title: No evidence for genetically determined alteration in insulin secretion or sensitivity predisposing to type 1 diabetes: a study of identical twins.
abstract: OBJECTIVE
  To determine whether inherited changes in insulin secretion or sensitivity could predispose to type 1 diabetes, we studied identical twins of type 1 diabetic patients.
  
  
  METHODS
  We studied prospectively a consecutive series of 27 identical twins of patients with type 1 diabetes who were initially nondiabetic, as well as 14 control subjects, over a period of 18 years. Of these 27 twins, 15 remain nondiabetic (now estimated at low disease risk) and 12 developed diabetes (pre-diabetic twins). Subjects were tested when not diabetic on at least two occasions with an intravenous glucose tolerance test (IVGTT), and we estimated insulin secretion as first-phase insulin response (FPIR), glucose clearance (K(g)), and insulin sensitivity both by homeostasis model assessment of insulin resistance (HOMA-IR) and relative to insulin response by the basal HOMA-IR-to-FPIR ratio.
  
  
  RESULTS
  Twins now at low risk and control subjects had similar fasting blood glucose and insulin levels, FPIR, K(g), HOMA-IR, and HOMA-IR-to-FPIR ratio. In contrast, pre-diabetic twins compared with control twins had higher fasting insulin levels (10.3 +/- 6.0 vs. 4.6 +/- 4.0 mIU/ml), lower FPIR (245 +/- 129 vs. 796 +/- 622 mIU . ml(-1) . 10 min(-1)), lower K(g) (1.5 +/- 0.6 vs. 2.6 +/- 0.8% per min), and higher HOMA-IR-to-FPIR ratio (0.007 +/- 0.005 vs. 0.001 +/- 0.0009) (all P < 0.01).
  
  
  CONCLUSIONS
  These observations in low-risk nondiabetic identical twins failed to identify a familial alteration in either insulin secretion or sensitivity predisposing to type 1 diabetes.
authors.affiliation: St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, U.K.
authors.forename: Mohammed I
authors.initials: MI
authors.lastname: Hawa
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bonfanti
authors.forename: Christina
authors.initials: C
authors.lastname: Valeri
authors.forename: Michela
authors.initials: M
authors.lastname: Delli Castelli
authors.forename: Huriya
authors.initials: H
authors.lastname: Beyan
authors.forename: R David G
authors.initials: RD
authors.lastname: Leslie
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000235:genetics* / Q000276:immunology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007328:Insulin / Q000097:blood / Q000235:genetics / Q000378:metabolism*; D000078790:Insulin Secretion; D008297:Male; D011446:Prospective Studies; D014430:Twins, Monozygotic
chemical_list: D001323:Autoantibodies; D007328:Insulin