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J Clin Endocrinol Metab. 2013 Oct;98(10):4152-9. doi: 10.1210/jc.2013-1937. Epub 2013 Jul 24.

Longitudinal decline of β-cell function: comparison of a direct method vs a fasting surrogate measure: the Insulin Resistance Atherosclerosis Study.

Author information

1
PhD, University of Toronto, 150 College Street, Room 341, Toronto, ON, M5S 3E2. anthony.hanley@utoronto.ca.

Abstract

CONTEXT:

β-Cell function (BCF) declines over the course of type 2 diabetes, but little is known about BCF changes across glucose tolerance status (GTS) categories, and comparisons of direct vs surrogate measures.

OBJECTIVE:

To assess longitudinal changes in BCF across GTS.

DESIGN:

The Insulin Resistance Atherosclerosis Study is a multicenter, observational, epidemiologic study.

SETTING:

Four clinical centers in the US that could identify subjects likely to have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

PATIENTS:

We compared longitudinal changes in BCF in 1052 subjects over 5 years. Subjects were categorized according to baseline GTS: normal glucose tolerance (NGT: n = 547), impaired fasting glucose or impaired glucose tolerance (IFG/IGT: n = 341), and newly diagnosed type 2 diabetes (n = 164).

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

BCF was assessed from a frequently sampled iv glucose tolerance test (AIR, acute insulin response), and the homeostasis model assessment of BCF (HOMA B).

RESULTS:

NGT and IFG/IGT subjects increased their insulin secretion over time, whereas those with type 2 diabetes experienced either decline or little change in BCF. After adjustment for demographic variables and change in insulin resistance, change in HOMA B underestimated the magnitude of changes in BCF, as assessed by change in AIR. Relative to NGT, the 5-year change in insulin secretion in IFG/IGT and type 2 diabetes was 31% and 70% lower (by HOMA B) and 50% and 80% lower (by AIR).

CONCLUSIONS:

The decline in BCF over time in IFG/IGT and type 2 diabetes may be more pronounced than previously estimated; HOMA B may underestimate this decline significantly.

PMID:
23884776
PMCID:
PMC3790620
DOI:
10.1210/jc.2013-1937
[Indexed for MEDLINE]
Free PMC Article

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