Hyperinsulinemia in a Population at High Risk for Non-Insulin-Dependent Diabetes Mellitus

Steven M. Haffner, Michael P. Stern, Helen P. Haztjda, Jacqueline A. Pugh, Judith K. Patterson

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329 Scopus citations

Abstract

The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) is higher in Mexican Americans than in non-Hispanic white Americans, even after adjustment for the former's greater overall and more centralized adiposity. We postulated that this excess risk of NIDDM could be due to resistance to insulin. We performed oral glucose-tolerance tests with measurements of serum insulin concentrations in 225 Mexican Americans and 180 non-Hispanic whites without diabetes as part of the San Antonio Heart Study, a population-based study of risk factors for diabetes. Changes in serum insulin concentrations in response to the glucose challenge were quantified by the area under the serum insulin curve. Overall adiposity was characterized by body-mass index, and regional body-fat distribution by the ratio of subscapular to triceps skinfolds and the ratio of waist to hip circumference. After adjustment for these indicators of adiposity and also for differences in glucose tolerance, Mexican Americans were found to have significantly greater areas under the serum insulin curve than non-Hispanic whites. These data suggest that, like other populations at high risk for NIDDM such as Pima Indians and Micronesians, Mexican Americans have more hyperinsulinemia than can be accounted for by their adiposity. (N Engl J Med 1986; 315:220–4.), In addition to obesity, which is a well-established cause of peripheral resistance to insulin action,1 the distribution of body fat also influences resistance to insulin and the risk of non-insulin-dependent diabetes mellitus (NIDDM).2 3 4 5 6 7 Compared with non-Hispanic whites, Mexican Americans have a higher prevalence of obesity,8 9 10 a more centralized distribution of body fat,3,4 and three to five times the prevalence of NIDDM.8 9 10 The excess of NIDDM persists even after their greater overall and more centralized adiposity are taken into account.4 Other factors must therefore be operative. Diet and exercise, however, are relatively similar in Mexican Americans and non-Hispanic whites.11,12 A genetic…

Original languageEnglish (US)
Pages (from-to)220-224
Number of pages5
JournalNew England Journal of Medicine
Volume315
Issue number4
DOIs
StatePublished - Jul 24 1986

ASJC Scopus subject areas

  • Medicine(all)

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