Different accelerators to early-onset Type 2 diabetes: a comparison of Anglo-Celtic and Chinese patients

Abstract

Aims The “accelerator hypothesis” postulates that metabolic syndrome (MS) factors—overweight and insulin resistance—increase functional demand on islets, accelerating diabetes onset to a younger age in both Type 1 and Type 2 diabetes (T2DM). Previous research has focused only on the former. We examine to what extent the MS and individual components are accelerators to the earlier onset of T2DM in Anglo-Celtic and Chinese populations. Methods A cross-sectional study of 1016 Anglo-Celtic and 1514 Chinese patients with recent-onset diabetes (duration <2 years) evaluated over a 12-year period. The MS syndrome and components were analyzed after stratification by age at presentation. Results The Anglo-Celtic group shows a high prevalence of MS in early-onset disease and a striking inverse relationship of body mass index (BMI) with age at presentation. For every increase in BMI of 1 kg/m 2, there is a reduction in the age of presentation by 0.5 years ( r=−0.3; P<.0001) .Younger groups had a higher prevalence of insulin resistance, elevated triglyceride (Tg), and low high-density lipoprotein cholesterol (HDL-C) ( P<.0001 for trend for all three indices). In contrast, the Chinese group showed no relationship between age of presentation with BMI, insulin resistance, Tg, or HDL-C. Conclusions MS factors are important accelerators for T2DM in the Anglo-Celtic but not the Chinese population. This suggests that earlier onset of pancreatic beta cell deficiency is more important as an accelerator of diabetes presentation in Chinese. These data confirm the heterogeneity of T2DM and support the need for more ethnic specific strategies in diabetes prevention.