Decreased insulin action and insulin secretion predict the development of impaired glucose tolerance

被引:113
作者
Haffner, SM
Miettinen, H
Gaskill, SP
Stern, MP
机构
[1] Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
[2] Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78284-7873
关键词
insulin resistance; insulin secretion; impaired glucose tolerance;
D O I
10.1007/BF02658507
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The relative importance of insulin resistance and abnormal insulin secretion as risk factors for the development of impaired glucose tolerance (IGT) is controversial. Few prospective data are available on metabolic precursors of IGT. We examined the relation of fasting serum insulin level (as a marker of insulin resistance) and change in insulin/glucose ratio (Delta I-30/Delta G(30)) over the first 30 min after glucose ingestion (as a marker of insulin secretion) as predictors of the 7-year development of IGT in 839 Mexican Americans and non-Hispanic whites with normal glucose tolerance at baseline from the San Antonio Heart Study. IGT eventually developed in 148 subjects. When modelled separately, fasting serum insulin (odds ratio (OR) = 2.60, 95 % confidence interval (CI) = 1.58,4.28, p < 0.005), but not Delta I-30/Delta G(30) (OR = 0.80,95 % CI = 0.50,1.27,p = 0.339) predicted the development of IGT. However, when both variables were included in the same logistic regression model, fasting serum insulin (OR = 3.50, 95 % CI = 1.97,6.21, p < 0.001) and low Delta I-30/Delta G(30) (OR = 0.48,95 % CI = 0.28,0.82, p = 0.008) both predicted IGT. These results were basically unchanged after further adjustment for obesity, body fat distribution and fasting plasma glucose level. We conclude that both decreased insulin secretion (as assessed by low Delta I-30/Delta G(30)) and increased insulin resistance (as assessed by fasting serum insulin) predict the development of IGT and are thus early precursors of noninsulin-dependent diabetes mellitus; further studies of insulin secretion should take into account the level of basal insulin resistance.
引用
收藏
页码:1201 / 1207
页数:7
相关论文
共 43 条
[1]   ASSOCIATION OF ELEVATED FASTING C-PEPTIDE LEVEL AND INCREASED INTRA-ABDOMINAL FAT DISTRIBUTION WITH DEVELOPMENT OF NIDDM IN JAPANESE-AMERICAN MEN [J].
BERGSTROM, RW ;
NEWELLMORRIS, LL ;
LEONETTI, DL ;
SHUMAN, WP ;
WAHL, PW ;
FUJIMOTO, WY .
DIABETES, 1990, 39 (01) :104-111
[2]   RISK-FACTORS FOR NIDDM IN WHITE-POPULATION - PARIS PROSPECTIVE-STUDY [J].
CHARLES, MA ;
FONTBONNE, A ;
THIBULT, N ;
WARNET, JM ;
ROSSELIN, GE ;
ESCHWEGE, E .
DIABETES, 1991, 40 (07) :796-799
[3]   ASPECTS OF THE PATHOGENESIS OF TYPE-2 DIABETES [J].
EFENDIC, S ;
LUFT, R ;
WAJNGOT, A .
ENDOCRINE REVIEWS, 1984, 5 (03) :395-410
[4]   EARLY METABOLIC DEFECTS IN PERSONS AT INCREASED RISK FOR NON-INSULIN-DEPENDENT DIABETES-MELLITUS [J].
ERIKSSON, J ;
FRANSSILAKALLUNKI, A ;
EKSTRAND, A ;
SALORANTA, C ;
WIDEN, E ;
SCHALIN, C ;
GROOP, L .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 321 (06) :337-343
[5]   THE METABOLIC PROFILE OF NIDDM IS FULLY ESTABLISHED IN GLUCOSE-TOLERANT OFFSPRING OF 2 MEXICAN-AMERICAN NIDDM PARENTS [J].
GULLI, G ;
FERRANNINI, E ;
STERN, M ;
HAFFNER, S ;
DEFRONZO, RA .
DIABETES, 1992, 41 (12) :1575-1586
[6]   INCIDENCE OF TYPE-II DIABETES IN MEXICAN-AMERICANS PREDICTED BY FASTING INSULIN AND GLUCOSE-LEVELS, OBESITY, AND BODY-FAT DISTRIBUTION [J].
HAFFNER, SM ;
STERN, MP ;
MITCHELL, BD ;
HAZUDA, HP ;
PATTERSON, JK .
DIABETES, 1990, 39 (03) :283-288
[7]   INCREASED INCIDENCE OF TYPE-II DIABETES-MELLITUS IN MEXICAN-AMERICANS [J].
HAFFNER, SM ;
HAZUDA, HP ;
MITCHELL, BD ;
PATTERSON, JK ;
STERN, MP .
DIABETES CARE, 1991, 14 (02) :102-108
[8]  
HAFFNER SM, 1986, INT J OBESITY, V10, P493
[9]   HYPERINSULINEMIA IN A POPULATION AT HIGH-RISK FOR NON-INSULIN-DEPENDENT DIABETES-MELLITUS [J].
HAFFNER, SM ;
STERN, MP ;
HAZUDA, HP ;
PUGH, JA ;
PATTERSON, JK .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 315 (04) :220-224
[10]   DECREASED INSULIN-SECRETION AND INCREASED INSULIN-RESISTANCE ARE INDEPENDENTLY RELATED TO THE 7-YEAR RISK OF NIDDM IN MEXICAN-AMERICANS [J].
HAFFNER, SM ;
MIETTINEN, H ;
GASKILL, SP ;
STERN, MP .
DIABETES, 1995, 44 (12) :1386-1391