The metabolic associations of intravenous glucose tolerance in the 10 years from diagnosis of type 2 diabetes.
Intravenous glucose tolerance was measured at diagnosis and during the subsequent 10 years in 103 Type 2 diabetic patients not treated with insulin. KG (the rate constant for clearance of intravenous glucose) was inversely related to fasting plasma glucose at all review times (at diagnosis being Rs = -0.77, p less than 0.001), and at times to the circulating concentrations of ketone bodies (at diagnosis being Rs = -0.52, p less than 0.001) and glycerol (Rs = -0.29, p less than 0.01). In the first year of treatment, most metabolic abnormalities improved. One to 10 years after diagnosis, fasting glucose concentration and intravenous glucose tolerance deteriorated (median glucose from 6.4 to 7.4 mmol l-1, p less than 0.001; median KG from 0.81 to 0.69% min-1, p less than 0.01). Likewise, the 'homeostatic model assessment' of insulin insensitivity deteriorated (median from 2.3 to 3.7 arbitrary units, p less than 0.001) over the same period but first-phase insulin secretion remained steady or improved. This suggests that increases in insulin insensitivity have a predominant effect on slowly deteriorating glucose tolerance from 1 to 10 years after diagnosis in Type 2 diabetes.
Coppack
S W
SW
Sheikh Rashid Diabetes Unit, Radcliffe Infirmary, Oxford, UK.
Yajnik
C S
CS
Doll
H A
HA
Thursfield
V
V
Hockaday
T D
TD
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis