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Acute insulin response is an independent predictor of type 2 diabetes mellitus in individuals with both normal fasting and 2‐h plasma glucose concentrations
Author(s) -
Bunt Joy C.,
Krakoff Jonathan,
Ortega Emilio,
Knowler William C.,
Bogardus Clifton
Publication year - 2006
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.686
Subject(s) - medicine , endocrinology , insulin , diabetes mellitus , type 2 diabetes , population , impaired glucose tolerance , environmental health
Background Earlier prospective studies have identified insulin action and secretion as predictors of T2DM in populations with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) (2‐h OGTT < 7.8 and 7.8–11 mmol/L, respectively). Fasting plasma glucose (FPG), an additional and recently modified (normal <5.6 mmol/L) diagnostic criterion is associated with insulin secretion. We wanted to establish whether insulin secretion persists as an independent predictor of T2DM in individuals with no clinical evidence of impaired glucose regulation based on FPG and 2‐h plasma glucose concentrations. Methods Insulin action (M, euglycemic‐hyperinsulinemic clamp), insulin secretion (acute insulin response (AIR), IVGTT), and adiposity (%Fat, DXA or densitometry) were compared at baseline in 358 Pima Indians (232M/126F, 18–44 years old) with normal glucose regulation of whom 61 (35M/26F) developed diabetes (DIAB) during a median follow‐up time of 7.6 years. Results In proportional‐hazard analysis, % Fat (HR = 1.52, p = 0.03), M (HR = 0.51, p = 0.04) and AIR (HR = 0.64, p = 0.003) predicted the development of diabetes after adjustment for age and sex. In regression analysis adjusting for age, sex, %Fat and M at baseline, the non‐diabetic group (NON‐DM) had a higher AIR ( p = 0.0002) than the DIAB group; the positive association of AIR with adiposity observed in the NON‐DM group was absent in the DIAB group. Cumulative incidence rates (12y) for diabetes were highest (48%) in subjects with both M and AIR below the population median and lowest (11%) in subjects with both M and AIR above the population median. Conclusion AIR can predict diabetes prior to the current clinical indicators of impaired glucose regulation. Published in 2006 by John Wiley & Sons, Ltd. John Wiley & Sons, Ltd.