More Race in Medicine: The Multiracial Advocacy

The Ethnic Gap in Diabetes The risk of diabetes may be different for people from different racial and ethnic backgrounds....  But when does this gap begin? Findings from a recent study showed that ethnic differences in diabetes risk can be spotted even before people develop full-blown diabetes. The authors concluded, "Ethnic differences can be detected at both the early and later stages of the diabetes disease process." Carlos Lorenzo, MD, and his colleagues from the University of Texas Health Science Center wanted to see if ethnic differences in diabetes risk started early in the diabetes disease process. Dr. Lorenzo and colleagues compared the risks of impaired glucose tolerance, impaired fasting glucose and diabetes between Mexican Americans and non-Hispanic whites. They found that Mexican Americans were 1.48 times more likely to have impaired glucose tolerance and 1.71 times more likely to have impaired fasting glucose, compared to whites. In addition, Mexican Americans were 2.20 times more likely than whites to develop diabetes, even among participants who started the study with normal 2-hour glucose (a measure of blood sugar levels 2 hours after eating a glucose load). Obesity also played a role in the relationship between ethnicity and the risk of developing impaired glucose tolerance or diabetes. Among non-obese participants, Mexican Americans had a higher risk of impaired glucose tolerance or diabetes. Among obese participants, however, these risks were similar between Mexican Americans and whites. Even though whites generally had a lower risk of prediabetes and diabetes, their risk became similar to that of Mexican Americans when they became obese This study included 3,015 Mexican Americans and non-Hispanic whites between 25 and 64 years of age. Source: Diabetes Care, Aug. 24, 2012

Multiracial Exercise?

Once again, we wonder how many of these white and black girls are actually multiracial.  Excluded from studies one more time.

Benefits of Exercise Show Racial Differences

By Hannah Sacks

While exercise may be beneficial in combating obesity in adolescents, a new study suggests physical activity may be less successful in preventing obesity in black girls than in their white counterparts.

The study, published in the Archives of Pediatrics and Adolescent Medicine, examines the levels of physical activity and obesity of more than 1,100 girls at ages 12 and 14. The racial split was 538 black girls and 610 white ones.

Measurements of obesity include Centers for Disease Control and Prevention definitions of obesity, the International Obesity Task Force body mass index cut points, and the sums of skin-fold thickness. The study also compares participants' physical activity and food intake, reports the Los Angeles Times.

Based on the girls' level of physical activity, they were divided into lower and upper halves within their respective racial categories. Twelve-year-old white girls in the upper half were 85 percent less likely to become obese at age 14 than their white peers in the bottom half. However, black girls in the top half were only 15 percent less likely to be obese two years later than black girls in the lower half, reports the Times.

The study concludes by suggesting that obesity preventions aimed at black girls may need to be adapted to account for their decreased sensitivity to the effects of physical activity.
Authors James White of Cardiff University and Russell Jago of the University of Bristol write that their results "suggest that prompting adolescent girls to be active may be important to prevent obesity but that using different approaches ... may be necessary to prevent obesity in black girls."
Source: Education Week

Multiracial, Race, Ethnicity and Drugs: Major Health News

Comment from Susan Graham: This is very big news that shows black adults with diabetes benefit specifically from a drug. However, it also leaves the question of what about the multiracial population? AACE: The First Study to Show That an Ethnic Group Can Gain Benefits from a DPP-4 Compound

The dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin (Tradjenta, Boehringer Ingelheim and Lilly) is associated with significant improvements in glycated hemoglobin (HbA1c) in black patients with type 2 diabetes....

"We found that this drug had clinically significant and clinically relevant reductions in all measures of hyperglycemia that we looked at," said lead researcher James Thrasher, MD, from the Arkansas Diabetes and Endocrinology Center in Little Rock. The study was sponsored by the drug's manufacturers. The multicenter, randomized, placebo-controlled, double-blind trial -- the first study of a DPP-4 inhibitor specifically conducted in black adults -- showed that linagliptin 5 mg once daily reduced HbA1c by 0.88% over 24 weeks, compared with 0.24% with placebo (P = .0002). Black adults tend to suffer from diabetes at a higher rate than white non-Hispanic adults, and "they have higher rates of complications," said Dr. Thrasher during a press conference. "In most clinical trials, the majority of participants are white non-Hispanic patients. We wanted to do this first-of-a-kind study of a DPP-4 inhibitor to look at a minority group, specifically blacks," he said. "This is...something relatively new for us to do, to look at ethnic groups specifically with a clinical trial and a drug." The study involved 226 patients who were randomized to linagliptin 5 mg (n = 106) or placebo (n = 120) once daily for 24 weeks. Slightly more than half (54%) of the patients were men, mean age was 54 years, and mean body mass index was 32.7 kg/m². Almost three quarters (72%) of the patients had hypertension, and most patients were on metformin or a sulfonylurea, which they continued throughout the study period. The remaining 12% were treatment-naïve. HbA1c levels were similar in the linagliptin and placebo groups at baseline (8.63% vs 8.70%), and were measured every 6 weeks during the study.Patients who had a baseline HbA1c measurement and at least 1 post-baseline measurement (n = 200) were included in the efficacy analysis; those who received at least 1 dose of the study drug were included in the safety analysis.In terms of efficacy, HbA1c levels were significantly different at 6 weeks, and remained so for the rest of the study. Patients in the linagliptin group were significantly more likely than those in the placebo group to see an HbA1c reduction of 0.5% by week 24 (55.3% vs 28.3%; P < .0001). In addition, significantly more patients in the linagliptin group than in the placebo group achieved an HbA1c level below 7.0% (28.0% vs 8.7%; P = .001), a target recommended by the American Diabetes Association. The rates of adverse events were similar in the 2 groups, were mostly mild or moderate, and were considered to be unrelated to the study drug. The most common adverse events were hyperglycemia (2.8% with linagliptin and 9.2% with placebo) and nasopharyngitis (3.8% with linagliptin and 5.0% with placebo). Researcher-defined hypoglycemia occurred in 3 patients in the linagliptin group and in 1 patient in the placebo group; none of the events required external assistance. "In this high-risk group, this is a drug that's efficacious, has a similar side-effect profile to placebo, and is a treatment option for patients who have inadequate control of their type 2 diabetes," concluded Dr. Thrasher. Presented at the American Association of Clinical Endocrinologist (AACE) May 24, 2012. Abstract 206.