title: Greater use of insulin by southern European compared with Anglo-Celt patients with type 2 diabetes: the Fremantle Diabetes Study.
abstract: OBJECTIVE
  To investigate the relationship between blood glucose-lowering therapy, glycaemia and ethnicity in urban Australians with type 2 diabetes.
  
  
  METHODS
  Prospective observational community-based study of diabetes care, control and complications.
  
  
  METHODS
  We analysed cross-sectional data from 1057 patients, 238 from a southern European (SE) migrant background and 819 Anglo-Celts (AC). Follow-up data were available for 539 patients (113 SE, 426 AC) who had annual reviews over 4 years.
  
  
  RESULTS
  The SE patients were of similar age to the AC patients but had longer diabetes duration, were less fluent in English and had less formal education. After adjustment for diabetes duration, glycosylated haemoglobin and glutamic acid decarboxylase antibody positivity in a logistic regression model, insulin use at study entry was approximately twice as frequent amongst SE as AC patients (odds ratio (95% confidence interval); 1.90 (1.20-3.02)). In the prospective arm, progression to insulin increased in both groups, from 18.0% at baseline to 22.1% at 4 years in SE and from 7.1% to 14.4% in AC patients. beta-cell function (%B) and insulin sensitivity (%S) using the homoeostasis model assessment in a subset of diet-treated patients at baseline showed that SE ethnicity was associated with lower %B and greater %S than in the AC group.
  
  
  CONCLUSIONS
  SE patients with early non-antibody-mediated beta-cell failure progress to insulin requirement within the first 4-5 years of type 2 diabetes. This could reflect either a longer period of undiagnosed diabetes or a more rapid loss of beta-cell function after diagnosis.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Clifford
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.forename: Carole A
authors.initials: CA
authors.lastname: Cull
authors.forename: David G
authors.initials: DG
authors.lastname: Bruce
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Batty
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy* / Q000208:ethnology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D007515:Islets of Langerhans / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014171:Transients and Migrants; D006113:United Kingdom / Q000208:ethnology; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin