Insulin secretion in type 2 diabetes: clinical aspects.
Type 2 diabetes is a complex disease that involves insulin secretion abnormalities and defects in the action of insulin on its target tissues. Insulin resistance alone is not sufficient to lead to type 2 diabetes in the absence of a beta-cell defect. Patients with impaired glucose tolerance or in the early stages of type 2 diabetes always present with beta-cell secretion defects. In the early stages of type 2 diabetes, abnormalities in the physiological biphasic insulin secretion are already encountered, with very often a loss of the first phase insulin secretion. In this review, we discuss the methods to evaluate beta-cell function and their limitations, then their relationship with genetic knowledge. Currently, it is still impossible, in the absence of biological parameters characterizing the etiology of type 2 diabetes, to precisely correlate the insulin-secretion tests with the diagnosis of the disease. Autoimmune type 1 diabetes appears a useful model to study type 2 diabetes. The availability of individual genetic mapping will permit a reliable clinical evaluation and interpretation of tests of insulin secretion in the future.
Boitard
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Service d'immunologie clinique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 05.
D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000378:metabolism*
D001786:Blood Glucose; D007328:Insulin