NON-INSULIN-DEPENDENT DIABETES-MELLITUS (NIDDM) IN MINORITY YOUTH - RESEARCH PRIORITIES AND NEEDS

The prevalence of non-insulin dependent diabetes mellitus (NIDDM) is i ncreasing in Native American and African-American youth, with females more frequently affected than males, This increase is related to incre asing rates of obesity and to the greater demand for insulin at adoles cence, This review examines the epidemiologic data about NIDDM in mino rity youth and addresses questions about the type of diabetes minority youth have, the relative contributions of environment and genetics to their diabetes, and whether prevention or control is possible. The he terogeneity of NIDDM in the minority youth population includes: typica l NIDDM; atypical diabetes mellitus (ADM), which has been described in a substantial number of African-American youngsters; and a small prop ortion with a range of defects in the pathway of insulin action. Clini cal and experimental evidence that insulin resistance or insulin defic iency is the primary defect in NIDDM are reviewed, as is evidence that fetal undernutrition may be a contributing factor, The numerous repor ts of linkages, associations, and mutations or polymorphisms in candid ate genes account for a very small proportion of non-type 1 diabetes, Environmental and genetic contributors to obesity are also important, Research issues relating to the questions discussed include the need f or data comparing various populations and assessing risk factors assoc iated with the epidemic of NIDDM and obesity, costs to the health syst em and attendant personal and societal costs, clarification of the typ es of NIDDM in minority populations that will permit appropriate thera py and counseling, and extensive studies of environmental and genetic factors. Genetic studies include a genome wide search and continued an alysis for candidate genes for both NIDDM and obesity, Environmental f actors for study include the role of fetal and perinatal nutrition and drug exposure. Finally, collaborative multicenter studies are needed of prevention or control of obesity and NIDDM.