22 January 2019
Insulin resistance (IR) leads to high blood glucose levels due to an inability to use the hormone eﬀectively, and is generally considered a hallmark of type II diabetes. A new study, however, shows that IR may not occur together with type II diabetes in Saudis as often as it does in other populations.
Blood analyses of 107 Saudis with type II diabetes and 101 non-diabetic controls revealed that only 47% of the diabetic group had IR. A study published in 1994 examining more than 5,000 people in the UK with type II diabetes had reported a much higher prevalence of association in other populations: 81% for Asians of Indian origin, 77% for Caucasians and 73% for Afro-Caribbeans.
The analysis also conﬁrmed an association between IR and the ‘hunger hormone’ ghrelin. Released mainly by the stomach, ghrelin influences appetite, body weight and glucose metabolism. High ghrelin levels decrease total body fat by raising the expression of insulin receptors in adipose tissue. As expected, Saudis with diabetes had signiﬁcantly lower levels of plasma ghrelin than controls. But more speciﬁcally, ghrelin levels were signiﬁcantly lower in people when type II diabetes was associated with IR.
Despite the small sample size and the possible inﬂuence of therapeutic treatment, which could have obscured the real IR rate, the study highlights the need to further investigate IR prevalence in Saudi Arabia and diﬀerentiate patients accordingly. “Some anti-diabetic drugs are used to overcome the eﬀects of IR, but the management of type II diabetes with and without IR should vary. Therefore, to track the disease progress, we advise the parallel screening for IR, together with diabetes, after the age of 45,” says Hayder Giha of the Arabian Gulf University College of Medicine and Medical Sciences in Bahrain, who conducted the study in collaboration with colleagues at Saudi Arabia’s National Guard Health Aﬀairs.
- Qarni, A., Ahmed, A., Joatar, F. E., Das, N., Awad, M., Eltayeb, M., ... & Gumaa, K. Association of plasma ghrelin levels with insulin resistance in type 2 diabetes mellitus among Saudi subjects. Endocrinology and Metabolism, 32, 230-240 (2017). | article
- UK Prospective Diabetes Study Group. UK Prospective Diabetes Study. XII: Differences between Asian, Afro-Caribbean and white Caucasian type 2 diabetic patients at diagnosis of diabetes. Diabet Med 1994; 11:670-7. | article