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Insulin deficiency and insulin resistance in Type 2 (non‐insulin‐dependent) diabetes: quantitative contributions of pancreatic and peripheral responses to glucose homeostasis
Author(s) -
NESHER R.,
CASA L. DELLA,
LITVIN Y.,
SINAI J.,
RIO G. DEL,
PEVSNER BELLA,
WAX Y.,
CERASI E.
Publication year - 1987
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.1987.tb01247.x
Subject(s) - insulin resistance , medicine , endocrinology , insulin , peripheral , homeostasis , glucose homeostasis , type 2 diabetes , diabetes mellitus
. A non‐steady state dose‐response study was designed to quantitate peripheral sensitivity to insulin and pancreatic responsiveness to glucose, and to assess their relative contribution to glucose intolerance in Type 2 diabetes (Type 2 DM, non‐insulin‐dependent). Eleven lean and eleven obese patients with mild diabetes (fasting plasma glucose, FPG, 10·3 pL 1·0 and 9·4 pL 0·6 mmol l ‐1 , respectively) were examined; twenty‐six lean and twelve weight‐matched obese subjects served as controls. Pancreatic response was measured by sequential injection of 0·1, 0·3 and 0·9 g kg ‐1 glucose; peripheral sensitivity to insulin was determined from the rate of clearance (Kgluc) of 0·3 g glucose injected sequentially together with 25, 50 and 100 mU insulin kg ‐1 or with 0, 12·5 and 50 mU kg ‐1 , under somatostatin infusion. The mean dose‐response curve describing glucose‐induced insulin release showed increased maximal capacity to secrete insulin in obese controls, while the responses of lean as well as obese Type 2 DM were reduced by more than 80%. The mean dose‐response curves relating plasma exogenous insulin levels to Kgluc were similar in lean diabetics and lean controls. The curves of both obese controls and obese diabetics were shifted to the right, demonstrating similar insulin resistance. In four lean controls, sensitivity to insulin was tested also during a hyperglycemic clamp set at 10·3 pL 0·6 mmol l ‐1 . Hyperglycemia reduced the Kgluc at all insulin levels. Individual dose‐response curves were transformed to single weighted numerical pancreatic responsiveness scores [PRS], and peripheral sensitivity scores [PSS]. Pancreatic responsiveness scores were significantly higher in controls than in diabetics (nine‐fold differences in both the obese and lean groups). Pancreatic responsiveness scores distinguished well between diabetics and non‐diabetics (84% of the cases), while PSS did not. When the odds for disease of a subject with a given PRS and PSS was estimated by multiple logistic analysis, only PRS determined significantly the differentiation of Type 2 DM from controls: 90% of diabetics could be correctly classified with this method. We conclude that decreased responsiveness of the beta cell to glucose is predominantly responsible for the abnormal glucose metabolism in Type 2 DM. Insulin resistance is unlikely to be the primary factor leading to glucose intolerance, since normal beta cells can cope with insulin resistance by increasing adequately the hormone production.