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Direct evidence that insulin resistance precedes the development of Type 2 diabetes comes from prospective studies among the Pima Indian population. This graph shows the cumulative incidence of diabetes over a five-year period in individuals with NGTat the begining. Those with the highest fasting insulin levels had the highest risk of developing diabetes over the period. In people with NGT the fasting insulin level is a reflection of the extent of insulin resistance. Similar patterns have now been seen in many other ethnic groups.