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Cited by 898Diabetes, Cardiovascular Risks, and LipoproteinsPancreatic function and diabetesAdipokines, Inflammation, and Metabolic Diseases

Insulin resistance and hypersecretion in obesity: European Group for the Study of Insulin Resistance (EGIR)

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Ferrannini, E, Natali, A, Bell, P, Cavallo-Perin, P, Lalic, N, Mingrone, G·1997·Journal of Clinical Investigation
DOI 10.1172/jci119628PMC PMC508292
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Abstract

Insulin resistance and insulin hypersecretion are established features of obesity. Their prevalence, however, has only been inferred from plasma insulin concentrations. We measured insulin sensitivity (as the whole-body insulin-mediated glucose uptake) and fasting posthepatic insulin delivery rate (IDR) with the use of the euglycemic insulin clamp technique in a large group of obese subjects in the database of the European Group for the Study of Insulin Resistance (1,146 nondiabetic, normotensive Caucasian men and women aged 18-85 yr, with a body mass index (BMI) ranging from 15 to 55 kg.m-2). Insulin resistance, defined as the lowest decile of insulin sensitivity in the lean subgroup (608 subjects with a mean BMI of 29 kg.m-2). Insulin sensitivity declined linearly with BMI at an age- and sex-adjusted rate of 1.2 micromol.min-1.kg FFM-1 per BMI unit (95% confidence intervals = 1.0-1.4). Insulin hypersecretion, defined as the upper decile of IDR, was significantly (P<0.0001) more prevalent (38%) than insulin resistance in the obese group. In the whole dataset, IDR rose as a function of both BMI and insulin resistance in a nonlinear fashion. Neither the waist circumference nor the waist-to-hip ratio, indices of body fat distribution, was related to insulin sensitivity after adjustment for age, gender, and BMI; both, however, were positively associated (P<0.001) with insulin hypersecretion, particularly in women. In nondiabetic, normotensive obese subjects, the prevalence of insulin resistance is relatively low, and is exceeded by the prevalence of insulin hypersecretion, particularly in women with central obesity. In the obese with preserved insulin sensitivity, risk for diabetes, cardiovascular risk, and response to treatment may be different than in insulin resistant obesity.

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  • Insulin resistance in muscle is the earliest demonstrable defect in the natural history of type 2 diabetes, but overt type 2 diabetes occurs only in individuals whose β-cells cannot compensate.

    “Because the great majority of glucose disposal after intravenous glucose administration occurs in muscle, these results provide strong evidence that insulin resistance in muscle is the earliest demonstrable defect in the natural history of type 2 diabetes, but that the development of overt type 2 diabetes occurs only in those individuals whose β-cells are unable to compensate for the defect in”

    From Skeletal Muscle Insulin Resistance Is the Primary Defect in Type 2 Diabetes (2009) · cites this paper as [48]

    The Discussion (page unavailable) says skeletal muscle accounts for most glucose uptake under clamp conditions and suggests that prolonged obesity with insulin resistance may eventually strain β-cells in predisposed people. It does not establish muscle insulin resistance as the earliest defect in type 2 diabetes or show that overt diabetes occurs only when β-cells fail to compensate; the study examined nondiabetic participants rather than following diabetes development. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The strong link between BMI and insulin sensitivity means that groups differing widely in insulin sensitivity are usually difficult to match on BMI and fat mass, which complicates interpretation.

    “Given the strong association between BMI and insulin sensitivity (8), groups with large differences in insulin sensitivity are generally difficult to match for BMI and fat mass, complicating data interpretation.”

    From Metabolic flexibility to lipid availability during exercise is enhanced in individuals with high insulin sensitivity (2018) · cites this paper as [8]

  • A similar relationship also exists between BMI and the degree of insulin resistance.

    “A similar relationship also exists between BMI and the degree of insulin resistance.22”

    From A review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives (2021) · cites this paper as [22]

  • One study reported that 19, 34 and 60% of individuals with a BMI of <30, ≥30-35 and >35, respectively, were insulin resistant.

    “one study reported that 19, 34 and 60% of individuals with a BMI of <30, ≥30–35 and >35, respectively, were insulin resistant.22”

    From A review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives (2021) · cites this paper as [22]

  • There is a generally directly proportional relationship between BMI and both fasting and postprandial insulin levels.

    “It is well established that there is a generally directly proportional relationship between BMI and both fasting and postprandial insulin levels.21,22”

    From A review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives (2021) · cites this paper as [22]

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Research works printed but not linked: 1

  1. [15]15. L. DeGroot, editor. W.B. Saunders Company, Philadel- phia. 2624-2662.

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Authors
Ferrannini, E., Natali, A., Bell, P., Cavallo-Perin, P., Lalic, N., & Mingrone, G.
Affiliations
Istituto di Fisiologia Clinica (IT)
ORCID
Venue
Journal of Clinical Investigation
Publisher
American Society for Clinical Investigation
Published
1997-09-01
Volume
100
Issue
5
Pages
1166-1173
ISSN
0021-9738 (ISSN-L)
DOI
10.1172/jci119628
PMC
PMC508292
OpenAlex
W2036400933
Cited by
898
References
53
Citations by year
2026: 9 · 2025: 14 · 2024: 20 · 2023: 13 · 2022: 20 · 2021: 28 · 2020: 32 · 2019: 26 · 2018: 32 · 2017: 26 · 2016: 26 · 2015: 36 · 2014: 30 · 2013: 36 · 2012: 43
FWCI
10.82
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
Funders
  • Università degli Studi di Napoli Federico II
  • Helsingin Yliopisto
  • Universität Heidelberg
  • Lunds Universitet
  • Università degli Studi di Padova
  • National and Kapodistrian University of Athens
  • Université de Genève
  • Università degli Studi di Torino
  • Università degli Studi di Verona
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
insulin resistance, insulin hypersecretion, obesity, insulin sensitivity, body mass index, waist circumference, waist-to-hip ratio, abdominal obesity, sex differences, hyperinsulinemic-euglycemic clamp, type 2 diabetes risk
MeSH terms
Insulin Secretion, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Obesity, Body Mass Index

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