Potential Identification of Type 2 Diabetes with Elevated Insulin Clearance

Insulin sensitivity, disposition index and insulin clearance in cystic fibrosis: a cross-sectional study

AIMS/HYPOTHESIS

The aim of this study was to investigate insulin secretion, insulin sensitivity, disposition index and insulin clearance by glucose tolerance status in individuals with cystic fibrosis (CF) and exocrine pancreatic insufficiency.

METHODS

In a cross-sectional study, we conducted an extended (ten samples) OGTT in individuals with pancreatic-insufficient CF (PI-CF). Participants were divided into normal glucose tolerance (NGT), early glucose intolerance (EGI), impaired glucose tolerance (IGT) and CF-related diabetes (CFRD) groups. We used three different oral minimal models to assess insulin secretion, insulin sensitivity and insulin clearance during the OGTT. We evaluated insulin secretion using total secretion (Φ total), first-phase secretion (Φ dynamic) and second-phase secretion (Φ static) from the model, and we estimated the disposition index by multiplying Φ total and insulin sensitivity.

RESULTS

Among 61 participants (NGT 21%, EGI 33%, IGT 16%, CFRD 30%), insulin secretion indices (Φ total, dynamic and static) were significantly lower in the CFRD group compared with the other groups. Insulin sensitivity declined with worsening in glucose tolerance (p value for trend <0.001) and the disposition index declined between NGT and EGI and between IGT and CFRD. Those with CFRD had elevated insulin clearance compared with NGT (p=0.019) and low insulin secretion (Φ total) was also associated with high insulin clearance (p<0.001).

CONCLUSIONS/INTERPRETATION

In individuals with PI-CF, disposition index declined with incremental impairment in glucose tolerance due to a reduction in both insulin secretion and insulin sensitivity. Moreover in CF, reduced insulin secretion was associated with higher insulin clearance.

Precision Diagnostics for Type 2 Diabetes Mellitus - Have We Arrived?

Type 2 diabetes mellitus (T2DM) is defined by a common end point: hyperglycemia diagnosed by fasting plasma glucose, plasma glucose during an oral glucose tolerance test, or hemoglobin A1c without autoimmune β-cell destruction.1 Historically, little attention has been paid to the etiologies driving hyperglycemia; as a result, there has been an absence of an elegant pathophysiologically directed diagnostic and therapeutic approach. T2DM has simply been thought to be a result of insulin deficiency and/or peripheral insulin resistance. However, the phenotype of T2DM is heterogeneous, as is the pathophysiology.2,3.