Acta Diabetologica

, Volume 31, Issue 1, pp 26–30 | Cite as

On the interplay beween insulin secretion and sensitivity as determinants of glucose tolerance

  • L. Lind
  • H. Lithell
  • T. Pollare
  • S. Ljunghall
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Abstract

Both insulin secretion and sensitivity have been claimed to be the main characteristics in the determination of future detoriation in glucose tolerance. In this cross-sectional study insulin secretion and insulin sensiturity were determined in 228 subjects with varying degrees of glucose tolerance. Insulin secretion was measured in an intravenous glucose tolerance test (IVGTT) and insulin sensitivity by the hyperinsulinaemic euglycaemic clamp test. Both the early insulin response in the IVGTT (increment) and the glucose disposal rate in the clamp test (M-value) were found to be related hyperbolically to fasting glucose (r=−0.63 and −0.66, respectively; bothP<0.0001) and in a second-order polynomial manner to the glucose disappearence rate (k-value) in the IVGTT (r=0.53 and 0.48, respectively; bothP<0.0001). Multiple regression analysis showed the insulin increment in the IVGTT and theM-value in the clamp test to be equally important determinants of glucose tolerance, together explaining about 50% of the variation in fasting glucose and thek-value in the IVGTT. In conclusion, in this cross-sectional study insulin secretion and sensitivity studied over a broad range of glucose tolerance were found to be of amost equal importance in the determination of glucose tolerance. However, low levels of insulin increment in the IVGTT were more often associated with glucose intolerance than was a low insulin sensitivity.

Key words

Glucose Insulin re Insulin resistance Diabetes mellitus 

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References

  1. 1.
    Reaven GM, Bernstein R, Davies B, Olefsky JM, Nonketotic diabetes mellitus: insulin deficiency or insulin resistance. Am J Med 60: 80–89, 1976Google Scholar
  2. 2.
    DeFronzo RA, Ferrannini E, The pathogenesis on non-insulin dependent diabetes. Medicine 61: 125–140, 1982Google Scholar
  3. 3.
    Weir GC, Non-insulin dependent diabetes mellitus: interplay between b-cell inadequacy and insulin resistance. Am J Med 73: 461–464, 1982Google Scholar
  4. 4.
    Efendic S, Luft R, Wajngot A, Aspects of the pathogenesis of type 2 diabetes. Endocr Rev 5: 395–410, 1984Google Scholar
  5. 5.
    Lillioja S, Mott DM, Howard BV, Bennett PH, Yki-Järvinen H, Freymond D, Nyoma BL, Zurlo F, Swinburn B, Bogardus C, Impaired glucose tolerance as a disorder of insulin action. N Engl J Med 318: 1217–1225, 1988Google Scholar
  6. 6.
    Bolinder J, Lithell H, Skarfors E, Arner P, Effects of obesity, hyperinsulinemia, and glucose intolerance on insulin action in adipose tissue of sixty-year-old men. diabetes 35: 282, 1986Google Scholar
  7. 7.
    DeFronzo RA, Tobin JD, Andres R, Glucose clamp technique: A method for quantifying insulin secretion and resistance. Am J Physiol 237: 214, 1979Google Scholar
  8. 8.
    Ikkos D, Luft R, On the intravenous glucose tolerance test. Acta Endocrinol (Kbh) 25: 312, 1957Google Scholar
  9. 9.
    Lerner RL, Porte D, Relationships between intravenous glucose loads, insulin responses and glucose disappearance rate. J Clin Endocrinol 33: 409–413, 1971Google Scholar
  10. 10.
    Chen M, Porte D, The effect of rate and dose of glucose infusion on the acute insulin response in man. J Clin Endocrinol Metab 42: 1168–1172, 1976Google Scholar
  11. 11.
    Brunzell JD, Robertson RP, Lerner RL, Hazzard WR, Ensinch JW, Bierman EL, Porte D, Relationships between fasting plasma glucose levels and insulin secretion during intravenous glucose tolerance test. J Clin Endocrinol Metab 42: 222–228, 1976Google Scholar
  12. 12.
    Luzi L, DeFronzo RA, Effects of loss of first-phase insulin secretion on hepatic glucose production and tissue glucose disposal in humans. Am J Physiol 257: 241–246, 1979Google Scholar
  13. 13.
    Campbell PJ, Mandarina LJ, Gerich JE, Quantification of the relative impairment in actions of insulin on hepatic glucose production and peripheral glucose uptake in non-insulin-dependent diabetes mellitus. Metabolism 37: 15–21, 1988Google Scholar
  14. 14.
    DeFronzo RA, Ferrannini E, Hendler R, Felig P, Wahren J, Regulation of splanchnic and peripheral glucose uptake by insulin and hyperglycemia in man. Diabetes 32: 35–45, 1983Google Scholar
  15. 15.
    Bruce DG, Chisholm DJ, Storlien LH, Kraegen EW, Physiological importance of deficiency in early prandial insulin secretion in non-insulin-dependent diabetes. Diabetes 37: 736–744, 1988Google Scholar
  16. 16.
    Skarfors E, Selinus I, Lithell H, Risk factors for developing non-insulin-dependent diabetes mellitus: a ten-year follow-up of men in Uppsala. BMJ 303: 755–760, 1991Google Scholar
  17. 17.
    Ferrannini E, Buzzigoli G, Bonadonna R, et al, Insulin resistance in essential hypertension. N Engl J Med 317: 350–357, 1987Google Scholar
  18. 18.
    Pollare T, Lithell H, Berne C, Insulin resistance is a characteristic feature of primary hypertension independently of obesity. Metabolism 39: 167–174, 1990Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • L. Lind
    • 1
    • 2
  • H. Lithell
    • 2
  • T. Pollare
    • 2
  • S. Ljunghall
    • 1
  1. 1.Department of Internal MedicineUniversity HospitalUppsalaSweden
  2. 2.Department of GeriatricsKungsgärdets HospitalUppsalaSweden

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