and White Adults The Atherosclerosis Risk in Communities Study: 1987–1998

OBJECTIVE — In this study, we tested the hypothesis that fasting serum insulin is higher in nonobese black adults than in white adults and that high fasting insulin predicts type 2 diabetes equally well in both groups. RESEARCHDESIGNANDMETHODS — At the baseline examination (1987–1989) of the Atherosclerosis Risk in Communities Study, fasting insulin and BMI were measured in 13,416 black and white men and women without diabetes. Participants were examined at years 3, 6, and 9 for incident diabetes based on fasting glucose and American Diabetes Association criteria. RESULTS — Fasting insulin was 19.7 pmol/l higher among nonobese (BMI30 kg/m2) black women compared with white women (race and obesity interaction term, P 0.01). There were no differences among men. Among nonobese women, the relative risk for developing diabetes was similar between racial groups: 1.4 (95 % CI 1.2–1.5) and 1.3 (1.2–1.4) per 60 pmol/l increase in insulin (P 0.01) for black and white women, respectively (interaction term, P 0.6). Findings were similar among men. Adjusting for established risk factors did not attenuate this association