The relationship between fasting hyperglycemia and insulin secretion in subjects with normal or impaired glucose tolerance

Abstract

To assess the relationship between the fasting plasma glucose (FPG) concentration and insulin secretion in normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) subjects, 531 nondiabetic subjects with NGT (n = 293) and IGT (n = 238; 310 Japanese and 232 Mexican Americans) received an oral glucose tolerance test (OGTT) with measurement of plasma glucose, insulin, and C-peptide every 30 min. The insulin secretion rate was determined by plasma C-peptide deconvolution. Insulin sensitivity (Matsuda index) was measured from plasma insulin and glucose concentrations. The insulin secretion/insulin resistance (IS/IR) or disposition index was calculated as DeltaISR/DeltaG / IR. As FPG increased in NGT subjects, the IS/IR index declined exponentially over the range of FPG from 70 to 125 mg/dl. The relationship between the IS/IR index and FPG was best fit with the equation: 28.8 exp(-0.036 FPG). For every 28 mg/dl increase in FPG, the IS/IR index declined by 63%. A similar relationship between IS/IR index and FPG was observed in IGT. However, the decay constant was lower than in NGT. The IS/IR index for early-phase insulin secretion (0-30 min) was correlated with the increase in FPG in both NGT and IGT (r = -0.43, P < 0.0001 and r = -0.20, P = 0.001, respectively). However, the correlation between late-phase insulin secretion (60-120 min) and FPG was not significant. In conclusion, small increments in FPG, within the "normal" range, are associated with a marked decline in glucose-stimulated insulin secretion and the decrease in insulin secretion with increasing FPG is greater in subjects with NGT than IGT and primarily is due to a decline in early-phase insulin secretion.

Fig. 1.

A: relationship between insulin secretion/insulin resistance index calculated during the entire oral glucose tolerance test (OGTT; 0–120 min) and fasting plasma glucose (FPG) concentration in the entire population in normal glucose tolerance (NGT; •), impaired glucose tolerance, (IGT; ○), and diabetic (◊) subjects; top line: least square fit for subjects with NGT and is described by the equation y = 18.25 exp(−0.031x). The lower line is the least square fit for subjects with IGT and is described by the equation y = 0.84 exp(−0.0083x). B: log-log transformation of the data shown in A. Regression lines are the least square fit (r = −0.39, P < 0.0001 for NGT and r = 0.19, P < 0.05 for IGT) of the data.

Fig. 2.

A: relationship between insulin secretion/insulin resistance index calculated during the first 30 min of the OGTT (0–30 min) and FPG concentration in the entire population in NGT (•) and IGT (○) subjects. Top line: least squares fit for NGT subjects and is described by the equation y = 2.4 exp(−0.036x); bottom line: least squares fit for NGT subjects and is described by the equation y = 1.78 exp(−0.015x). B: log-log transformation of the data shown in A. Regression lines are the least squares fit for NGT (r = −0.43; P < 0.0001 ) and IGT (r = −0.2; P = 0.001) subjects.

Fig. 3.

A: relationship between insulin secretion/insulin resistance index calculated during the last hour of the OGTT (60–120 min) and FPG concentration in the entire population in NGT (•) and IGT (○) subjects. Top line: least squares fit for subjects with NGT and is described by the equation y = 1.8 exp(−0.0068x). Bottom line: least squares fit for IGT subjets and is described by the equation y = 0.56 exp(−0.0043x). B: log-log transformation of the data shown in A. Regression lines are the least squares fit for NGT (r = 0.09; P = NS) and IGT (r = 0.05; P = not significant) subjects.