title: Basal state hyperinsulinemia in healthy normoglycemic adults heralds dysglycemia after more than two decades of follow up.
abstract: BACKGROUND
  In a preliminary report, we found an association between hyperinsulinemia in the basal (fasting) state and the development of diabetes.
  
  
  OBJECTIVE
  The current analysis further explored the long term link between basal hyperinsulinemia and conversion to dysglycemia.
  
  
  METHODS
  This is a prospective study with up to 24 years of follow-up of 515 normoglycemic individuals (mean age at follow up = 70.3 ± 7.0; range 58-94) of an Israeli cohort. Fasting glucose and insulin were measured, and dysglycemia was defined as fasting glucose > 100 mg/dL.
  
  
  RESULTS
  At the end of the follow-up period, almost half had progressed to dysglycemia. Male sex and elevated baseline levels of basal insulin, body mass index, blood glucose and blood pressure each favoured progression to dysglycemia over the subsequent two decades. A multivariate logistic regression model identified basal hyperinsulinemia as the strongest predictor for progression to dysglycemia (odds ratio = 1.79; 95% confidence interval 1.12-2.88), while controlling for ethnicity, blood pressure, fasting glucose, male sex, body mass index and age.
  
  
  CONCLUSIONS
  Basal hyperinsulinemia in normoglycemic adults constitutes an independent risk factor for metabolic deterioration to dysglycemia over adulthood, and may help to identify apparently healthy subjects at increased risk for diabetes.
authors.affiliation: Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel. racheld@gertner.health.gov.il
authors.forename: R
authors.initials: R
authors.lastname: Dankner
authors.forename: A
authors.initials: A
authors.lastname: Chetrit
authors.forename: M H
authors.initials: MH
authors.lastname: Shanik
authors.forename: I
authors.initials: I
authors.lastname: Raz
authors.forename: J
authors.initials: J
authors.lastname: Roth
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D015331:Cohort Studies; D018450:Disease Progression; D042241:Early Diagnosis; D005215:Fasting / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000503:physiopathology*; D007328:Insulin / Q000097:blood*; D007557:Israel; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D001786:Blood Glucose; D007328:Insulin