Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults: the atherosclerosis risk in communities study: 1987-1998.
OBJECTIVE
In this study, we tested the hypothesis that fasting serum insulin is higher in nonobese black adults than in white adults and that high fasting insulin predicts type 2 diabetes equally well in both groups.


METHODS
At the baseline examination (1987-1989) of the Atherosclerosis Risk in Communities Study, fasting insulin and BMI were measured in 13,416 black and white men and women without diabetes. Participants were examined at years 3, 6, and 9 for incident diabetes based on fasting glucose and American Diabetes Association criteria.


RESULTS
Fasting insulin was 19.7 pmol/l higher among nonobese (BMI <30 kg/m(2)) black women compared with white women (race and obesity interaction term, P < 0.01). There were no differences among men. Among nonobese women, the relative risk for developing diabetes was similar between racial groups: 1.4 (95% CI 1.2-1.5) and 1.3 (1.2-1.4) per 60 pmol/l increase in insulin (P < 0.01) for black and white women, respectively (interaction term, P = 0.6). Findings were similar among men. Adjusting for established risk factors did not attenuate this association.


CONCLUSIONS
Nonobese black women have higher fasting insulin levels than nonobese white women, and fasting insulin is an equally strong predictor of diabetes in both groups. These results suggest one mechanism to explain the excess incidence of diabetes in nonobese black women but do not explain the excess among black men. Future research should evaluate additional factors: genetic, environmental, or the combination of both, which might explain higher fasting insulin among black women when compared with white women.
Carnethon
Mercedes R
MR
Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Stanford, California 94304, USA. carnethon@stanford.edu
Palaniappan
Latha P
LP
Burchfiel
Cecil M
CM
Brancati
Frederick L
FL
Fortmann
Stephen P
SP
D015415:Biomarkers; D044383:Black People; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D005215:Fasting; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis / Q000208:ethnology*; D015994:Incidence; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity; D011237:Predictive Value of Tests; D012307:Risk Factors; D044465:White People
D015415:Biomarkers; D007328:Insulin