Insufficiency of Insulin Secretory Responses in Primary Diabetes

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Glucose intolerance is an important feature of diabetes mellitus. However, the mear abnor-mality of glucose tolerance is inadequate for the accurate diagnosis, since there are so many pathological conditions which impair glucose tolerance. The aim of the present study is to investi-gate whether the maturity onset type diabetes developes from low insulin responders to glucose load or not.<BR>Blood glucose and IRI were assayed before and at 30min, 60min, 90min, 120min and 180 min after oral administration of 100g glucose.(1) In definitely diabetic patients, even in the sub-jects who showed normal type glucose tolerance curve after a certain treatment period, IRI (the sums of six insulin values) remained low throughout the wide range of BG (the sums of six blood glucose values). As the absolute increase in plasma insulin depends on the magnitude of glycemic stimulus, the ratios of increment of insulin (ΔIRI in μU/ml) to that of blood glucose (ΔBG in mg/100ml) 30min after glucose load were calculated. ΔIRI/ΔBG values scattered considerably in patients who visited diabetes clinic. However, the values of definitely diabetic patients were invariably lower than 0.5 whether they were obese or not, and regardless of their glucose intol-erance.(2) The investigation was extended to the studies of insulin responses of the patients who had equivocal diabetes initially but later developed diabetic retinopathy. About half of these patients had a family history of diabetes. Their initial glucose tolerance curves were either diabetic, borderline or normal. However, the initial ΔIRI/ΔBG ratios were all less than 0.5 irrespective of their types of glucose tolerance and remained consistently low during the entire follow-up periods regardless of changes in types of glucose tolerance.(3) The offsprings of two diabetic parents have high chance to get diabetes in the future. In 57 such cases, 23 had normal, 15 had borderline and 19 had diabetic type glucose tolerance. The overall prevalence of low insulin responders (ΔIRI/ ΔBG less than 0.5) was about 60 per cent, and it was fairly constant in different age groups despite an increase in the number of cases with glucose intolerance as an increase of age. When the results were expressed by BG-IRI plots, these siblings with ΔIRI/ΔBG below 0.5 were distributed in the zone of definite diabetes, and those with ΔIRI/ΔBG above 0.5 fell in the zone of various pathological conditions other than diabetes.<BR>The present study supports that the early low insulin response after glucose load is a characteristic feature for true diabetes and presents before the development of overt diabetes.
Japan Society of Clinical Chemistryの論文

Insufficiency of Insulin Secretory Responses in Primary Diabetes

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