Ethnic differences in the glycemic response to exogenous insulin treatment in the veterans affairs cooperative study in type 2 diabetes mellitus (VA CSDM)

Lily Agrawal, Nicholas V. Emanuele, Carlos Abraira, William G. Henderson, Seymour R. Levin, Clark T. Sawin, Cynthia K. Silbert, Frank Q. Nuttall, John P. Comstock, John A. Colwell

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

OBJECTIVE - The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus was conducted in NIDDM patients to determine if a significant difference in HbA(1c) could be achieved between groups receiving standard and intensive treatment. We observed differences in the response to exogenous insulin between African-Americans and other intensively treated patients. Therefore, we assessed the variations of response and correlated factors that might explain such differences. RESEARCH DESIGN AND METHODS - One hundred fifty-three men aged 40-69 years with NIDDM for ≤ 15 years were randomized to either the standard therapy (n = 78) or the intensive therapy (n = 75) arm. Of the 75 patients in the intensive therapy group, 57 completed the study on insulin therapy alone. Of these, 18 were African-Americans and 39 were non-African-Americans. We conducted an analysis of the data collected to determine differences in baseline characteristics, glycemic response, insulin requirement, body weight, exercise, and basal C-peptide level, factors that may explain a difference in response to insulin therapy. RESULTS - Glycemic control improved in all patients with intensive insulin therapy African- Americans achieved a greater improvement in HbA(1c) compared with non- African-Americans with a similar increment in insulin. This difference could not be explained by differences in body weight, activity, concomitant use of other medicines, or insulin-secretory capacity of the pancreas. CONCLUSIONS - We conclude that ethnic differences may exist in the response to insulin therapy A knowledge of such differences may aid in achieving good glycemic control, especially since minorities have a greater prevalence of and burden from the microvascular complications of diabetes.

Original languageEnglish (US)
Pages (from-to)510-515
Number of pages6
JournalDiabetes care
Volume21
Issue number4
DOIs
StatePublished - Apr 28 1998

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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