Mode of onset of type 2 diabetes from normal or impaired glucose tolerance
Open accessAbstract
Fasting plasma glucose concentrations (FPG) predict development of type 2 diabetes. Whether hyperglycemia evolves from normoglycemia gradually over time or as a step increase is not known. We measured plasma glucose and insulin levels during oral glucose testing in 35- to 64-year-old men and nonpregnant women from a population-based survey (Mexico City Diabetes Study) at baseline (n = 2,279) and after 3.25 (n = 1,740) and 7 years (n = 1,711) of follow-up. In subjects with normal glucose tolerance (NGT) on all three occasions (nonconverters; n = 911), FPG increased only slightly (0.23 ± 0.79 mmol/l, mean ± SD; P < 0.0001) over 7 years. In contrast, conversion to diabetes among NGT subjects (n = 98) was marked by a large step-up in FPG regardless of time of conversion (3.06 ± 2.57 and 2.94 ± 3.11 mmol/l, respectively, at 3.25 and 7 years; P < 0.0001 vs. nonconverters). Likewise, in subjects who converted to diabetes from impaired glucose tolerance (n = 75), FPG rose by 3.14 ± 3.83 and 3.12 ± 3.61 mmol/l (P < 0.0001 vs. nonconverters). Three-quarters of converters had increments in FPG above the 90th percentile of the corresponding increments in nonconverters. Converters had higher baseline BMI (30.4 ± 4.9 vs. 27.3 ± 4.0 kg/m2; P < 0.001) and fasting plasma insulin values (120 ± 78 vs. 84 ± 84 pmol/l; P < 0.02) than nonconverters; however, no consistent change in either parameter had occurred before conversion. In contrast, changes in 2-h postglucose insulin levels between time of conversion and preceding measurement were significantly (P < 0.0001) related to the corresponding changes in FPG in an inverse manner. We conclude that, within a 3-year time frame, the onset of diabetes is very often rapid rather than gradual and is in part explained by a fall in glucose-stimulated insulin response.
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The development of diabetes from normal glucose tolerance is a continuous process.
“As evidenced by studies with repeat measures of glucose levels, insulin sensitivity and insulin secretion, the development of diabetes from NGT is a continuous process.35,36,40,41”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [40]
The pattern of glycaemic changes before diabetes was confirmed by other studies.
“This pattern of glycaemic changes was confirmed by others.35,40,41”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [40]
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Self-citation
- Authors
- Ferrannini, E., Nannipieri, M., Williams, K., Gonzales, C., Haffner, S. M., & Stern, M. P.
- Affiliations
- University of Pisa (IT)
- The University of Texas at San Antonio Health Science Center (US)
- Mexican Social Security Institute (MX)
- Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2004-01-01
- Volume
- 53
- Issue
- 1
- Pages
- 160-165
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2111493733
- Cited by
- 153
- References
- 17
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 9 · 2021: 7 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 12 · 2016: 8 · 2015: 8 · 2014: 7 · 2013: 11 · 2012: 10
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- National Institutes of Health (5r37hl036820-10)
- National Heart, Lung, and Blood Institute (R37HL36820, HL24799)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- type 2 diabetes, diabetes onset, impaired glucose tolerance, normal glucose tolerance, fasting blood glucose, hyperglycemia, insulin, body mass index, oral glucose tolerance test, prediabetes, insulin resistance, beta-cell dysfunction, insulin sensitivity, HOMA-IR, insulin sensitivity index
- MeSH terms
- Blood Glucose, Body Constitution, Body Weight, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Humans, Male, Middle Aged, Risk Factors, Glucose Intolerance, Disease Progression
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