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

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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 (ΔI 30/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 ΔI 30/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 ΔI 30/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 ΔI 30/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.

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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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Authors and Affiliations

  1. Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, 78284-7873, San Antonio, TX, USA

    S. M. Haffner, H. Miettinen, S. P. Gaskill & M. P. Stern

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  1. S. M. Haffner
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  2. H. Miettinen
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  3. S. P. Gaskill
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  4. M. P. Stern
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Haffner, S.M., Miettinen, H., Gaskill, S.P. et al. Decreased insulin action and insulin secretion predict the development of impaired glucose tolerance. Diabetologia 39, 1201–1207 (1996). https://doi.org/10.1007/BF02658507

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