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Diabetes Care. 2017 Jan;40(1):85-93. doi: 10.2337/dc16-0455. Epub 2016 Nov 1.

Adiponectin, Insulin Sensitivity, β-Cell Function, and Racial/Ethnic Disparity in Treatment Failure Rates in TODAY.

Author information

1
Children's Hospital of Pittsburgh, Pittsburgh, PA.
2
Biostatistics Center, George Washington University, Rockville, MD elghorml@bsc.gwu.edu.
3
Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
4
Yale University School of Medicine, New Haven, CT.
5
Columbia University, New York, NY.
6
Massachusetts General Hospital for Children, Boston, MA.
7
University of Colorado Anschutz Medical Campus, Aurora, CO.
8
Washington University in St. Louis, St. Louis, MO.
9
Children's Hospital of Philadelphia, Philadelphia, PA.

Abstract

OBJECTIVE:

The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated that glycemic failure rates in the three treatments combined-metformin plus rosiglitazone, metformin alone, and metformin plus lifestyle-were higher in non-Hispanic blacks (NHB; 52.8%) versus non-Hispanic whites (NHW; 36.6%) and Hispanics (H; 45.0%). Moreover, metformin alone was less effective in NHB versus NHW versus H youth. This study describes treatment-associated changes in adiponectin, insulin sensitivity, and β-cell function over time among the three racial/ethnic groups to understand potential mechanism(s) responsible for this racial/ethnic disparity.

RESEARCH DESIGN AND METHODS:

TODAY participants underwent periodic oral glucose tolerance tests to determine insulin sensitivity, C-peptide index, and oral disposition index (oDI), with measurements of total and high-molecular-weight adiponectin (HMWA).

RESULTS:

At baseline NHB had significantly lower HMWA than NHW and H and exhibited a significantly smaller increase (17.3% vs. 33.7% vs. 29.9%, respectively) during the first 6 months overall. Increases in HMWA were associated with reductions in glycemic failure in the three racial/ethnic groups combined (hazard ratio 0.61, P < 0.0001) and in each race/ethnicity separately. Over time, HMWA was significantly lower in those who failed versus did not fail treatment, irrespective of race/ethnicity. There were no differences in treatment-associated temporal changes in insulin sensitivity, C-peptide index, and oDI among the three racial/ethnic groups.

CONCLUSIONS:

HMWA is a reliable biomarker of treatment response in youth with type 2 diabetes. The diminutive treatment-associated increase in HMWA in NHB (∼50% lower) compared with NHW and H may explain the observed racial/ethnic disparity with higher therapeutic failure rates in NHB in TODAY.

PMID:
27803118
PMCID:
PMC5180463
DOI:
10.2337/dc16-0455
[Indexed for MEDLINE]
Free PMC Article

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