CLINICAL CHARACTERISTICS OF TYPE-II DIABETIC SUBJECTS CONSUMING HIGH VERSUS LOW CARBOHYDRATE DIETS LOW CARBOHYDRATE DIETS IN MEXICO-CITY AND SAN-ANTONIO, TEXAS

OBJECTIVE- To compare the clinical status of type II diabetic subjects identified in two population-based surveys, one performed in Mexico a nd the other in San Antonio Texas. RESEARCH DESIGN AND METHODS- In a l ow income area of Mexico City, 3517 age-eligible (35-64 years of age) individuals were randomly selected of whom 3,319 were interviewed at h ome and 2,198 were examined in a clinic (response rates 62.5%). In San Antonio, 2,357 similarly aged low-income Mexican Americans were rando mly selected of whom 2,076 were interviewed at home and 1,511 were exa mined 0response rate 64.1%). Oral glucose tolerance tests were perform ed at both sites and diabetes were diagnosed according to the World He alth Organization (WHO) criteria. In Mexico City, 288 type II diabetic individuals were identified, and 255 were identified in San Antonio. The following variables were measured: height, weight, subscapular and triceps skinfolds, waist-to-hip circumference ratios (WHR), systolic and diastolic blood pressure (random 0 sphygmomomanometer), fasting an d 2-h postgluclose lead glucose and insulin concentrations, and fastin t total-cholesterol, HDL-cholesterol, and triglyceride (TG) levels. A food frequency questionnaire was used to estimate total calories and t he percentage of calories derived from protein, fat, and carbohydrate. Only type II diabetic patients were included in the analyses. Age-adj ustment was performed by analysis of covariance for continuous variabl es and by the Mantel-Haenszel procedure for discrete variables. RESULT S- The mean age, the percentage newly diagnosed cases, and the percent age of males were similar in both sites. The percentage of diabetic pa tients treated with oral agents was significantly higher in Mexico Cit y (56.9 vs 72.2% in San Antonio and Mexico City, respectively, P < 0.0 01), whereas the percentage treated with insulin was significantly hig her in San Antonio (18.8 vs. 2.1% for San Antonio and Mexico City, res pectively, P < 09001) and fat (18.4-20.0 and 30.1-33.0% for Mexico Cit y and San Antonio, respectively, P < 0.001). Body mass index (BMI) was higher in San Antonio (27.6-30.4 vs. 30.2-32.9% for Mexico City and S an Antonio, respectively, P < 0.05). Total serum cholesterol was simil ar at both sites. HDL cholesterol, however, was lower in Mexico City, both in newly and in previously diagnosed patients (30.5-35.8 vs 39.6- 43.3 mg/dl in Mexico City and San Antonio, respectively, P < 0.001). T he association between diabetes and the anthropometric and metabolic v ariables was similar in Mexico City and San Antonio with the following exceptions: Diabetes in Mexico City was associated with less of an el evation in BMI, WHR, and fastning insulin concentration and less of a reduction in the 2-h postoral glucose lead insulin concentration compa red with diabetes in San Antonio. In addition, although diabetes was a ssociated with a lower HDL in San Antonio subjects, no association app eared between diabetes and HDL in Mexico City subjects. CONCLUSIONS- D iabetic subjects in Mexico City were more likely to be treated with or al agents and less likely to be treated with insulin compared with San Antonio patients. Previously diagnosed diabetic subjects in San Anton io had higher BMIs than diabetic subjects in Mexico City. Diabetic sub jects in Mexico City ate less fat but more carbohydrate than those in San Antonio. TG levels were higher and HDL-cholesterol levels were low er in Mexico City diabetic subjects compared with those in San Antonio . San Antonio diabetic subjects had lower HDL levels than non-diabetic subjects but, in Mexico City, HDL levels were similar in diabetic sub jects and nondiabetic subjects. Postchallenge insulin levels appear to be less suppressed in Mexico City than in San Antonio diabetic subjec ts.