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#11
Postprandial
Insulin Deficiency Major Factor Of Deteriorating Glucose Control
Postprandial
insulin deficiency is the most powerful explanatory factor of
deteriorating glucose control in newly presenting type 2 diabetes.
"Indices of insulin sensitivity and pancreatic beta-cell
responsiveness explain fasting glucose and HbA1c
(glycated hemoglobin) well but fail to explain postprandial
glucose," add investigators from City University in London
and the University of Wales College of Medicine, United Kingdom.
The investigators examined the ability of indices of insulin
sensitivity and pancreatic beta-cell responsiveness to explain
interindividual variability of glucose control measures in 65
patients with newly presenting type 2 diabetes.
Minimal model-derived insulin sensitivity, glucose effectiveness,
first-phase insulin secretion and disposition index were
determined using an insulin-modified iv glucose tolerance test.
Fasting/basal and postprandial pancreatic beta-cell responsiveness
was measured by a standard meal tolerance test.
Stepwise linear regression was used with these indices to explain
the interindividual variability of fasting and postprandial
concentrations of plasma glucose, plasma insulin and HbA1c.
Results showed a negative correlation between measures of
pancreatic beta-cell responsiveness and fasting plasma glucose.
Pancreatic beta-cell responsive measures were positively
correlated with fasting plasma insulin and insulin response to the
meal tolerance test.
Minimal model-derived insulin sensitivity was found to be
negatively correlated with fasting plasma insulin but was not
correlated with any glucose variable.
Postprandial beta-cell responsiveness and disposition index were
the "most informative in explaining interindividual
variability," according to the investigators.
J Clin Endocrinol
Metab 2002; 87(1): 198-203
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Did
You Know:
According to
the survey, awareness of the increased cardiovascular disease risk
is lower among older adults and Hispanics, with three-quarters (75
percent) unaware that cardiovascular disease is a serious health
problem caused by diabetes.
Fact: Older adults and Hispanics have high rates of diabetes and its
complications. Educational efforts about the
diabetes-cardiovascular disease link must target these
communities.
Also:
Diabetes
Care November 1999
–“The
immediate feedback of HbA1c results at the time of patient
encounters resulted in a significant improvement of glycemic
control at 6-month follow-up and persisted for the 12-month study
–“Availability
of rapid HbA1c determinations appears to facilitate diabetes
management. The more favorable HbA1c profile in the rapid HbA1c
group occurs independently of the decision to intensify therapy,
suggesting the involvement of other factors such as enhanced
provider and/or patient motivation.”
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