Diabetologia

, Volume 16, Issue 1, pp 17–24 | Cite as

An attempt to define the nature of chemical diabetes using a multidimensional analysis

  • G. M. Reaven
  • R. G. Miller
Originals

Summary

The relationship between chemical diabetes and overt diabetes in 145 nonobese adult subjects has been examined. The degree of glucose intolerance, insulin response to oral glucose, and insulin resistance in normal subjects and patients with nonketotic diabetes were first determined. These variables were then analyzed by a computer program which permits direct visualization of the three-dimensional shape of the data set. The picture obtained was that of a boomerang with two wings and a fat middle. The patients were then divided into three groups (normal, chemical diabetes, overt diabetes) on the basis of their oral glucose tolerance. Two-dimensional views of the relationship between the metabolic variables in these subjects resembled the initial three-dimensional image, i. e., a central core with two wings going off in opposite directions. The two wings represented patients with chemical diabetes and overt diabetes, respectively. Following this, the patients were reclassified on the basis of all three metabolic variables (plasma glucose response to oral glucose, plasma insulin response to oral glucose, and degree of insulin resistance) by means of a computer classification which employed a cluster analysis technique. This again resulted in the definition of three groups, in which there was a divergence between subjects classified as having chemical diabetes as contrasted to overt diabetes. This apparent separation between subjects with chemical and overt diabetes may explain why patients with chemical diabetes rarely develop overt diabetes.

Key words

Chemical diabetes multidimensional analysis insulin resistance insulin secretion glucose intolerance diabetes mellitus 

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References

  1. 1.
    Reaven, G.M., Miller, R.: Study of the relationship between glucose and insulin responses to an oral glucose load. Diabetes 17, 560–569 (1968)Google Scholar
  2. 2.
    Chiles, R., Tzagournis, M.: Excessive serum insulin response to oral glucose in obesity and mild diabetes. Diabetes 19, 458–464 (1970)Google Scholar
  3. 3.
    Savage, P.J., Dippe, S.E., Bennett, P.H., Gorden, P., Roth, J., Rushforth, N.B., Miller, M.: Hyperinsulinemia and hypoinsulinemia. Diabetes 24, 362–368 (1975)Google Scholar
  4. 4.
    Shen, S.-W., Reaven, G.M., Farquhar, J.W.: Comparison of impedance to insulin mediated glucose uptake in normal and diabetic subjects. J. Clin. Invest. 49, 2151–2160 (1970)Google Scholar
  5. 5.
    Desbuquois, B., Aurbach, G.D.: Use of polyethylene glycol to separate free and antibody-bound peptide hormones in radioimmunoassays. J. Clin. Endocrinol. Metab. 33, 732–738 (1971)Google Scholar
  6. 6.
    Friedman, H.P., Rubin, J.: On some invariant criteria for grouping data. J. Am. Statist. Assoc. 62, 1159–1178 (1967)Google Scholar
  7. 7.
    Reaven, G.M., Bernstein, R., Davis, B., Olefsky, J.M.: Non-ketotic diabetes mellitus: insulin deficiency or insulin resistance? Am. J. Med. 60, 80–88 (1976)Google Scholar
  8. 8.
    Fajans, S.S.: The natural history of idiopathic diabetes mellitus. Heterogeneity of insulin responses in latent diabetes. In: The Genetics of Diabetes Mellitus. Creutzfeldt, W., Köbberling, J., Neel, J.V. (Ed.), pp. 64–78. Berlin, Heidelberg, New York: Springer 1976Google Scholar
  9. 9.
    O'Sullivan, J.B., Mahan, C.M.: Prospective study of 352 young patients with chemical diabetes. N. Engl. J. Med. 278, 1038–1041 (1968)Google Scholar
  10. 10.
    Rosenbloom, A.L., Drash, A., Guthrie, R.: Conference summary: chemical diabetes in childhood. Metabolism 22, 413–419 (1973)Google Scholar
  11. 11.
    Irvine, W.J.: Classification of idiopathic diabetes. Lancet 1977 II, 638–642Google Scholar
  12. 12.
    Tattersall, R.B., Fajans, S.S.: A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. Diabetes 24, 44–53 (1975)Google Scholar
  13. 13.
    Reaven, G.M., Olefsky, J.M.: Relationship between heterogeneity of insulin responses and insulin resistance in normal subjects and patients with chemical diabetes. Diabetologia 13, 201–206 (1977)Google Scholar
  14. 14.
    Rosenbloom, A.L., Wheeler, L., Bianchi, R., Chin, F.T., Tiwary, C.M., Grgic, A.: Age-adjusted analysis of insulin responses during normal and abnormal glucose tolerance tests in children and adolescents. Diabetes 24, 820–828 (1975)Google Scholar
  15. 15.
    Fajans, S.S., Floyd, Jr., J.C., Tattersall, R.B., Williamson, J.R., Pek, S., Taylor, C.I.: The various faces of diabetes in the young. Arch. Intern. Med. 136, 194–202 (1976)Google Scholar
  16. 16.
    Irvine, W.J., Gray, R.S., McCallum, C.J., Duncan, L.J.P.: Clinical and pathogenic significance of pancreatic-islet-cell antibodies in diabetics treated with oral hypoglycaemic agents. Lancet 1977 I, 1025–1027Google Scholar
  17. 17.
    Ginsberg, H., Olefsky, J.M., Reaven, G.M.: Further evidence that insulin resistance exists in patients with chemical diabetes. Diabetes 23, 674–678 (1974)Google Scholar
  18. 18.
    Ginsberg, H., Kimmerling, G., Olefsky, J.M., Reaven, G.M.: Demonstration of insulin resistance in untreated adult onset diabetic subjects with fasting hyperglycemia. J. Clin. Invest. 55, 454–461 (1975)Google Scholar
  19. 19.
    Schoenle, E., Zapf, J., Froesch, E.R.: Effects of insulin and NSILA on adipocytes of normal and diabetic rats: receptor binding, glucose transport and glucose metabolism. Diabetologia 13, 243–249 (1977)Google Scholar
  20. 20.
    Reaven, G.M., Sageman, W.S., Swenson, R.S.: Development of insulin resistance in normal dogs following alloxan induced insulin deficiency. Diabetologia 13, 459–462 (1977)Google Scholar

Copyright information

© Springer-Verlag 1979

Authors and Affiliations

  • G. M. Reaven
    • 1
  • R. G. Miller
    • 1
  1. 1.Departments of Medicine and StatisticsStanford University and Veterans Administration HospitalPalo AltoUSA

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