Type 2 diabetes (T2D) is a global public health priority, particularly for populations of black African-Caribbean ethnicity, who suffer disproportionately high rates of the disease. While the mechanisms underlying the development of T2D are well documented, there is growing evidence describing distinctions among black African-Caribbean populations. In the present paper, we review the evidence describing the impact of black African-Caribbean ethnicity on T2D pathophysiology. Ethnic differences were first recognised through evidence that metabolic syndrome diagnostic criteria fail to detect T2D risk in black populations due to less central obesity and dyslipidaemia. Subsequently more detailed investigations have recognised other mechanistic differences, particularly lower visceral and hepatic fat accumulation and a distinctly hyperinsulinaemic response to glucose stimulation. While epidemiological studies have reported exaggerated insulin resistance in black populations, more detailed and direct measures of insulin sensitivity have provided evidence that insulin sensitivity is not markedly different to other ethnic groups and does not explain the hyperinsulinaemia that is exhibited. These findings lead us to hypothesise that ectopic fat does not play a pivotal role in driving insulin resistance in black populations. Furthermore, we hypothesise that hyperinsulinaemia is driven by lower rates of hepatic insulin clearance rather than heightened insulin resistance and is a primary defect rather than occurring in compensation for insulin resistance. These hypotheses are being investigated in our ongoing South London Diabetes and Ethnicity Phenotyping study, which will enable a more detailed understanding of ethnic distinctions in the pathophysiology of T2D between men of black African and white European ethnicity.

Associations between ferritin and insulin sensitivity have been described in recent studies. The possible association showed conflicting results by sex and menopausal status. We aimed to investigate the cross-sectional association of ferritin levels with insulin resistance and β-cell function. A total of 2518 participants (1033 men, 235 pre-menopausal women and 1250 post-menopausal women) were enrolled from the Changfeng Study. A standard interview was conducted, as well as anthropometric measurements and laboratory analyses, for each participant. The serum ferritin level was measured using electrochemiluminescence immunoassay. Insulin resistance and β-cell function indices were derived from a homeostasis model assessment. The results showed that the serum ferritin levels were 250·4 (sd 165·2), 94·6 (sd 82·0) and 179·8 (sd 126·6) ng/ml in the men, pre-menopausal and post-menopausal women, respectively. In fully adjusted models (adjusting for age, current smoking, BMI, waist:hip ratio, systolic blood pressure, diastolic blood pressure, TAG, HDL-cholesterol, LDL-cholesterol, log urine albumin:creatinine ratio, leucocytes, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transpeptidase), serum ferritin concentrations are significantly associated with insulin resistance in men and post-menopausal females, and the null association was observed in pre-menopausal females. Interestingly, an increased β-cell function associated with higher ferritin was observed in post-menopausal participants, but not in male participants. In conclusion, these results suggested that elevated serum ferritin levels were associated with surrogate measures of insulin resistance among the middle-aged and elderly male and post-menopausal women, but not in pre-menopausal women.

Serum 25-hydroxyvitamin D (25(OH)D) concentrations have been reported to increase following weight loss. Moreover, both weight loss and higher serum 25(OH)D concentrations have been associated with a lower risk of developing type 2 diabetes. The objective of the present study was to determine whether the increase in serum 25(OH)D concentration following weight loss is associated with improved insulin sensitivity, insulin secretion and disposition index (β-cell function). Data from two prospective lifestyle modification studies had been combined. Following a lifestyle-modifying weight loss intervention for 1 year, eighty-four men and women with prediabetes and a BMI ≥ 27 kg/m2 were divided based on weight loss at 1 year: < 5 % (non-responders, n 56) and ≥ 5 % (responders, n 28). The association between the change in serum 25(OH)D concentration and changes in insulin sensitivity (homeostasis model assessment of insulin sensitivity (HOMA%S) and Matsuda), insulin secretion (AUC of C-peptide) and disposition index after adjustment for weight loss was examined. Participants in the responders' group lost on average 9·5 % of their weight when compared with non-responders who lost only 0·8 % of weight. Weight loss in responders resulted in improved insulin sensitivity (HOMA%S, P= 0·0003) and disposition index (P= 0·02); however, insulin secretion remained unchanged. The rise in serum 25(OH)D concentration following weight loss in responders was significantly higher than that in non-responders (8·9 (sd 12·5) v. 3·6 (sd 10·7) nmol/l, P= 0·05). However, it had not been associated with amelioration of insulin sensitivity and β-cell function, even after adjustment for weight loss and several confounders. In conclusion, the increase in serum 25(OH)D concentration following weight loss does not contribute to the improvement in insulin sensitivity or β-cell function.

