Obese Children Show Ethnic Differences in Insulin Dynamics

Insulin hypersecretion and insulin resistance may be distinct phenomena among obese, non-diabetic children. Moreover, white and black children exhibit different glucose and insulin dynamics in response to oral glucose tolerance testing (OGTT), according to investigators.

Past research has shown increased insulin resistance among black children compared to whites. Black children have less visceral and more subcutaneous fat than whites, and black adults and children are less likely than whites to develop metabolic syndrome, Dr. Robert H. Lustig of the University of California San Francisco and colleagues note.

While hyperinsulinemia in obesity has been hypothesized as a reaction to insulin resistance, "controversy continues regarding which comes first: the hyperinsulinism, the insulin resistance or the obesity."

To investigate, Dr. Lustig and colleagues performed OGTT in 113 children, all of whom were above the 95th percentile for BMI for their age. The group consisted of 37 black children, 41 whites, and 35 children with hypothalamic obesity from central nervous system (CNS) insult, most of whom were white.

Caucasian children showed a greater glucose excursion than African Americans. Black children’s insulin levels rose higher in the first 30 minutes of the test and plateaued, while the white children’s insulin rose less sharply and then declined steadily.

After the researchers controlled for corrected insulin response at glucose peak (CIRgp) and other confounding factors, black children showed a 13% lower composite insulin sensitivity index (CISI) than whites. But after controlling for CISI, black children showed a 58% higher CIRgp. Children with CNS injury showed a 40% higher CIRgp and 11% higher CISI (not a significant difference) than white children without CNS injury.

These variations suggest that insulin secretion and insulin resistance "are under partially separate control," the researchers write. They conclude that "measurement of insulin dynamics may play a role in the future success of targeting pediatric obesity pharmacotherapy."

J Pediatr 2005;146:474-481.

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FACT: Drug for Black Patients With Heart Failure Nears Approval: Physicians who have steered clear of confronting racial health care inequities may be in for a reality check if the combination of isosorbide dinitrate and hydralazine (BiDil, NitroMed)—the first medication carrying a race-specific indication—receives Food and Drug Administration (FDA) approval for use in black patients with heart failure. Availability of this so-called "ethnic drug" will press the question of whether it represents a marketing maneuver involving the pharmaceutical industry, the patent system, and the FDA, or a critical step toward eliminating racial disparities in cardiac care. Doc News June, 2005

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