Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic patients

Article Abstract:

Non-insulin-dependent diabetes mellitus (NIDDM), or type II diabetes, is characterized by overproduction of glucose by the liver, insensitivity to insulin's effects, and impairment of the beta cells of the pancreas in the production of insulin. These pathological changes act together to produce excessively high levels of blood glucose. There is lack of agreement over whether the primary event in the development of NIDDM is insensitivity to insulin action (insulin resistance) or insulin deficiency. Previous studies have examined close relatives of NIDDM patients in an effort to identify which metabolic abnormality predominates, but long-term follow-up studies to determine the predictive value of these conditions are lacking. A study was carried out with 155 non-diabetic offspring of two type II diabetic patients and 186 offspring of normal control subjects. Metabolic profiles were determined at the initial visit, and the subjects were followed for an average of 13 years to monitor the development of type II diabetes. The children of diabetic patients were characterized by a decreased rate of glucose clearance (i.e. disappearance of ingested glucose from the blood, resulting from the action of insulin) and compensatory hyperinsulinemia (excessive blood insulin). These differences were even more pronounced when the offspring were grouped according to whether or not they themselves eventually developed type II diabetes. Multivariate statistical methods indicated that even when corrections were made for the differential incidence of obesity among the groups, both decreased glucose clearance and hyperinsulinemia were good predictors of incipient type II diabetes. These results indicate that the primary defect in type II diabetes is peripheral insulin insensitivity, rather than a defect in the function of the insulin-secreting pancreatic beta cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of

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Predicting type II diabetes in persons at risk

Article Abstract:

Non-insulin-dependent diabetes mellitus (NIDDM), or 'type II diabetes', is a disease characterized by insensitivity to the effects of the insulin that is produced within the body, overproduction of glucose by the liver, and, ultimately, the insufficient functioning of the beta cells of the pancreas in producing insulin. These pathological changes act in concert to produce excessively high levels of blood glucose. There is a strong genetic component in the development of NIDDM; if one member of a pair of identical twins develops NIDDM, the likelihood of the other member developing the disease is about 100 percent. Nevertheless, the primary defect responsible for NIDDM onset remains unknown. Obesity is considered to be an important risk factor for NIDDM. However, longitudinal studies have shown that insulin insensitivity develops in most cases prior to the onset of obesity, arguing against obesity as the primary event. The most compelling evidence, gathered from the offspring of patients with NIDDM (prior to onset of the disease in the offspring), suggests that the first detectable event in developing NIDDM is fasting and glucose-stimulated hyperinsulinemia (high insulin levels in the blood); this appears to be the most reliable predictor of the eventual development of NIDDM. Additionally, there is evidence implicating alterations in the rate at which the body disposes of glucose as a predictor of NIDDM onset. To date, most of the data collected have been in relatives of known NIDDM patients; extrapolation to the population at large must be done with caution, and should await completion of similar studies in a more heterogeneous population. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, editorial

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Regression of microalbuminuria in type 1 diabetes

Article Abstract:

Many diabetics who have a protein called albumin in their urine?will not necessarily develop diabetic kidney disease, according to a study of 386 patients. In fact, they may even stop excreting albumin in their urine. Diabetics with low blood pressure, low cholesterol levels, and low glycosylated hemoglobin levels were three times more likely to stop excreting albumin in their urine than other diabetics. Albumin in the urine is a sign that a person may be developing kidney disease.

Development and progression, Diabetic nephropathies, Albuminuria

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