A beta cell defect is responsible for the development of prediabetes and type 2 diabetes in people from East Asia, according to new research.
The study, conducted at the Seoul National University College of Medicine, South Korea, used oral glucose tolerance tests to examine pancreatic beta cell function and insulin sensitivity.
The researchers examined data from more than 4,000 South Korean adults. At the beginning of the study, all of the participants had non-diabetic blood glucose levels. They were then followed for 10 years, during which time the researchers noticed that those who developed lower glucose tolerance had impaired beta cell function prior to the study. Because of their lower beta cell function, their bodies could not compensate for decreases in insulin sensitivity.
The study did not reveal why East Asians have lower beta cell function. The reasons could be genetic, epigenetic, environmental or lifestyle related.
“It is important to preserve and enhance beta-cell function in Asian patients with type 2 diabetes,” said Kyong Soo Park, professor at the department of internal medicine, College of Medicine, and department of molecular medicine and biopharmaceutical sciences, Seoul National University, and co-author of the study. “Studies are warranted that investigate the role of pharmacologic and lifestyle interventions in enhancing beta cell functions in Asians.”
An accompanying editorial by Daisuke Yabe, MD, PhD, and Yutaka Seino, MD, of the Yutaka Seino Distinguished Centre for Diabetes Research, describes the findings as having “solidified the notion that the pathophysiology of type 2 diabetes in East Asians is unique.”
Yabe and Seino continued: “Lifestyle and pharmacological interventions should be rigorously investigated in the future to improve prevention and management of type 2 diabetes in East Asian people, and such evidence should be used to establish dedicated recommendations for this ethnic group.”
The study supports the idea that the process of type 2 diabetes development can vary significantly among ethnic groups, which may explain why some ethnicities have a higher risk of type 2 diabetes than others. It is possible that providing different treatments for different ethnic groups could yield positive results; something explored by the authors of this study. Dr. Park identified a recent meta-analysis which found that DPP-4 inhibitors were more effective in lowering HbA1c in Asian people than white people. He told Medscape Medical News:
“As DPP-4 inhibitors are suggested to work by improving beta-cell function through the incretin system, [this drug class] may have a beneficial role in glycemic control of Asian patients.
“We think that future sufficiently powered multiethnic studies among Asians are necessary to address the question.”
The findings are published in Lancet Diabetes and Endocrinology.

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