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, MD, FACE,
- Nicholas V Emanuele, MD,
- Carlos Abraira, MD,
- William G Henderson, PHD,
- Seymour R Levin, MD,
- Clark T Sawin, MD,
- Cynthia K Silbert, MD,
- Frank Q Nuttall, MD, PHD,
- John P Comstock, MD, PHD,
- John A Colwell, MD, PHD and
- VA CSDM Group
- Endocrinology/Diabetes Section, Hines VA Hospital Hines, Illinois
- Metabolism Division, Medical Service, and the Cooperative Studies Program Coordinating Center, Hines VA Hospital Hines, Illinois
- Special Diagnostic and Treatment Center, Medicine, Wadsworth VA Medical Center Los Angeles, California
- Endocrine-Diabetes Section, VA Medical Center Boston, Massachusetts
- Endocrinology Section, Medical Service, VA Medical Center Minneapolis, Minnesota
- VA Medical Center Houston, Texas
- Endocrinology Division, Diabetes Center, Medical University of South Carolina Charleston, South Carolina
- Address correspondence and reprint requests to Lily Agrawal, MD, Endocrinology/Diabetes Section (111A), Hines VA Hospital, Roosevelt Rd. and Fifth Ave., Box 5000, Bldg. 200, Rm. 1226, Hines, IL 60141-5000
Abstract
OBJECTIVE The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus was conducted in NIDDM patients to determine if a significant difference in HbA1c 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 HbA1c 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.
- Received July 29, 1997.
- Accepted January 7, 1998.
- Copyright © 1998 by the American Diabetes Association
