The natural course of beta-cell function in nondiabetic and diabetic individuals: the Insulin Resistance Atherosclerosis Study.
Data from the UKPDS (U.K. Prospective Diabetes Study) indicate a continuous decline in beta-cell function in patients with type 2 diabetes. We studied longitudinal changes in beta-cell function (follow-up of 5.2 years) in subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes, using acute insulin response (AIR) and insulin sensitivity index (S(i)) from a frequently sampled intravenous glucose tolerance test among African-American, Hispanic, and non-Hispanic white subjects aged 40-69 years. At baseline, decreasing levels of both S(i) and AIR (either unadjusted or adjusted for S(i)) mirrored deteriorating glucose tolerance status at baseline and at follow-up. A different pattern was found with respect to longitudinal changes; S(i) declined in each glucose tolerance category, ranging from -0.81 x10(-4) min(-1) x muU(-1) x ml(-1) in NGT at baseline and NGT at follow-up (NGT/NGT) to -1.06 x10(-4) in NGT/diabetes, whereas the directional change in AIR principally determined the glucose tolerance status at follow-up. In NGT/NGT S(i) decreased by 35% and AIR increased by 34%. Results were similar in each of the three ethnic groups. These data shed light on the natural course of beta-cell function; over 5.2 years, mean insulin sensitivity declined in each glucose tolerance category. The change in AIR, however, principally determined glucose tolerance status at follow-up; NGT was maintained by a compensatory increase in insulin secretion. Failure to increase insulin secretion led to IGT, and a decrease in insulin secretion led to overt diabetes. This data may have important implications for the prevention and treatment of type 2 diabetes.
University of Texas Health Science Center, Department of Medicine, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900, USA.
Andreas
A
Festa
Ken
K
Williams
Ralph
R
D'Agostino
Lynne E
LE
Wagenknecht
Steven M
SM
Haffner
D050197:Atherosclerosis / Q000453:epidemiology / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005947:Glucose / Q000494:pharmacology; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000187:drug effects / Q000502:physiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012016:Reference Values
D007328:Insulin; D005947:Glucose