Vol 2, No 2 (2001): Practical Diabetology
Other materials agreed with the Editors
Published online: 2001-03-08
Insulin resistance and insulin secretory dysfunction are independent predictors of worsening of glucose tolerance during each stage of type 2 diabetes development
Diabetologia Praktyczna 2001;2(2):167-172.
Abstract
OBJECTIVE. Although prospective studies indicate
that insulin resistance and insulin secretory dysfunction
predict type 2 diabetes, they provide limited
information on the relative contributions of both
abnormalities to worsening glucose tolerance at different
developmental stages of the disease. We therefore
assessed the predictive effect of insulin resistance
and insulin secretory dysfunction separately
for the progression from normal glucose tolerance
(NGT) to impaired glucose tolerance (IGT) and from
IGT to diabetes.
RESEARCH DESIGN AND METHODS. Insulin-stimulated glucose disposal (M) (hyperinsulinemic clamp), acute insulin secretory response (AIR) (25-g intravenous glucose tolerance test), and body composition (hydrodensitometry or dual-energy X-ray absorptiometry) were measured in 254 Pima Indians with NGT and in 145 Pima Indians with IGT, who were then followed for 0.513 years.
RESULTS. After follow-ups of 4.4 ± 3.1 and 5.5 ± 3.4 years, 79 (31%) of the subjects with initial NGT had developed IGT, and 64 (44%) of the subjects with initial IGT had developed diabetes. In proportional-hazards analyses with adjustment for age, sex, and percent body fat, low M and low AIR were independent predictors of both the progression from NGT to IGT (relative hazards [95% CI] for 10th vs. 90th percentile: M2.4 [1.24.7], P < 0.02; AIR 2.1 [1.14.1], P < 0.04) and from IGT to diabetes (M2.5 [1.35.0], P < 0.01; AIR 1.8 [0.993.3], P = 0.055).
CONCLUSIONS. During each stage of the development of type 2 diabetes, insulin resistance and insulin secretory dysfunction are independent predictors of worsening glucose tolerance and are, therefore, both targets for the primary prevention of the disease.
RESEARCH DESIGN AND METHODS. Insulin-stimulated glucose disposal (M) (hyperinsulinemic clamp), acute insulin secretory response (AIR) (25-g intravenous glucose tolerance test), and body composition (hydrodensitometry or dual-energy X-ray absorptiometry) were measured in 254 Pima Indians with NGT and in 145 Pima Indians with IGT, who were then followed for 0.513 years.
RESULTS. After follow-ups of 4.4 ± 3.1 and 5.5 ± 3.4 years, 79 (31%) of the subjects with initial NGT had developed IGT, and 64 (44%) of the subjects with initial IGT had developed diabetes. In proportional-hazards analyses with adjustment for age, sex, and percent body fat, low M and low AIR were independent predictors of both the progression from NGT to IGT (relative hazards [95% CI] for 10th vs. 90th percentile: M2.4 [1.24.7], P < 0.02; AIR 2.1 [1.14.1], P < 0.04) and from IGT to diabetes (M2.5 [1.35.0], P < 0.01; AIR 1.8 [0.993.3], P = 0.055).
CONCLUSIONS. During each stage of the development of type 2 diabetes, insulin resistance and insulin secretory dysfunction are independent predictors of worsening glucose tolerance and are, therefore, both targets for the primary prevention of the disease.
Keywords: glucose tolerancediabetestype 2 diabetesinsulin