In a cross-sectional study, we assessed β-cell function and insulin sensitivity index (ISI) with hyperglycemic clamps (10 mmol/l) in 24 subjects with impaired fasting glycemia (IFG, fasting plasma glucose [FPG] between 6.1 and 7.0 mmol/l), 15 type 2 diabetic subjects (FPG >7.0 mmol/l), and 280 subjects with normal fasting glycemia (NFG, FPG <6.1 mmol/l). First-phase insulin release (0–10 min) was lower in IFG (geometric mean 541 pmol/l · 10 min; 95% confidence interval [CI] 416–702 pmol/l · 10 min) and in type 2 diabetes (geometric mean 376 pmol/l · 10 min; 95% CI 247–572 pmol/l · 10 min) than NFG (geometric mean 814 pmol/l · 10 min; 95% CI 759–873 pmol/l · 10 min) (P < 0.001). Second-phase insulin secretion (140–180 min) was also lower in IFG (geometric mean 251 pmol/l; 95% CI 198–318 pmol/l; P = 0.026) and type 2 diabetes (geometric mean 157 pmol/l; 95% CI 105–235 pmol/l; P < 0.001) than NFG (geometric mean 295 pmol/l; 95% CI 276–315 pmol/l). IFG and type 2 diabetic subjects had a lower ISI (0.15 ± 0.02 and 0.16 ± 0.02 μmol/kg fat-free mass [FFM]/min/pmol/l, respectively) than NFG (0.24 ± 0.01 μmol/kg FFM/min/pmol/l, P < 0.05). We found a stepwise decline in first-phase (and second-phase) secretion in NFG subjects with progressive decline in oral glucose tolerance (P < 0.05). IFG subjects with impaired glucose tolerance (IGT) had lower first-phase secretion than NFG subjects with IGT (P < 0.02), with comparable second-phase secretion and ISI. NFG and IFG subjects with a diabetic glucose tolerance (2-h glucose >11.1 mmol/l) had a lower ISI than their respective IGT counterparts (P < 0.05). We conclude that the early stages of glucose intolerance are associated with disturbances in β-cell function, while insulin resistance is seen more markedly in later stages.
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Accepted for publication 25 June 2001.
DGT, diabetic glucose tolerance;FFM, fat-free mass;FPG, fasting plasma glucose;GIR, glucose infusion rate;IFG, impaired fasting glycemia;IGT, impaired glucose tolerance; NFG, normal fasting glycemia; ISI, insulin sensitivity index; LBM, lean body mass; OGTT, oral glucose tolerance test;WHR, waist-to-hip ratio.
The symposium and the publication of this article have been made possible by an unrestricted educational grant from Servier, Paris.