title: Declining beta-cell function in type 2 diabetes: 5-year follow-up and immunologic studies of the population of Wadena, MN.
abstract: The aim of the study was to describe 5-year changes in meal-stimulated pancreatic insulin reserve in adults with normal and impaired glucose tolerance (NGT, IGT) and diabetes, with or without islet-related antibodies. This was a 5-year follow-up of 270 residents of Wadena, MN, of northern European origin, with good kidney function, defined as creatinine clearance greater than 60 mL/min/1.73 m(2). The subjects comprised a population-based sample originally studied in 1986 to 1987. Urine C-peptide (CP), in a 260-minute collection, was the integrated measure of insulin secretion; Ensure-Plus (Ross, Columbus, OH) was the liquid meal. Islet cytoplasmic antibodies (ICA), insulin autoantibodies (IAA), and glutamate decarboxylase antibodies (GAD65ab) were measured. In 182 subjects with NGT, there was no mean within-subject change in urine CP over 5 years (P =.34). In 41 subjects with impaired GT (IGT), there was a moderate, but nonsignificant, increase in mean CP, and 6 (15%) subjects increased. In 37 type 2 diabetic subjects not taking insulin (type 2-No Ins), who had a mean diabetes duration at the 5-year examination of 9.6 +/- 6.3 years, there was a 21% decrease in mean urine CP (P =.012), attributable mostly to a major drop in 8 of the 37 subjects (22%). Islet-related antibody tests were mostly negative; GAD65ab positivity was related to CP decline only among insulin-taking subjects. In summary, in Wadena adults, meal-stimulated urine CP was stable or increased over 5 years in subjects with NGT and IGT, but CP decreased significantly in about one fifth of type 2-No Ins subjects, with no relation to antibody test results.
authors.affiliation: Division of Diabetes and Endocrinology, Department of Medicine, University of Minnesota Medical School, Minneapolis 55454, USA.
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Goetz
authors.forename: Joseph
authors.initials: J
authors.lastname: Roel
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Jose
authors.initials: J
authors.lastname: Barbosa
authors.forename: Peter
authors.initials: P
authors.lastname: Hannan
authors.forename: Jerry
authors.initials: J
authors.lastname: Palmer
authors.forename: William
authors.initials: W
authors.lastname: Hagopian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000652:urine; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007515:Islets of Langerhans / Q000276:immunology / Q000502:physiology*; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011159:Population Surveillance
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D003404:Creatinine