Understanding the High Prevalence of Diabetes in U.S. South Asians Compared With Four Racial/Ethnic Groups: The MASALA and MESA Studies
Open Access
- 10 May 2014
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 37 (6), 1621-1628
- https://doi.org/10.2337/dc13-2656
Abstract
OBJECTIVE: We compared South Asians with four other racial/ethnic groups in the U.S. to determine whether sociodemographic, lifestyle, or metabolic factors could explain the higher diabetes prevalence and whether insulin resistance and β-cell dysfunction occurred at younger ages and/or lower adiposity levels compared with other groups. RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis of two community-based cohorts, the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and the Multi-Ethnic Study of Atherosclerosis (MESA); all participants had no known cardiovascular disease and were between 44 and 84 years of age. We compared 799 South Asians with 2,611 whites, 1,879 African Americans, 1,493 Latinos, and 801 Chinese Americans. Type 2 diabetes was classified by fasting plasma glucose ≥126 mg/dL or use of a diabetes medication. Insulin resistance was estimated by the homeostasis model assessment (HOMA) and β-cell function was measured by the HOMA-β model. RESULTS: South Asians had significantly higher age-adjusted prevalence of diabetes (23%) than the MESA ethnic groups (6% in whites, 18% in African Americans, 17% in Latinos, and 13% in Chinese Americans). This difference increased further after adjustment for potential confounders. HOMA of insulin resistance (HOMA-IR) levels were significantly higher and HOMA-β levels were lower among South Asians compared with all other racial/ethnic groups after adjustment for age and adiposity. CONCLUSIONS: The higher prevalence of diabetes in South Asians is not explained by traditionally measured risk factors. South Asians may have lower β-cell function and an inability to compensate adequately for higher glucose levels from insulin resistance.Keywords
This publication has 38 references indexed in Scilit:
- Elevated Rates of Diabetes in Pacific Islanders and Asian SubgroupsDiabetes Care, 2013
- Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With EuropeansDiabetes Care, 2013
- CARRS Surveillance study: design and methods to assess burdens from multiple perspectivesBMC Public Health, 2012
- Globalization of DiabetesDiabetes Care, 2011
- Trends in the Prevalence of Type 2 Diabetes in Asians Versus WhitesDiabetes Care, 2011
- Ethnicity and Sex Affect Diabetes Incidence and OutcomesDiabetes Care, 2010
- Prevalence and Correlates of Diabetes in South Asian Indians in the United States: Findings From the Metabolic Syndrome and Atherosclerosis in South Asians Living in America Study and the Multi-Ethnic Study of AtherosclerosisMetabolic Syndrome and Related Disorders, 2010
- High Prevalence of Diabetes and Cardiovascular Risk Factors Associated With Urbanization in IndiaDiabetes Care, 2008
- Metabolic Consequences of Obesity and Body Fat Pattern: Lessons from Migrant StudiesPublished by Wiley ,2007
- Body mass index and percent body fat: a meta analysis among different ethnic groupsInternational Journal of Obesity, 1998