Diabetes Metab J.  2015 Apr;39(2):117-125. 10.4093/dmj.2015.39.2.117.

The Insulin Resistance but Not the Insulin Secretion Parameters Have Changed in the Korean Population during the Last Decade

• Yang HK
• Lee JH
• Choi IY
• Kwon HS
• Shin JA
• Jeong SH
• Lee SH
• Cho JH
• Son HY
• Yoon KH

• KMID: 1805894
• DOI: http://doi.org/10.4093/dmj.2015.39.2.117

Abstract

BACKGROUND
This study aimed to compare the patterns of insulin secretion and resistance between Korean subjects in the 1990s and 2000s.
METHODS
Insulin secretion and resistance indices were calculated from subjects who underwent 75-g oral glucose tolerance tests in the year 1997 to 1999 and 2007 to 2011 at the Seoul St. Mary's Hospital, Korea.
RESULTS
A total of 578 subjects from the 1990s (mean age, 48.5 years) and 504 subjects from the 2000s (mean age, 50.2 years) were enrolled. Compared with the subjects from the 1990s, those from the 2000s exhibited increased insulin resistance (increased homeostatic model assessment for insulin resistance), and reduced insulin sensitivity (reduced Matsuda index and quantitative insulin sensitivity check index), regardless of their glucose tolerance status. However, insulinogenic index did not reveal significant differences between the 2 decades in subjects with or without diabetes. A distinct relationship was confirmed between Matsuda index and total area under the curve (insulin/glucose) in each glucose tolerance group. The mean product of the Matsuda index and the total area under the curve (insulin/glucose) as well as the oral disposition index, was lower in subjects with normal glucose tolerance from the 2000s than in those from the 1990s.
CONCLUSION
After rapid economic growth and changes in lifestyle patterns, insulin resistance has worsened across the glucose tolerance status; however, the insulin secretory function remained unchanged, which resulted in an increase in the susceptibility to the development of type 2 diabetes mellitus among Korean subjects without diabetes. We could not rule out the potential selection bias and therefore, further studies in general Korean population are needed.

Keyword

Diabetes mellitus; Insulin resistance; Insulin secretion; Korea; Oral glucose tolerance test

MeSH Terms

Diabetes Mellitus
Diabetes Mellitus, Type 2
Economic Development
Glucose
Glucose Tolerance Test
Insulin Resistance*
Insulin*
Korea
Life Style
Selection Bias
Seoul
Glucose
Insulin

Figure

• 

  Fig. 1 Results of the 75-g oral glucose tolerance test in subjects from the 1990s and 2000s. Measurements obtained during the 75-g oral glucose tolerance test (OGTT) were compared at each time points using the t-test in subjects with (A) normal glucose tolerance (NGT), (B) pre-diabetes mellitus (pre-DM), and (C) diabetes mellitus (DM). Comparison of time course curves during OGTT were analyzed by repeated measures analysis of variance (ANOVA). Open circles and dashed lines represent measurements obtained in subjects from the 1990s. Black squares and solid lines represent measurements obtained in subjects from the 2000s. aP value <0.05 at the 0, 30, 60, 90, or 120-minute time points during the 75-g OGTT. "P for trend" indicates the comparison of time course curves during OGTT, analyzed by repeated measures ANOVA.

• 

  Fig. 2 Hyperbolic relationship between the Matsuda index and the total area under the curve (total AUC; insulin/glucose [I/G]). A distinct hyperbolic relationship was observed between the Matsuda index and the total AUC (I/G) in subjects with normal glucose tolerance (NGT), pre-diabetes mellitus (pre-DM), and diabetes mellitus (DM) from (A) the 1990s (P<0.001) and (B) the 2000s (P<0.001). (C) Mean values of Matsuda index and total AUC (I/G) in each glucose tolerance group from the 1990s and 2000s. Open and filled circles represent the subjects with NGT from the 1990s and 2000s, respectively. Open and filled triangles represent the subjects with pre-DM from the 1990s and 2000s, respectively. Open and filled squares represent the subjects with DM from the 1990s and 2000s respectively.

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