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Adiponectin, Insulin Sensitivity, β-Cell Function, and Racial/Ethnic Disparity in Treatment Failure Rates in TODAY.
Citation | “Adiponectin, Insulin Sensitivity, Β-Cell Function, And Racial/Ethnic Disparity In Treatment Failure Rates In Today.”. Diabetes Care, pp. 85-93. . |
Center | Yale University |
Author | Silva Arslanian, Laure El Ghormli, Fida Bacha, Sonia Caprio, Robin Goland, Morey W Haymond, Lynne Levitsky, Kristen J Nadeau, Neil H White, Steven M Willi, TODAY Study Group |
Abstract |
OBJECTIVE: The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated that glycemic failure rates in the three treatments combined-metformin plus rosiglitazone, metformin alone, and metformin plus lifestyle-were higher in non-Hispanic blacks (NHB; 52.8%) versus non-Hispanic whites (NHW; 36.6%) and Hispanics (H; 45.0%). Moreover, metformin alone was less effective in NHB versus NHW versus H youth. This study describes treatment-associated changes in adiponectin, insulin sensitivity, and β-cell function over time among the three racial/ethnic groups to understand potential mechanism(s) responsible for this racial/ethnic disparity. RESEARCH DESIGN AND METHODS: TODAY participants underwent periodic oral glucose tolerance tests to determine insulin sensitivity, C-peptide index, and oral disposition index (oDI), with measurements of total and high-molecular-weight adiponectin (HMWA). RESULTS: At baseline NHB had significantly lower HMWA than NHW and H and exhibited a significantly smaller increase (17.3% vs. 33.7% vs. 29.9%, respectively) during the first 6 months overall. Increases in HMWA were associated with reductions in glycemic failure in the three racial/ethnic groups combined (hazard ratio 0.61, P < 0.0001) and in each race/ethnicity separately. Over time, HMWA was significantly lower in those who failed versus did not fail treatment, irrespective of race/ethnicity. There were no differences in treatment-associated temporal changes in insulin sensitivity, C-peptide index, and oDI among the three racial/ethnic groups. CONCLUSIONS: HMWA is a reliable biomarker of treatment response in youth with type 2 diabetes. The diminutive treatment-associated increase in HMWA in NHB (∼50% lower) compared with NHW and H may explain the observed racial/ethnic disparity with higher therapeutic failure rates in NHB in TODAY. |
Year of Publication |
2017
|
Journal |
Diabetes care
|
Volume |
40
|
Issue |
1
|
Number of Pages |
85-93
|
Date Published |
01/2017
|
ISSN Number |
1935-5548
|
DOI |
10.2337/dc16-0455
|
Alternate Journal |
Diabetes Care
|
PMID |
27803118
|
PMCID |
PMC5180463
|
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