{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:34:15Z","timestamp":1790728455910,"version":"4.1.0"},"reference-count":40,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T00:00:00Z","timestamp":1631750400000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Intramural Research Program of NIDDK","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Intramural Research Program of the NIH Clinical Center","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Intramural Program of NIMHD","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2021,8,26]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Uncertainties exist on whether the main determinant of abnormal glucose tolerance (Abnl-GT) in Africans is \u03b2-cell failure or insulin resistance (IR). Therefore, we determined the prevalence, phenotype and characteristics of Abnl-GT due to \u03b2-cell failure versus IR in 486 African-born blacks (male: 64%, age: 38\u00b110 years (mean\u00b1SD)) living in America.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>Oral glucose tolerance test were performed. Abnl-GT is a term which includes both diabetes and prediabetes and was defined as fasting plasma glucose (FPG) \u22655.6\u2009mmol\/L and\/or 2-hour glucose \u22657.8\u2009mmol\/L. IR was defined by the lowest quartile of the Matsuda Index (\u22642.98) and retested using the upper quartile of homeostatic model assessment of insulin resistance (HOMA-IR) (\u22652.07). Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-\u03b2-cell failure was defined as Abnl-GT without IR. Beta-cell compensation was assessed by the Disposition Index (DI). Fasting lipids were measured. Visceral adipose tissue (VAT) volume was obtained with abdominal CT scan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The prevalence of Abnl-GT was 37% (182\/486). For participants with Abnl-GT, IR occurred in 38% (69\/182) and \u03b2-cell failure in 62% (113\/182). Compared with Africans with Abnl-GT-IR, Africans with Abnl-GT-\u03b2-cell failure had lower body mass index (BMI) (30.8\u00b14.3 vs 27.4\u00b14.0\u2009kg\/m<jats:sup>2<\/jats:sup>), a lower prevalence of obesity (52% vs 19%), less VAT (163\u00b172 vs 107\u00b163\u2009cm<jats:sup>2<\/jats:sup>), lower triglyceride (1.21\u00b10.60 vs 0.85\u00b10.42\u2009mmol\/L) and lower FPG (5.9\u00b11.4 vs 5.3\u00b10.6\u2009mmol\/L) and 2-hour glucose concentrations (10.0\u00b13.1 vs 9.0\u00b11.9\u2009mmol\/L) (all p&lt;0.001) and higher DI, high-density lipoprotein (HDL), low-density lipoprotein particle size and HDL particle size (all p&lt;0.01). Analyses with Matsuda Index and HOMA-IR yielded similar results. Potential confounders such as income, education, alcohol and fiber intake did not differ by group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Beta-cell failure occurred in two-thirds of participants with Abnl-GT and may be a more frequent determinant of Abnl-GT in Africans than IR. As BMI category, degree of glycemia and lipid profile appeared more favorable when Abnl-GT was due to \u03b2-cell failure rather than IR, the clinical course and optimal interventions may differ.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT00001853\">NCT00001853<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2021-002447","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T12:49:17Z","timestamp":1631796557000},"page":"e002447","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Beta-cell failure rather than insulin resistance is the major cause of abnormal glucose tolerance in Africans: insight from the Africans in America study"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct00001853","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"M C Sage","family":"Ishimwe","sequence":"first","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"Wentzel","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elyssa M","family":"Shoup","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana H","family":"Osei-Tutu","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hormenu","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arielle C","family":"Patterson","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadi","family":"Bagheri","sequence":"additional","affiliation":[{"name":"Clinical Center, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W","family":"DuBose","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian S","family":"Mabundo","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon","family":"Ha","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Sherman","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9640-8999","authenticated-orcid":false,"given":"Anne E","family":"Sumner","sequence":"additional","affiliation":[{"name":"NIDDK, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"2025073112255016000_9.1.e002447.1","unstructured":"IDF . 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