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Quantification of Insulin Secretion in Relation to Insulin Sensitivity in Nondiabetic Postmenopausal Women

From the Department of Medicine, Lund University, Lund, Sweden

To evaluate mechanisms underlying the close association between insulin secretion and insulin sensitivity, insulin sensitivity was evaluated by the euglycemic-hyperinsulinemic clamp technique (M/I_clamp) and insulin secretion was determined from the 75-g oral glucose tolerance test (OGTT) and from the glucose-dependent arginine-stimulation test in 81 nondiabetic postmenopausal women, all aged 61 years. M/I_clamp was normally distributed with mean ± SD of 69.9 ± 30.5 nmol glucose · kg^-1 · min^-1/pmol insulin · l^-1. It was found that the several different measures of insulin secretion from the OGTT and the glucose-dependent arginine-stimulation test were all inversely related to M/I_clamp. However, measures determining the direct insulin responses were more markedly potentiated by low M/I_clamp than were measures determining glucose potentiation of insulin secretion. Moreover, the product of M/I_clamp times measures of insulin secretion (disposition index [DI]) was inversely related to the 2-h glucose value. Finally, surrogate insulin sensitivity measures quantified from OGTT and the glucose-dependent arginine-stimulation test only weakly correlated to M/I_clamp (R² 0.25). Thus, 1) insulin secretion is adaptively increased when insulin sensitivity is low in nondiabetic postmenopausal women; 2) ß-cell exocytotic ability shows more efficient adaptation than ß-cell glucose recognition to low insulin sensitivity; 3) impaired ß-cell adaptation (i.e., low DI) is associated with higher 2-h glucose values during OGTT, although other regulatory mechanisms also exist; and 4) indirect surrogate measures of insulin sensitivity only weakly correlate to insulin sensitivity as determined by the euglycemic-hyperinsulinemic clamp.

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