J Korean Diabetes Assoc.  2006 May;30(3):198-206. 10.4093/jkda.2006.30.3.198.

Insulin Secretion and Insulin Resistance in Newly Diagnosed, Drug Naive Prediabetes and Type 2 Diabetes Patients With/Without Metabolic Syndrome

• Rhee SY
• Chon S
• Oh S
• Kim SW
• Kim JW
• Kim YS
• Woo JT

• KMID: 2177614
• DOI: http://doi.org/10.4093/jkda.2006.30.3.198

Abstract

BACKGROUND: To evaluate the relationships between deterioration in insulin secretion and aggravated insulin resistance in patients with newly diagnosed prediabetes (preDM) and type 2 diabetes mellitus (T2DM) according to the presence of metabolic syndrome (MS).
METHODS
We performed oral glucose tolerance test (OGTT) on 322 drug naive subjects with a history of hyperglycemia of < or = 3 months, and divided these patients into 3 groups, normal glucose tolerance (NGT), preDM (IFG and/or IGT) and T2DM. We also diagnosed these subjects with respect to MS according to ATP III criteria modified by Asia-Pacific guidelines and compared IGI and HOMA-IR in the 3 groups.
RESULTS
According to OGTT, 63 subjects were diagnosed with NGT, 81 with preDM, and 178 with T2DM. Using modified ATP III criteria, 218 (67.7%) subjects were diagnosed as MS. When compare groups stratified by the presence of MS, preDM and T2DM groups with MS showed significantly higher mean HOMA-IR and IGI than those without MS. When compare groups with respect to glucose tolerance, NGT, preDM, and T2DM subgroups in MS group showed significant higher HOMA-IR and lower IGI according to glucose tolerance. However, NGT, preDM, and T2DM subgroups in non-MS group showed a significant decrease in IGI but no significant difference in HOMA-IR as glucose tolerance worsened.
CONCLUSION
Deterioration in IGI and aggravation of HOMA-IR are both important in the primary pathogenesis of diabetes in those with MS. However, IGI deterioration may be the only important factor in the primary pathogenesis of T2DM in the absence of MS.

Keyword

Diabetes mellitus; Insulin Resistance; Insulin secretion; Metabolic syndrome

MeSH Terms

Adenosine Triphosphate
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucose
Glucose Tolerance Test
Humans
Hyperglycemia
Insulin Resistance*
Insulin*
Prediabetic State*
Adenosine Triphosphate
Glucose
Insulin

Figure

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  Fig. 1 Prevalence of Metabolic syndrome among study subjects.

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  Fig. 2 IGI and HOMA-IR differences according to the presence of MS in the three glucose tolerance subgroups. Both IGI and HOMA-IR were significantly elevated in MS subgroups.

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  Fig. 3 Differences in IGI and HOMA-IR according to glucose tolerance in patients with/without MS. In MS patients, IGI values progressively decreased and HOMA-IR values progressively increased with increased glucose tolerance aggravation. However, though IGI values progressively decreased in patients without MS with increasing glucose tolerance aggravation, HOMA-IR values were unaffected.

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  Fig. 4 Hypothesis concerning primary metabolic changes during the development of type 2 DM. In patients with MS, IGI (compensatory insulin secretion) deterioration and HOMA-IR (insulin resistance) aggravation are both important in the primary pathogenesis of diabetes. However, HOMA-IR aggravation may not be an important factor in the pathogenesis of diabetes in those without MS.

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