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Six-year Cumulative incidence of Type 2 DM
by Acute Insulin Response and Insulin Action

  Glucose Uptake <2.0 mg/kgMBS.min
  Glucose Uptake 2.0 - 5.0 mg/kgMBS.min
  Glucose Uptake >5.0 mg/kgMBS.min
The most convincing evidence that insulin resistance precedes the development of Type 2 diabetes comes from hyperinsulinemic euglycemic clamp studies. Insulin resistant Pima Indians i.e. those with low rates of insulin-mediated glucose uptake (red bars), are at highest risk of developing Type 2 diabetes over the following 6-year period. The majority of individuals who developed diabetes are in the lower third of the distribution of glucose uptake (glucose uptake <2.0mg/kg estimated metabolic body mass). The level of insulin secretion also influences the risk of developing Type 2 diabetes with those who have the greatest insulin secretion in response to an intravenous glucose load (>400uU/ml) having a lower incidence of diabetes than those who have lower insulin secretory responses. The high incidence in the more insulin resistant subjects shown here suggests that a high degree of insulin resistance in the Pima Indian population is necessary for the development of Type 2 diabetes. The level of insulin secretion modifies the rate of development of Type 2 diabetes among individuals who are insulin resistant.

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