Jewish World Review May 19, 2002 / 8 Sivan, 5762

Ethnic differences in diabetic complications

By Robert A. Wascher, M.D., F.A.C.S. | Inadequate access to medical care has been cited as the primary explanation for the poorer outcomes that ethnic minorities with certain diseases often experience. In this week's Journal of the American Medical Association (JAMA), 62,432 diabetic patients enrolled in a large HMO were longitudinally studied for a period of four years. Caucasians made up 64% of the study population, while 14% of patients were Black, 12% were Asian, and 10% were Latino. As all patients, irrespective of their ethnic background, presumably had equal access to care, this study sought to evaluate intrinsic ethnicity-related factors that might affect the incidence of complications due to diabetes.

Interestingly, the Caucasian diabetic patients experienced, on the average, a higher incidence of heart attack and stroke than did any of the minority group patients. However, the risk of developing kidney failure was 1.5 to 2 times as high among the minority group patients when compared to Caucasian patients. The authors, therefore, concluded that access to care may not be the only issue that impacts upon diverse disease outcomes between different ethnic groups. This large study's results point to a probable genetic variation in responses to diabetes among people of different ethnic backgrounds.

The next step towards proving this hypothesis would be to study the activation patterns of large numbers of genes in diabetics. Comparing gene activation patterns between diabetics from different ethnic groups may identify unique genetic characteristics that could explain this study's findings. Other diseases, including cardiovascular disease, stroke, high blood pressure, obesity and cancer should be studied from this perspective as well, as prior research has shown variation in the incidence of -- and mortality from -- these diseases among different ethnic groups.


Moderate alcohol intake (1 to 2 drinks per day) has been shown to reduce the risk of coronary artery disease and stroke in a number of research studies. There is also some evidence that moderate drinking might improve the sensitivity of the body's cells to insulin, the hormone that allows cells to take-up glucose from the blood (the loss of insulin sensitivity causes adult onset , or type II, diabetes).

This week's JAMA contains an interesting study that looks at the effects of moderate alcohol intake on the insulin and glucose levels in the blood of postmenopausal women. Although the study included only 63 women, the researchers found that 2 alcoholic drinks per day was associated with significantly improved insulin sensitivity, as well as reduced levels of triglycerides (a form of fat) in the blood. Although excessive drinking has been clearly implicated in a number of diseases, this study provides further evidence that modest-to-moderate drinking may have important health benefits.


I recently reported on the favorable correlation between moderate tea drinking and a reduced risk of death after heart attack. Now a new study in the Archives of Internal Medicine suggests that regular tea drinking may be associated with improved bone mineral density as well. Over 1,000 men and women were queried about their tea drinking habits, and were then tested for bone mineral density using a sophisticated x-ray test called dual-energy x-ray absorptiometry (DEXA scan). A total of 58% of the study participants were habitual tea drinkers, with an average duration of tea consumption of about 10 years.

When compared to nonhabitual tea drinkers, the habitual tea drinkers had significantly increased bone mass in the bones of the lumbar spine (a common site of bone-thinning, or osteoporosis). Sex, age, body mass, and level of physical activity all affected bone mass, but the habitual consumption of tea for 10 or more years proved to be a significant and independent factor favoring increased bone mass. In addition to containing potent antioxidants, it appears that other components of tea might have a bone-strengthening effect that, in theory, might reduce the risk of bone fractures due to osteoporosis.


There have been a couple of previous studies that linked variations in blood potassium levels with an increased risk of heart disease. A new report from the Framingham Heart Study, one of the largest and longest-running cardiovascular health studies in the world, now strongly suggests that there is no relationship between blood potassium levels and the risk of heart disease. As reported in the Archives of Internal Medicine, more than 3,000 volunteers had their blood potassium levels monitored between 1979 and 1983. Contrary to previous reports, there was no apparent increase in cardiovascular disease-related deaths with increasing levels of potassium in the blood.


