Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2010 Mar;53(3):435-45.
doi: 10.1007/s00125-009-1614-2. Epub 2009 Dec 10.

Determinants of glucose tolerance in impaired glucose tolerance at baseline in the Actos Now for Prevention of Diabetes (ACT NOW) study

R A DeFronzo  1 , M A Banerji, G A Bray, T A Buchanan, S Clement, R R Henry, A E Kitabchi, S Mudaliar, N Musi, R Ratner, P Reaven, D C Schwenke, F D Stentz, D Tripathy; ACT NOW Study Group
Affiliations
Randomized Controlled Trial

Determinants of glucose tolerance in impaired glucose tolerance at baseline in the Actos Now for Prevention of Diabetes (ACT NOW) study

R A DeFronzo et al. Diabetologia. 2010 Mar.

Abstract

Aims/hypothesis: The aim of the study was to examine the determinants of oral glucose tolerance in 602 persons with impaired glucose tolerance (IGT) who participated in the Actos Now for Prevention of Diabetes (ACT NOW) study.

Methods: In addition to the 602 IGT participants, 115 persons with normal glucose tolerance (NGT) and 50 with impaired fasting glucose (IFG) were identified during screening and included in this analysis. Insulin secretion and insulin sensitivity indices were derived from plasma glucose and insulin during an OGTT. The acute insulin response (AIR) (0-10 min) and insulin sensitivity (S(I)) were measured with the frequently sampled intravenous glucose tolerance test (FSIVGTT) in a subset of participants.

Results: At baseline, fasting plasma glucose, 2 h postprandial glucose (OGTT) and HbA(1c) were 5.8 +/- 0.02 mmol/l, 10.5 +/- 0.05 mmol/l and 5.5 +/- 0.04%, respectively, in participants with IGT. Participants with IGT were characterised by defects in early (DeltaI (0-30)/DeltaG (0-30) x Matsuda index, where DeltaI is change in insulin in the first 30 min and DeltaG is change in glucose in the first 30 min) and total (DeltaI(0-120)/DeltaG(0-120) x Matsuda index) insulin secretion and in insulin sensitivity (Matsuda index and S(I)). Participants with IGT in whom 2 h plasma glucose was 7.8-8.3 mmol/l had a 63% decrease in the insulin secretion/insulin resistance (disposition) index vs participants with NGT and this defect worsened progressively as 2 h plasma glucose rose to 8.9-9.94 mmol/l (by 73%) and 10.0-11.05 mmol/l (by 80%). The Matsuda insulin sensitivity index was reduced by 40% in IGT compared with NGT (p < 0.005). In multivariate analysis, beta cell function was the primary determinant of glucose AUC during OGTT, explaining 62% of the variance.

Conclusion: Our results strongly suggest that progressive beta cell failure is the main determinant of progression of NGT to IGT.

PubMed Disclaimer

Comment in

  • Insulin secretion and impaired glucose tolerance.
    Jenkins AB, Campbell LV. Jenkins AB, et al. Diabetologia. 2010 Oct;53(10):2266-8; author reply 2269-70; discussion 2271-2. doi: 10.1007/s00125-010-1801-1. Epub 2010 May 22. Diabetologia. 2010. PMID: 20495971 No abstract available.

References

    1. Diabetes. 2006 Feb;55(2):517-22 - PubMed
    1. Diabetes. 2006 May;55(5):1430-5 - PubMed
    1. Diabetes Care. 2006 May;29(5):1130-9 - PubMed
    1. Diabet Med. 2007 Feb;24(2):137-44 - PubMed
    1. Diabetes. 2000 Jun;49(6):975-80 - PubMed

Publication types

LinkOut - more resources