Insulin Resistance Can Hasten Diabetes Progression

Insulin resistance in certain islet cell antibody (ICA)-positive relatives of patients with type 1 diabetes appears to accelerate onset of the disease, according to the results of a new study.

 Dr. Polly J. Bingley of the University of Bristol, UK and colleagues note that a number of situations associated with increased insulin resistance, including puberty and pregnancy, appear to hasten the onset of type 1 diabetes.

To determine whether insulin resistance might also be of value in risk assessment in ICA-positive first-degree relatives of diabetics, the researchers studied data on 213 such subjects who were less than 25 years old.

The overall cumulative risk of diabetes over 5 years was 54.1%. However, use of the homeostasis model assessment of insulin resistance (HOMA2-IR) provided results that were only of borderline significance when added to established markers.

Further analysis showed that that although it was possibly of marginal utility in the group as a whole, HOMA2-IR was not of value in assessing risk in participants with preserved baseline first-phase insulin response. However, say the investigators, it did emerge "as a major determinant of risk in those in whom beta-cell function was markedly reduced" (hazard ratio, 3.67).
This finding suggests, the team concludes, that "over the period studied, insulin sensitivity modulates the clinical onset of diabetes only in those with severely compromised cell function."

Diabetes Care Jan.2008;31:146-150.