Higher Acute Insulin Response to Glucose May Determine Greater Free Fatty Acid Clearance in African-American Women

Context: Obesity and diabetes are more common in African-Americans than whites. Because free fatty acids (FFA) participate in the development of these conditions, studying race differences in the regulation of FFA and glucose by insulin is essential. Objective: The objective of the study was to determine whether race differences exist in glucose and FFA response to insulin. Design: This was a cross-sectional study. Setting: The study was conducted at a clinical research center. Participants: Thirty-four premenopausal women (17 African-Americans, 17 whites) matched for age [36 +/- 10 yr (mean +/- SD)] and body mass index (30.0 +/- 6.7 kg/m(2)). Interventions: Insulin-modified frequently sampled iv glucose tolerance tests were performed with data analyzed by separate minimal models for glucose and FFA. Main Outcome Measures: Glucose measures were insulin sensitivity index (S-I) and acute insulin response to glucose (AIRg). FFA measures were FFA clearance rate (c(f)). Results: Body mass index was similar but fat mass was higher in African-Americans than whites (P < 0.01). Compared with whites, African-Americans had lower S-I (3.71 +/- 1.55 vs. 5.23 +/- 2.74 [x 10(-4) min(-1)/(microunits per milliliter)] (P = 0.05) and higher AIRg (642 +/- 379 vs. 263 +/- 206 mU/liter(-1).min, P < 0.01). Adjusting for fat mass, African-Americans had higher FFA clearance, c(f) (0.13 +/- 0.06 vs. 0.08 +/- 0.05 min(-1), P < 0.01). After adjusting for AIRg, the race difference in c(f) was no longer present (P = 0.51). For all women, the relationship between cf and AIRg was significant (r = 0.64, P < 0.01), but the relationship between c(f) and S-I was not (r = -0.07, P = 0.71). The same pattern persisted when the two groups were studied separately. Conclusion: African-American women were more insulin resistant than white women, yet they had greater FFA clearance. Acutely higher insulin concentrations in African-American women accounted for higher FFA clearance. (J Clin Endocrinol Metab 96: 2456-2463, 2011)