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Insulin Requirement in Non‐insulin‐dependent Diabetes Mellitus: Relation to Simple Tests of Islet B‐cell Function and Insulin Sensitivity
Author(s) -
Gjessing H. J.,
Matzen L. E.,
Pedersen P. C.,
Faber O. K.,
Frøland A.
Publication year - 1988
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 - 10.1111/j.1464-5491.1988.tb00999.x
Subject(s) - medicine , insulin , endocrinology , diabetes mellitus , c peptide , islet , glucagon , insulin sensitivity , insulin resistance
Evaluation of simple tests of islet B‐cell function and insulin sensitivity as predictors of metabolic control was performed during 3 months of insulin withdrawal in 25 insulin‐treated diabetic subjects. All patients had a glucagon stimulated plasma C‐peptide concentration above 0.33 nmol/l and a fasting plasma C‐peptide concentration above 0.20 nmol/l a few days before insulin withdrawal. Insulin sensitivity was measured as the glucose disappearance rate ( k ) during an intravenous insulin tolerance test. Two patients were considered insulin‐requiring due to high fasting blood glucose levels (>20 mmol/l) and two patients due to an increase in glycosylated haemoglobin of more than 1.1% (>∼3SD) in combination with weight loss. None of the remaining patients had a significant increase in glycosylated haemoglobin. An inverse correlation was found between stimulated C‐peptide levels and insulin sensitivity ( r =‐0.41, p <0.05). Fasting and stimulated C‐peptide concentrations of 0.40 and 0.70 nmol/l, respectively, separated non‐insulin‐requiring patients from a group consisting of both insulin‐ and non‐insulin‐requiring patients. At these C‐peptide levels the predictive value of a positive test was 100%, while the predictive value of a negative test was as low as 33%, or 27%, depending on whether fasting or stimulated C‐peptide concentration was used. Including the k value in the prediction only increased the predictive values of negative tests to 40%, and 33%, respectively.