2013, 'Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans: The Southall And Brent REvisited (SABRE) cohort', Diabetes Care, vol. 36, no. 2, pp. 383-393. https://doi.org/10.2337/dc12-0544

Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans: The Southall And Brent REvisited (SABRE) cohort. / Tillin, Therese; Hughes, Alun D.; Godsland, Ian F. et al.
In: Diabetes Care, Vol. 36, No. 2, 02.2013, p. 383-393.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans

T2 - The Southall And Brent REvisited (SABRE) cohort

AU - Tillin, Therese

AU - Hughes, Alun D.

AU - Godsland, Ian F.

AU - Whincup, Peter

AU - Forouhi, Nita G.

AU - Welsh, Paul

AU - Sattar, Naveed

AU - McKeigue, Paul M.

AU - Chaturvedi, Nish

N1 - The study was funded at baseline by the Medical Research Council, Diabetes UK, and the British Heart Foundation, and at follow-up by the Wellcome Trust and the British Heart Foundation.

PY - 2013/2

Y1 - 2013/2

N2 - OBJECTIVE To determine the extent of, and reasons for, ethnic differences in type 2 diabetes incidence in the U.K. RESEARCH DESIGN AND METHODS Population-based triethnic cohort. Participants were without diabetes, aged 40-69 at baseline (1989-1991), and followed-up for 20 years. Baseline measurements included fasting and postglucose bloods, anthropometry, and lifestyle questionnaire. Incident diabetes was identified from medical records and participant recall. Ethnic differences in diabetes incidence were examined using competing risks regression. RESULTS Incident diabetes was identified in 196 of 1,354 (14%) Europeans, 282 of 839 (34%) Indian Asians, and 100 of 335 (30%) African Caribbeans. All Indian Asians and African Caribbeans were first-generation migrants. Compared with Europeans, age-adjusted subhazard ratios (SHRs [95% CI]) for men and women, respectively, were 2.88 (95%, 2.36-3.53; P <0.001) and 1.91 (1.18-3.10; P = 0.008) in Indian Asians, and 2.23 (1.64-3.03; P <0.001) and 2.51 (1.63-3.87; P <0.001) in African Caribbeans. Differences in baseline insulin resistance and truncal obesity largely attenuated the ethnic minority excess in women (adjusted SHRs: Indian Asians 0.77 [0.49-1.42]; P = 0.3; African Caribbeans 1.48 [0.89-2.45]; P = 0.13), but not inmen (adjusted SHRs: Indian Asians 1.98 [1.52-2.58]; P <0.001 and African Caribbeans, 2.05 [1.46-2.89; P <0.001]). CONCLUSIONS Insulin resistance and truncal obesity account for the twofold excess incidence of diabetes in Indian Asian and African Caribbean women, but not men. Explanations for the excess diabetes risk in ethnic minority men remains unclear. Further study requires more precise measures of conventional risk factors and identification of novel risk factors. Diabetes Care 36:383-393, 2013

AB - OBJECTIVE To determine the extent of, and reasons for, ethnic differences in type 2 diabetes incidence in the U.K. RESEARCH DESIGN AND METHODS Population-based triethnic cohort. Participants were without diabetes, aged 40-69 at baseline (1989-1991), and followed-up for 20 years. Baseline measurements included fasting and postglucose bloods, anthropometry, and lifestyle questionnaire. Incident diabetes was identified from medical records and participant recall. Ethnic differences in diabetes incidence were examined using competing risks regression. RESULTS Incident diabetes was identified in 196 of 1,354 (14%) Europeans, 282 of 839 (34%) Indian Asians, and 100 of 335 (30%) African Caribbeans. All Indian Asians and African Caribbeans were first-generation migrants. Compared with Europeans, age-adjusted subhazard ratios (SHRs [95% CI]) for men and women, respectively, were 2.88 (95%, 2.36-3.53; P <0.001) and 1.91 (1.18-3.10; P = 0.008) in Indian Asians, and 2.23 (1.64-3.03; P <0.001) and 2.51 (1.63-3.87; P <0.001) in African Caribbeans. Differences in baseline insulin resistance and truncal obesity largely attenuated the ethnic minority excess in women (adjusted SHRs: Indian Asians 0.77 [0.49-1.42]; P = 0.3; African Caribbeans 1.48 [0.89-2.45]; P = 0.13), but not inmen (adjusted SHRs: Indian Asians 1.98 [1.52-2.58]; P <0.001 and African Caribbeans, 2.05 [1.46-2.89; P <0.001]). CONCLUSIONS Insulin resistance and truncal obesity account for the twofold excess incidence of diabetes in Indian Asian and African Caribbean women, but not men. Explanations for the excess diabetes risk in ethnic minority men remains unclear. Further study requires more precise measures of conventional risk factors and identification of novel risk factors. Diabetes Care 36:383-393, 2013

KW - RISK

KW - SENSITIVITY

KW - ATHEROSCLEROSIS

KW - ETHNIC-GROUPS

KW - C-PEPTIDE

KW - BODY-FAT

KW - NON-HISPANIC WHITES

KW - CARDIOVASCULAR-DISEASE

KW - AMERICANS

KW - IMPAIRED GLUCOSE-TOLERANCE

U2 - 10.2337/dc12-0544

DO - 10.2337/dc12-0544

M3 - Article

SN - 0149-5992

VL - 36

SP - 383

EP - 393

JO - Diabetes Care

JF - Diabetes Care

IS - 2

ER -