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Diabetologia

, Volume 39, Issue 10, pp 1201–1207 | Cite as

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

  • S. M. Haffner
  • H. Miettinen
  • S. P. Gaskill
  • M. P. Stern
Originals

Summary

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 (ΔI30/ΔG30) 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 ΔI30/ΔG30 (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 ΔI30/ΔG30 (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 ΔI30/ΔG30) and increased insulin resistance (as assessed by fasting serum insulin) predict the development of IGT and are thus early precursors of non-insulin-dependent diabetes mellitus; further studies of insulin secretion should take into account the level of basal insulin resistance.

Keywords

Insulin resistance insulin secretion impaired glucose tolerance 

Abbreviations

IGT

Impaired glucose tolerance

NIDDM

non-insulin-dependent diabetes mellitus

CI

confidence interval

OR

odds ratio

AIR

acute insulin response

NGT

normal glucose tolerance

WHR

waist/hip ratio

ANOVA

analysis of variance

OGTT

oral glucose tolerance test

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • S. M. Haffner
    • 1
  • H. Miettinen
    • 1
  • S. P. Gaskill
    • 1
  • M. P. Stern
    • 1
  1. 1.Division of Clinical Epidemiology, Department of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioUSA

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