Taking steps to reduce insulin resistance could delay the development of Type 1 diabetes. Glucose homeostasis is determined by interplay between insulin secretion and insulin action. In Type 1 diabetes, autoimmune destruction of pancreatic beta cells leads to impaired insulin secretion. However, the contribution of impaired insulin action (insulin resistance) to the development of Type 1 diabetes is often overlooked. Islet-antibody-positive first-degree relatives of Type 1 diabetes probands were followed for 4.0 years (median). Insulin secretion was measured as first-phase insulin response (FPIR) to intravenous glucose. Insulin resistance was estimated by homeostasis model assessment of insulin resistance (HOMA-R). We compared subjects who progressed ( n=43) and subjects who did not progress ( n=61) to diabetes, including 21 pairs matched for age, sex, islet antibodies and FPIR. Progressors had higher insulin resistance relative to insulin secretion at baseline.
In the matched comparison, progressors had higher fasting glucose, fasting insulin, HOMA-R and HOMA-R : FPIR, both at baseline and during the follow-up pre-clinical phase. Relatives positive for islet antibodies who progress most rapidly to diabetes have a subtle disturbance of insulin-glucose homeostasis years before the onset of symptoms, distinguished by greater insulin resistance for their level of insulin secretion. "Taking steps to reduce this insulin resistance could therefore delay the development of Type 1 diabetes."
Diabetologia, October 6, 2004
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