The aim of the present study was to evaluate the anti-diabetic mechanism of Asparagus officinalis, a dietary agent used for the management of diabetes. Streptozotocin (90 mg/kg) was injected in 2-d-old Wistar rat pups to induce non-obese type 2 diabetes. After confirmation of diabetes on the 13th week, diabetic rats were treated with a methanolic extract of A. officinalis seeds (250 and 500 mg/kg per d) or glibenclamide for 28 d. After the treatment, fasting blood glucose, serum insulin and total antioxidant status were measured. The pancreas was examined by haematoxylin–eosin staining and immunostained β- and α-cells were observed using a fluorescence microscope. Treatment of the diabetic rats with the A. officinalis extract at doses of 250 and 500 mg/kg suppressed the elevated blood glucose in a dose- and time-dependent manner. The 500 mg/kg, but not 250 mg/kg, dose significantly improved serum insulin levels in the diabetic rats. The insulin:glucose ratio was significantly increased at both doses in the A. officinalis-treated rats. Both qualitative and quantitative improvements in β-cell function were found in the islets of the A. officinalis-treated rats. The extract showed potent antioxidant activity in an in vitro assay and also improved the total antioxidant status in vivo. In most cases, the efficacy of A. officinalis (500 mg/kg) was very similar to a standard anti-diabetic drug, glibenclamide. Thus, the present study suggests that A. officinalis extract exerts anti-diabetic effects by improving insulin secretion and β-cell function, as well as the antioxidant status.

The objective of the present study was to investigate the changes in glucose and insulin metabolism in nutritionally stunted children that can be involved in the appearance of chronic diseases in adulthood. For this purpose, sixty-one children were selected, thirty-five boys and twenty-six girls, residents of slums in S˜o Paulo, Brazil. The children were classified according to the height-for-age as stunted (1·5 Z-score; n 21) or non-stunted (≥1·5 Z-score; n 40). The glucose and insulin plasma levels were determined and, from these values, the indexes that evaluate the pancreatic ·-cell function (homeostasis model assessment (HOMA-B)) and insulin sensitivity (HOMA-S) were assessed. Stunted children showed lower values of fasting insulin than those of the non-stunted group (boys: 29·7 (SD 14·9) v. 5=·4 (SD 29·2) pmol/l, P=·019; girls: 34·4 (SD 12·6) v. 62·3 (SD 28·7) pmol/l, P=·016) but the glucose levels were similar (boys: 4·6 (SD =·3) v. 4·5 (SD =·3) mmol/l; girls: 4·2 (SD =·3) v. 4·4 (SD =·3) mmol/l). Stunted children showed lower HOMA-B values (boys: 83 (SD 22) % v. 115 (SD 36) %, P=·011; girls: 107 (SD 23) % v. 144 (SD 46) %, P=·045) and higher HOMA-S values (boys: 196 (SD 92) % v. 120 (SD 62) %, P=·014; girls: 159 (SD 67) % v· 98 (SD 57) %, P=·016). The results show a decreased activity of μ-cell function and increased insulin sensitivity in stunted children. The decreased b-cell function of this group may strongly predict type 2 diabetes.