Post Script: As a follow-up to last week's story on breastfeeding, I wanted to pass along two breastfeeding resources sent to me by concerned readers. In many cases where mothers (and first time mothers in particular) encounter difficulties in breastfeeding their newborns, the advice and assistance of experienced lactation experts can make all the difference in the world between breastfeeding success and failure. The following hyperlinks should be of interest to parents of infants who might be experiencing breastfeeding challenges:

ASCO: I will be attending the annual meeting of the American Society of Clinical Oncology this week in Orlando. This is the largest annual cancer meeting in the world, and is the premier forum for the release of cutting-edge research in cancer-related science. I will be presenting my own research in Orlando, and look forward to sharing important new developments with my readers when I return next week.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


05/10/02: Tea drinkers and the risk of death following heart attack; duration of breastfeeding & adult intelligence; abdominal aortic aneurysms: surgery or observation?

05/03/02: Risk of adverse drug reactions from newly released medications; preoperative beta-blockers may reduce heart bypass deaths; shape-shifting plastics may alter surgical practice; weight loss supplement may cause liver damage
04/26/02: Angry young men & risk of premature cardiovascular disease; stay-at-home dads & risk of cardiovascular disease; more on the effects of statins; dairy consumption and the risk of pre-diabetes; smallpox vaccine: good to the last drop?
04/19/02: Change your sex by drinking water?; Anti-inflammatory RXs may reduce growth of breast cancer cells; radiation treatment reduces repeat narrowing of bypass grafts
04/05/02: Fish & Omega-3 fatty acid consumption and cardiac health; news briefs
04/05/02: Can coffee reduce your risk of tooth decay?; exercise & blood pressure; a single high-fat meal reduces coronary artery function
04/01/02: Pre-diabetes: a newly defined category of health risk; teen television viewing and subsequent aggressive behavior; the benefits of strength training in the elderly; more ...
03/22/02: Bacteria, antibiotics & heart disease; mammograms: the debate continues; calcium & the risk of colon cancer ... and more
03/15/02: Mammography debate continues; statins & fracture risk; physical fitness & the risk of death; other intriguing findings
03/08/02: Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate
03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection?
02/26/02: The continuing controversy regarding screening mammography
02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived?
02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt
02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited
02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment
01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons
01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health
01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders
01/09/02: Cancer & aging: Two sides of the same coin?
01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives
12/28/01: Magnetic Resonance Imaging (MRI) detects coronary artery disease; new development in obesity research; adverse childhood experiences & the risk of suicide attempts
12/21/01: Vaccination of children controls hepatitis a in the community; a possible cure for sickle cell disease; leptin and the risk of heart attacks
12/14/01: Chernobyl and the Risk of Thyroid Cancer in hildren; children & obesity; gastroesophageal reflux disease update
12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies
11/30/01: Flu vaccination in asthmatics; low-tar cigarettes are not less harmful; beans and your heart
11/21/01: Modified smallpox vaccine may reduce risk of cervical cancer; New approach to breast cancer diagnosis; New non-invasive prenatal diagnostic test for down's syndrome
11/16/01: Cholesterol-lowering drugs reduce risk of heart attack; supplemental radiation therapy reduces risk of breast cancer recurrence; brains of women may answer age-old questions
11/09/01: Bio-warfare (redux); my gray matter is bigger than yours; mad elk disease?
11/02/01: Making sense of bio-warfare
10/26/01: The impact of mammography on deaths due to breast cancer; diet & exercise may slow cancer cell growth; antidepressants and the risk of heart disease
10/19/01: New insights into autism; the wiley appendix
10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys?
10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant?
09/25/01: Advances in the detection of breast cancer; primary care physician awareness of peripheral arterial disease; arsenic in the water
09/17/01: In perspective
09/12/01: Genes may hold secret to long life; men and women: cognitive function in the elderly; physical activity, obesity and the risk of pancreatic cancer
09/05/01: English milk cows prefer Beethoven and Simon & Garfunkel over Bananarama; new prostate cancer prevention study: looking for a few good men; exercise & diet can help prevent diabetes
08/28/01: Arthritis drugs may be linked with increased risk of heart disease; errors in blood clotting tests can be fatal; infant soy formula not associated with reproductive side effects

© 2002, Dr. Robert A. Wascher