Early Metabolic Defects in Persons at Increased Risk for Non-Insulin-Dependent Diabetes Mellitus

TLDR

The study aimed to detect early metabolic abnormalities in NIDDM by measuring insulin sensitivity and secretion in 26 first‑degree relatives, 14 healthy controls, and 19 NIDDM patients. Insulin sensitivity was assessed using a euglycemic insulin clamp, indirect calorimetry, and [3‑3H]glucose infusion. First‑degree relatives showed impaired total‑body glucose metabolism, mainly due to defective non‑oxidative glucose storage, and exhibited first‑phase insulin secretion deficits when glucose tolerance was impaired, demonstrating that both insulin resistance and secretion defects are necessary for impaired glucose tolerance. Published in N Engl J Med 1989; 321:337–43.

Abstract

To identify early metabolic abnormalities in non-insulin-dependent diabetes mellitus (NIDDM), we measured sensitivity to insulin and insulin secretion in 26 first-degree relatives of patients with NIDDM and compared these subjects both with 14 healthy control subjects with no family history of NIDDM and with 19 patients with NIDDM. The euglycemic insulin-clamp technique, indirect calorimetry, and infusion of [3–3H]glucose were used to assess insulin sensitivity. Total-body glucose metabolism was impaired in the first-degree relatives as compared with the controls (P<0.01). The defect in glucose metabolism was almost completely accounted for by a defect in nonoxidative glucose metabolism (primarily the storage of glucose as glycogen). The relatives with normal rates of metabolism (mean±SEM, 1.81±0.27 mg per kilogram of body weight per minute) and impaired rates (1.40±0.22 mg per kilogram per minute) in oral glucose-tolerance tests had the same degree of impairment in glucose storage as compared with healthy control subjects (3.76±0.55 mg per kilogram per minute; P<0.01 for both comparisons). During hyperglycemic clamping, first-phase insulin secretion was lacking in patients with NIDDM (P<0.01) and severely impaired in their relatives with impaired glucose tolerance (P<0.05) as compared with control subjects; insulin secretion was normal in the relatives with normal glucose tolerance. We conclude that impaired glucose metabolism is common in the first-degree relatives of patients with NIDDM, despite their normal results on oral glucose-tolerance tests. Both insulin resistance and impaired insulin secretion are necessary for the development of impaired glucose tolerance in these subjects. (N Engl J Med 1989; 321:337–43.)