Parental history of type 2 diabetes is associated with lower resting energy expenditure in normoglycemic subjects

ObjectiveResting energy expenditure (REE) is linked to obesity, insulin resistance and type 2 diabetes (T2DM). REE and T2DM are inherited traits. Therefore, we investigated the effect of parental T2DM on REE in normoglycemic subjects.MethodsEighty-seven subjects with parental T2DM and 83 subjects without parental T2DM were matched in age, gender, race, BMI, weight and waist circumference. Subjects underwent a 75 g oral glucose tolerance test; REE was determined by indirect calorimetry and body composition was assessed by dual energy X-ray absorptiometry. Statistical analysis was performed using Student’s t-test, analysis of variance and regression analysis.ResultsThe mean age was 38.8±11.3 years, 57% were females and 53% were African-Americans. The mean BMI was 28.5±6.1 kg/m2, waist circumference 91.8±15.1 cm, weight 83.9±20.3 kg, fat mass 31.0%±10.0%, mean fat-free mass (FFM) 54.4±12.9 kg. REE was significantly lower in subjects with parental diabetes, normalized REE 1364.4±263.4Kcal/day vs 1489.4±323.2 Kcal/day, p=0.006 and 29.2±5.3Kcal/kg FFM/day vs 31.9±6.0 Kcal/kg FFM/day, p=0.002. African-Americans had a lower REE compared with Caucasians 28.6±5.4Kcal/kg FFM/day vs 32.6±5.5 Kcal/kg FFM/day, p<0.0001. In a multiple regression model, ethnicity (p<0.0001), parental history of T2DM (p=0.006) and FFM (p=0.021) were independent predictors of REE.ConclusionCompared with subjects without parental diabetes, offspring with parental T2DM had lower REE, which was more pronounced in African-Americans. This metabolic alteration could increase the risk of obesity, insulin resistance and dysglycemia.

Parental History of Type 2 Diabetes Abrogates Ethnic Disparities in Key Glucoregulatory Indices

Context There are ethnic differences in glucoregulation and prevalence of type 2 diabetes, but studies on the role of genetics in modifying ethnic effects in normoglycemic African-Americans and Caucasians are limited. Therefore, we investigated glucoregulation in normoglycemic African-Americans and Caucasians with or without parental diabetes. Design Fifty subjects with parental diabetes (from the Pathobiology of Prediabetes in a Biracial Cohort Study) and 50 subjects without parental diabetes were matched in age, sex, ethnicity, and body mass index (BMI). Subjects underwent a 75-g oral glucose tolerance test (OGTT), physical examination, anthropometry, biochemistries, indirect calorimetry and assessment of body composition, insulin sensitivity by euglycemic clamp (Si-clamp), and β-cell function by Disposition index. Results The mean age was 40.5 ± 11.6 years, BMI 28.7 ± 5.9 kg/m2, fasting plasma glucose 90.2 ± 5.9 mg/dL, and 2-hour postglucose 120.0 ± 26.8 mg/dL. Offspring with parental diabetes showed higher glycemic excursion during OGTT–area under the curve–glucose (16,005.6 ± 2324.7 vs 14,973.8 ± 1819.9, P &lt; 0.005), lower Si-clamp (0.132 ± 0.068 vs 0.162 ± 0.081 µmol/kg fat-free mass/min/pmol/L, P &lt; 0.05), and lower Disposition index (8.74 ± 5.72 vs 11.83 ± 7.49, P &lt; 0.05). Compared with lean subjects without parental diabetes, β cell function was lower by ∼30% in lean subjects with parental diabetes, ∼40% in obese subjects without parental diabetes, and ∼50% in obese individuals with parental diabetes (P &lt; 0.0001). African-Americans without parental diabetes had ∼40% lower insulin sensitivity (P &lt; 0.001), twofold higher acute insulin secretion (P &lt; 0.001), but ∼30% lower Disposition index (P &lt; 0.01) compared with Caucasians without parental diabetes. Remarkably, there were no significant differences by ethnicity in these glucoregulatory measures among subjects with parental diabetes. Conclusion Offspring with parental diabetes harbor substantial impairments in glucoregulation compared with individuals without parental diabetes. Ethnic disparities in glucoregulation were abrogated by parental diabetes.

Parental Diabetes Behaviors and Distress Are Related to Glycemic Control in Youth with Type 1 Diabetes: Longitudinal Data from the DINO Study

Objective. To evaluate (1) the longitudinal relationship between parental well-being and glycemic control in youth with type 1 diabetes and (2) if youth’s problem behavior, diabetes parenting behavior, and parental diabetes-distress influence this relationship. Research Design and Methods. Parents of youth 8–15 yrs (at baseline) (N=174) participating in the DINO study completed questionnaires at three time waves (1 yr interval). Using generalized estimating equations, the relationship between parental well-being (WHO-5) and youth’s HbA1c was examined. Second, relationships between WHO-5, Strength and Difficulties Questionnaire (SDQ), Diabetes Family Behavior Checklist (DFBC), Problem Areas In Diabetes-Parent Revised (PAID-Pr) scores, and HbA1c were analyzed. Results. Low well-being was reported by 32% of parents. No relationship was found between parents’ WHO-5 scores and youth’s HbA1c (β=−0.052, p=0.650). WHO-5 related to SDQ (β=−0.219, p<0.01), DFBC unsupportive scale (β=−0.174, p<0.01), and PAID-Pr (β=−0.666, p<0.01). Both DFBC scales (supportive β=−0.259, p=0.01; unsupportive β=0.383, p=0.017), PAID-Pr (β=0.276, p<0.01), and SDQ (β=0.424, p<0.01) related to HbA1c. Conclusions. Over time, reduced parental well-being relates to increased problem behavior in youth, unsupportive parenting, and parental distress, which negatively associate with HbA1c. More unsupportive diabetes parenting and distress relate to youth’s problem behavior.