Impaired fasting glucose with or without impaired glucose tolerance: progressive or parallel states of prediabetes?

Abstract

Our objective was to determine whether defects underlying impaired fasting glucose (IFG) are maintained and additive when combined with impaired glucose tolerance (IGT) (representing a progressive form of prediabetes) or are distinct in IFG/IGT (reflecting a parallel form of prediabetes). Volunteers with IFG (n = 10), IFG/IGT (n = 14), or normal glucose tolerance (NGT; n = 15) were matched for demographics and anthropometry. Insulin secretion was assessed using the glucose step-up protocol and insulin action through the use of a two-stage hyperinsulinemic euglycemic clamp with infusion of [6,6-(2)H(2)]glucose. Modeling of insulin secretory parameters revealed similar basal (Phi(b)) but diminished dynamic (Phi(d)) components in both IFG and IFG/IGT (P = 0.05 vs. NGT for both). Basal glucose rate of appearance (R(a)) was higher in IFG compared with NGT (P < 0.01) and also, surprisingly, with IFG/IGT (P < 0.04). Moreover, glucose R(a) suppressed more during the low-dose insulin clamp in IFG (P < 0.01 vs. NGT, P = 0.08 vs. IFG/IGT). Insulin-stimulated glucose uptake [glucose rate of disappearance (R(d))] was similar in IFG, IFG/IGT, and NGT throughout the clamp. We conclude that nuances of beta-cell dysfunction observed in IFG were also noted in IFG/IGT. A trend for additional insulin secretory defects was observed in IFG/IGT, possibly suggesting progression in beta-cell failure in this group. In contrast, basal glucose R(a) and its suppressability with insulin were higher in IFG, but not IFG/IGT, compared with NGT. Together, these data indicate that IFG/IGT may be a distinct prediabetic syndrome rather than progression from IFG.

Wczesne markery miażdżycy u chorych z nieprawidłową glikemią na czczo

“…Weyer et al note that patients with isolated IFG or IFG and IGT demonstrate reduced suppression of glucose production induced by insulin [31]. In contrast, Perrault et al report that in these conditions suppression of glucose production is not impaired [30]. It is known that morphological changes in blood vessels are greater in patients with IGT compared with those In our study in patients with IFG CIMT was increased, Strain and Strain rate were worse compared to control.…”

“…However, there are some differences in the nature of the defects between the two conditions. Individuals with isolated IFG manifest normal to slightly-decreased insulin secretion and normal or slightly-impaired insulin action [24][25][26][27][28][29][30]. Isolated IGT is characterized by more severe muscle insulin resistance and less severe hepatic insulin resistance.…”

“…Among subjects with prediabetes, those with combined IFG/IGT most closely resemble subjects with type 2 diabetes. Most authors suggest that excessive hepatic glucose production is observed during IFG [30][31][32]. It is unknown whether IFG is linked with insulin resistance in the liver.…”

Relationship Between Insulin Resistance and β-Cell Dysfunction in Subphenotypes of Prediabetes and Type 2 Diabetes

“…The IFG&IGT group had a combination of the defects observed in the isolated IFG and IGT groups, but with disposition indices close to the levels observed in F-DM and 2h-DM, supporting progressive beta cell failure when moving from i-IFG to IFG&IGT (33).…”

Prevalence of Prediabetes and the Associated Risk of Kidney Disease in Apparently Healthy Subjects in Nnewi, Anambra State, Nigeria

“…Recent studies also showed that prediabetes is the leading cause of kidney failure accounting for 44% of new cases of kidney failure [7]. Some data indicated that lifestyle interventions for prediabetes can return individuals for normoglyceamia Perreault, et al [12] and Schellenberg and Dryden [13]. The aim of this study is to evaluate the prevalence of prediabetes and its associated risk of kidney diseases in adult males and females in Nnewi, Anambra state, Nigeria.…”