Understanding the high prevalence of diabetes in U.S. south Asians compared with four racial/ethnic groups: the MASALA and MESA studies

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.

Figure 1

Median (95% CI) HOMA-IR and HOMA-β values adjusted by sex, age, clinical site, fasting glucose level, BMI, waist circumference, physical activity levels, smoking, and alcohol use; excludes those on any diabetes medications; the MASALA and MESA studies. *P < 0.001 in comparison to South Asians.

Figure 2

Association between age and insulin resistance (A) and β-cell function (B) in the five racial/ethnic groups adjusted for sex and clinical site; excludes those on any diabetes medications; the MASALA and MESA studies.

Figure 3

Association between BMI (A and B) and waist circumference (C and D) with insulin resistance (left panels) and β-cell function (right panels); adjusted for sex, age, and site; excludes those on any diabetes medications; MASALA and MESA studies. P for interaction <0.001 for each figure.