Race/ethnicity and challenges for optimal insulin therapy

Area of Science:

• Endocrinology and Metabolism
• Diabetes Mellitus Research
• Pharmacogenomics

Background:

• Current insulin therapy guidelines do not account for racial and ethnic variations.
• Significant differences exist in body composition, diet, and energy expenditure across populations.
• These factors influence insulin sensitivity, insulin response, and glycemic response to carbohydrates.

Purpose of the Study:

• To review insulin dosing, regulation, and determinants.
• To examine glycemic response to carbohydrates across ethnicities.
• To assess the efficacy and safety of insulin therapy in diverse racial/ethnic groups.

Main Methods:

• Systematic literature search of PubMed and Google Scholar up to March 2021.
• Keywords included "ethnicity", "diabetes", "insulin", "insulin therapy", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "glycaemic response", and "efficacy and safety".
• Reference lists of identified articles were also reviewed.

Main Results:

• Race/ethnicity influences glucose metabolism and insulin regulation.
• Body size, composition, BMI, fat distribution, diet, and energy expenditure vary significantly across populations.
• Disparities in insulin sensitivity, insulin response, and glycemic response to carbohydrates exist among ethnic groups, potentially affecting insulin therapy outcomes.

Conclusions:

• Race/ethnicity is a critical factor in glucose metabolism and insulin regulation.
• International guidelines lack comprehensive racial/ethnic-specific clinical recommendations for insulin therapy.
• Urgent need for updated insulin therapy guidelines that incorporate ethnicity-specific considerations.