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Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parent


Warram, James H; Martin, Blaise C; Krolewski, Andrzej S; Soeldner, J Stuart; Kahn, C Ronald (1990). Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parent. Annals of Internal Medicine, 113(12):909-915.

Abstract

OBJECTIVE
To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type II diabetes.
DESIGN
Cohort analytic study of persons with normal glucose tolerance but with a high risk for developing type II diabetes (average follow-up time, 13 years).
SETTING
Outpatients had an intravenous glucose tolerance test and were contacted periodically to ascertain diagnoses of diabetes.
PARTICIPANTS
One hundred and fifty-five normal offspring, ranging in age from 16 to 60 years, of two parents with type II diabetes and 186 normal control subjects in the same age range who had no family history of diabetes.
MEASUREMENTS AND MAIN RESULTS
Two phenotypic characteristics distinguished the offspring of diabetic parents from control subjects. They had slower glucose removal rates (Kg) (P less than 0.01) and higher insulin levels (fasting and during the second phase of insulin response to intravenous glucose; P less than 0.0001) than did control subjects, even after adjustment for differences in obesity. Sixteen percent of the offspring developed type II diabetes. Mean Kg at baseline was 1.7%/min among offspring who subsequently developed diabetes, 2.2%/min among offspring who remained nondiabetic, and 2.3%/min among control subjects. Corresponding means for first-phase insulin were 498, 354, and 373 pM, respectively, whereas second-phase insulin means were 329, 117, and 87 pM, respectively. In multivariate analysis, low Kg and high serum insulin levels independently increased the risk for developing diabetes among the offspring of diabetic parents.
CONCLUSIONS
One to two decades before type II diabetes is diagnosed, reduced glucose clearance is already present. This reduced clearance is accompanied by compensatory hyperinsulinemia, not hypoinsulinemia, suggesting that the primary defect is in peripheral tissue response to insulin and glucose, not in the pancreatic beta cell.

Abstract

OBJECTIVE
To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type II diabetes.
DESIGN
Cohort analytic study of persons with normal glucose tolerance but with a high risk for developing type II diabetes (average follow-up time, 13 years).
SETTING
Outpatients had an intravenous glucose tolerance test and were contacted periodically to ascertain diagnoses of diabetes.
PARTICIPANTS
One hundred and fifty-five normal offspring, ranging in age from 16 to 60 years, of two parents with type II diabetes and 186 normal control subjects in the same age range who had no family history of diabetes.
MEASUREMENTS AND MAIN RESULTS
Two phenotypic characteristics distinguished the offspring of diabetic parents from control subjects. They had slower glucose removal rates (Kg) (P less than 0.01) and higher insulin levels (fasting and during the second phase of insulin response to intravenous glucose; P less than 0.0001) than did control subjects, even after adjustment for differences in obesity. Sixteen percent of the offspring developed type II diabetes. Mean Kg at baseline was 1.7%/min among offspring who subsequently developed diabetes, 2.2%/min among offspring who remained nondiabetic, and 2.3%/min among control subjects. Corresponding means for first-phase insulin were 498, 354, and 373 pM, respectively, whereas second-phase insulin means were 329, 117, and 87 pM, respectively. In multivariate analysis, low Kg and high serum insulin levels independently increased the risk for developing diabetes among the offspring of diabetic parents.
CONCLUSIONS
One to two decades before type II diabetes is diagnosed, reduced glucose clearance is already present. This reduced clearance is accompanied by compensatory hyperinsulinemia, not hypoinsulinemia, suggesting that the primary defect is in peripheral tissue response to insulin and glucose, not in the pancreatic beta cell.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:15 December 1990
Deposited On:19 Jul 2016 08:04
Last Modified:20 Jul 2016 08:06
Publisher:American College of Physicians
ISSN:0003-4819
Publisher DOI:https://doi.org/10.7326/0003-4819-113-12-909
PubMed ID:2240915

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