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Predictors of insulin sensitivity in Type 2 diabetes mellitus
Author(s) -
Bonora E.,
Targher G.,
Alberiche M.,
Formentini G.,
Calcaterra F.,
Lombardi S.,
Marini F.,
Poli M.,
Zenari L.,
Raffaelli A.,
Perbellini S.,
Zenere M. B.,
Saggiani F.,
Bonadonna R. C.,
Muggeo M.
Publication year - 2002
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2002.00764.x
Subject(s) - medicine , endocrinology , insulin resistance , diabetes mellitus , insulin , type 2 diabetes , overweight , blood pressure , type 1 diabetes , body mass index
Aims To identify the independent predictors of insulin sensitivity in Type 2 diabetes, and to establish whether isolated Type 2 diabetes (i.e. diabetes without overweight, dyslipidaemia and hypertension) is a condition of insulin resistance. Methods We examined 45 patients with non‐insulin‐treated Type 2 diabetes undergoing a 4‐h euglycaemic hyperinsulinaemic clamp (20 mU/m 2 per min) combined with 3 H‐3‐D‐glucose and 14 C‐U‐glucose infusions and indirect calorimetry. We also examined 1366 patients with non‐insulin‐treated Type 2 diabetes randomly selected among those attending the Diabetes Clinic and in whom insulin resistance was estimated by Homeostasis Model Assessment (HOMA‐IR). Results In the 45 patients undergoing glucose clamp studies, insulin‐mediated total glucose disposal (TGD) was independently and negatively associated with systolic blood pressure (standardized β coefficient = −0.407, P = 0.003), plasma triglycerides (β= −0.355, P = 0.007), and HbA 1c (β= −0.350, P = 0.008). The overall variability of TGD explained by these variables was 53%. Overweight diabetic subjects with central fat distribution, hypertension, hypertriglyceridaemia and poor glycometabolic control had insulin‐mediated TGD values markedly lower than their lean counterparts without hypertension, with normal triglycerides, and with good glycometabolic control (16 ± 5 vs. 31 ± 10 µmol/min per kg lean body mass, P < 0.01). Nevertheless, the latter still were markedly insulin‐resistant when compared with sex‐ and age‐matched non‐diabetic control subjects (31 ± 10 vs. 54 ± 13 µmol/min per kg lean body mass, P < 0.01). In the 1366 Type 2 diabetic patients of the epidemiological study, HOMA‐IR value was independently associated with HbA 1c (β = 0.283, P < 0.0001), plasma triglycerides (β = 0.246, P < 0.0001), body mass index (β = 0.139, P < 0.001), waist girth (β = 0.124, P < 0.001) and hypertension (β = 0.066, P = 0.006). Conclusion Overweight, central fat distribution, dyslipidaemia, hypertension and poor glycometabolic control are strong independent predictors of insulin resistance in Type 2 diabetes. However, reduced insulin sensitivity can be found even when Type 2 diabetes is isolated and well controlled. Diabet. Med. 19, 535–542 (2002)