Cited by 1,508Diabetes, Cardiovascular Risks, and LipoproteinsPancreatic function and diabetesDiabetes Management and Research

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Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of pima indians

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Lillioja, Stephen, Mott, David M., Spraul, Maximilian, Ferraro, Robert, Foley, James E., Ravussin, Eric, Knowler, William C., Bennett, Peter H., Bogardus, Clifton·1993·New England Journal of Medicine

DOI 10.1056/nejm199312303292703

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Abstract

BACKGROUND: The relative roles of obesity, insulin resistance, insulin secretory dysfunction, and excess hepatic glucose production in the development of non-insulin-dependent diabetes mellitus (NIDDM) are controversial. We conducted a prospective study to determine which of these factors predicted the development of the disease in a group of Pima Indians. METHODS: A body-composition assessment, oral and intravenous glucose-tolerance tests, and a hyperinsulinemic--euglycemic clamp study were performed in 200 non-diabetic Pima Indians (87 women and 113 men; mean [+/- SD] age, 26 +/- 6 years). The subjects were followed yearly thereafter for an average of 5.3 years. RESULTS: Diabetes developed in 38 subjects during follow-up. Obesity, insulin resistance (independent of obesity), and low acute plasma insulin response to intravenous glucose (with the degree of obesity and insulin resistance taken into account) were predictors of NIDDM: The six-year cumulative incidence of NIDDM was 39 percent in persons with values below the median for both insulin action and acute insulin response, 27 percent in those with values below the median for insulin action but above that for acute insulin response, 13 percent in those with values above the median for insulin action and below that for acute insulin response, and 0 in those with values originally above the median for both characteristics. CONCLUSIONS: Insulin resistance is a major risk factor for the development of NIDDM: A low acute insulin response to glucose is an additional but weaker risk factor.

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Authors: Lillioja, S., Mott, D. M., Spraul, M., Ferraro, R., Foley, J. E., Ravussin, E., Knowler, W. C., Bennett, P. H., & Bogardus, C.
Affiliations: National Institutes of Health (US)
ORCID: Lillioja, Stephen
Spraul, Maximilian
Foley, James E.
Knowler, William C.
Bennett, Peter H.
Bogardus, Clifton
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1993-12-30
Volume: 329
Issue: 27
Pages: 1988-1992
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199312303292703
OpenAlex: W2334309509
Cited by: 1,508
References: 27
Citations by year: 2026: 13 · 2025: 16 · 2024: 30 · 2023: 22 · 2022: 34 · 2021: 38 · 2020: 39 · 2019: 37 · 2018: 40 · 2017: 30 · 2016: 40 · 2015: 52 · 2014: 44 · 2013: 45 · 2012: 44
FWCI: 30.07
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Research Online (University of Wollongong) (submittedVersion)
Figshare (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: insulin resistance, type 2 diabetes, Pima Indians, obesity, acute insulin response, hepatic glucose production, insulin action, diabetes risk factors, hyperinsulinemic-euglycemic clamp, glucose tolerance
MeSH terms: Insulin Secretion, Adult, Arizona, Body Composition, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glucose, Glucose Tolerance Test, Humans, Indians, North American, Insulin, Insulin Resistance, Liver, Male, Obesity, Prospective Studies, Risk Factors, Proportional Hazards Models

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Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of pima indians

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