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Ethnic and racial differences may play a role in insulin response, according to a recent study published in Diabetes Care. In a group of 153 men with type 2 diabetes put on intensive therapy, African-Americans achieved an improvement in HbA1c levels with less insulin than other ethnic groups. The differences could not be explained by differences in body weight, activity levels, use of other medicines or the insulin secretion ability of the pancreas.
The study, called the Veterans Affairs Cooperative Study (VA CSDM) compared responses of patients with type 2 diabetes of less than 15 years on two different treatment plans. One group received standard therapy consisting of one or two insulin injections per day. A second group received intensive therapy consisting of a stepped regimen of an injection of bedtime insulin in phase 1; addition of daytime glipizide in phase 2; replacement of the glipizide with two injections of insulin during the day in phase 3 or multiple injections of insulin in phase 4. The group receiving intensive therapy received weekly telephone contact, monthly visits and a comprehensive visits every three months. The group receiving standard treatment received only a visit every three months.
Both African-Americans and non-African-Americans receiving the intensive treatment had significant decreases in the fasting blood glucose levels and HbA1c levels during the 24-month follow-up period. The African-Americans required less insulin to achieve this decrease than their non-African-American counterparts.
The authors believe that pharmacological therapies have different effects in sub-groups of diabetes patients and urge physicians and researchers to assess ethnic differences in response to various treatments. Since minorities have a greater prevalence of diabetes and its microvascular complications, the authors believe that an understanding of these differences may aid in achieving better glycemic control in these populations.
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