Decline in the acute insulin response in relationship to plasma glucose concentrations

Abstract

With worsening insulin action, the decline in insulin secretion occurred prior to current diagnostic guidelines for impaired glucose regulation. However, the relationship between acute insulin response and increasing plasma glucose varies and was not always non-linear. Understanding the dynamics of this relationship may determine when to initiate preventive pharmacotherapy directed at the preservation of β-cell failure.

Disruption of fasting and post-load glucose homeostasis are largely independent and sustained by distinct and early major beta-cell function defects: a cross-sectional and longitudinal analysis of the Relationship between Insulin Sensitivity and Cardiovascular risk (RISC) study cohort

“…In particular, whether the defect in insulin secretion is absolute [8] or it emerges only in relationship to the degree of insulin resistance (failure of compensation) [10], and which is/are the earliest detectable defect/s remains unknown. While some of the variability depends on the ethnic background [13,14] and the prevalence of obesity [15], the relatively small sample size (n=40-664) and the large heterogeneity (in number and quality) of the methods employed must have also contributed. Finally, another factor could be responsible for the lack of accurate and consistent information.…”

Reproducibility and determinants of the metabolic responses during a mixed‐meal tolerance test

“…We initially analyzed associations in those with NGR and full Southwestern Indigenous American heritage only because of the known lower insulin secretion in individuals with IGR and in those with less than full Southwestern Indigenous American heritage [21]. In these models, in which we adjusted for age, sex, and body fat (percentage), M and AIR were inversely and independently associated with glucose AUC 180‐min ( M partial R : −0.32, AIR partial R : −0.25, p < 0.01), AUC 240‐min ( M partial R : −0.28, AIR partial R : −0.20, p < 0.01), and OGTT AUC 180‐min ( M partial R : −0.37, AIR partial R : −0.25, p < 0.01).…”

Physiologic hormone administration improves HbA1C in Native Americans with type 2 diabetes: A retrospective study and review of insulin secretion and action

“…Other risk factors, including age, sex, body fat, heritage, and insulin action during the hyperinsulinemic euglycemic clamp, did not influence the propensity for developing type 2 diabetes 78 . Among Native Americans, with declining insulin action, the reduction in insulin secretion manifests before blood glucose concentrations reach the diagnostic guidelines for impaired glucose tolerance 79 …”

“…78 Among Native Americans, with declining insulin action, the reduction in insulin secretion manifests before blood glucose concentrations reach the diagnostic guidelines for impaired glucose tolerance. 79 Similarly, in other races such as in Hispanics, low insulin clearance is associated with increased risk of incident diabetes after adjusting for demographics, lifestyle factors, indices of adiposity, and insulin secretion. 80 In Blacks, hepatic first-pass insulin extraction has been estimated to be two-thirds lower, whereas extrahepatic insulin clearance is similar, compared to Whites.…”