INSULIN DEFICIENCY AMONG NEWLY DIAGNOSED TYPE 2 DIABETICS
Abstract
Background: Any patient above the age of 40 years, coming with the symptoms of diabetes islabelled as type 2 diabetic. If insulin levels are included in the protocol for initial investigations ofdiabetic patients, they can be differentiated as having insulin deficiency or insulin resistance. Theycan thus be treated accordingly. This study was conducted to see the prevalence of insulinresistance and insulin deficiency in newly diagnosed type 2 diabetics. Methods: This study wasconducted on 75 newly diagnosed diabetic subjects, and 75 control subjects for comparison.Fasting serum insulin was assayed by ELISA and HOMA-IR index was calculated. The diabeticsubjects with fasting hyperglycaemia and serum insulin level below 20 µIU/ml and HOMA-IRindex below 3.5 were grouped as insulin deficient (Group-A), and the diabetic subjects withfasting insulin level above 20 µIU/ml and HOMA-IR index above 3.5 were grouped as insulinresistant (Group-B). Results: Twenty-eight percent subjects were found to have insulin levelbelow 20 µIU/ml while 72% subjects had insulin resistance. When gender was taken intoconsideration, it was seen that 18.7% males had fasting insulin level of 6.98±0.737 µIU/ml and9.3% females had fasting insulin level of 5.21±0.885 µIU/ml while 32% males and 40% femaleshad insulin resistance. The mean age of male subjects with insulin resistance was significantlyhigher compared to the male subjects with insulin deficiency. Mean weight and body mass indexof the male and female subjects having insulin resistance was significantly higher than theirrespective control groups and also higher than the subjects with insulin deficiency. Pearsoncoefficient of correlation was calculated for fasting serum insulin level with age and BMI. Asignificant positive correlation was observed between fasting serum insulin and age of femaleswith insulin resistance. Conclusion: A considerable number of persons who develop diabetes after40 years of age but are not insulin resistant. Twenty-eight percent subjects have relative insulindeficiency, and 72% subjects have insulin resistance.Keywords: Type 2 diabetics, insulin deficiency, BMIReferences
Atkinson MA, Maclaren NK. The pathogenesis of insulin
dependent diabetes. N Engl J Med 1994;331:1428–36.
Baekkeskov S, Neilson JH, Marner B, Bilde T, Ludsigsson J,
Lernmark A. Autoantibodies in newly diagnosed diabetic
children with immunoprecipitate human pancreatic islet cell
protein. Nature 1998;298:167–9.
Zimmet PZ, Tuomi T, Mackay R, Rowley MJ, Knowels W,
Cohen M, et al. Latent autoimmune diabetes mellitus in adults
(LADA): the role of antibodies to glutamic acid decarboxylase in
diagnosis and prediction of insulin dependency. Diabet Med
;11:299–303.
Banerji M, Lebovitz H. Insulin sensitive and insulin resistant
variants in IDDM. Diabetes 1989;38:784–92.
Tuomi T, Groop LC, Zimmet PZ, Rowley MJ, Knowels W,
Mackay IR. Antibodies to GAD reveal latent autoimmune DM in
adults with a non-insulin dependent onset of disease. Diabetes
;42:359–62.
Palmer JP, Hirsch IB. What’s in a name: Latent autoimmune
diabetes of adults, type 1.5, adult onset and type 1 diabetes.
Diabetes Care 2003;26:536–8.
Nabhan F, Emanuele MA, Emanuele N. Latent autoimmune
diabetes of adulthood. Unique features that distinguish it from
type 1 and 2. Postgraduate Medicine 2005;117:12–7.
Pietropaolo M, Barinas Mitchell E, Pietropaolo SL, Kuller LH,
Trucco M. Evidence of islet cell autoimmunity in elderly patients
with type 2 diabetes. Diabetes 2000;49:32–38.
Kolterman OG, Gray RS, Griffin J, Burstein P, Insel J, Scarlett
JA, et al. Receptor and postreceptor defects contribute to the
insulin resistance in non-insulin dependent diabetes mellitus. J
Clin Invest 1981;68:957–9.
Butkeiwicz EK, Leibson C, O’Brien PC, Palumbo P, Rizza
RA. Insulin therapy for diabetic ketoacidosis. Bolus insulin
injection versus continuous insulin infusion. Diabetes Care
;18:1187–90.
J Ayub Med Coll Abbottabad 2012;24(2)
http://www.ayubmed.edu.pk/JAMC/24-2/Tahira.pdf
MacDonald MJ, Gapinski JP. A rapid ELISA for measuring
insulin in a large number of research samples. Metabolism
;38(5):450-2
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher
DF, Turner RC. Homeostasis model assessment: insulin
resistance and beta cell function from fasting plasma glucose and
insulin concentrations in man. Diabetologia 1985;28:412–9.
Asacaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R.
Diagnosing insulin resistance by simple quantitative methods in
subjects with normal glucose metabolism. Diabetes Care
;26:3320–5.
Carlsson A, Sundkvist G, Groop L, Tuomi T. Insulin and
Glucagon secretion in patients with slowly progressing
autoimmune diabetes (LADA). J Clin Endocrinol Metab
;85:76–80.
Jasem MA, Al-Ubaidi AA, Admon A, Zwaer KN. Prevalence of
LADA among clinically diagnosed type 2 diabetic patients. Med
J Islamic World Acad Sci 2010;18(2):49–54.
Pozzilli P, Dimario U. Autoimmune diabetes not requiring
insulin at diagnosis —definition, characterization and potential
prevention. Diabetes Care 2001;24:1460–7.
Gerich JE. Addressing the insulin secretion defect: a logical first
line approach. Metabolism 2000;49:12–6.
Caceres M, Teran CG, Rodriguez S, Medina M. Prevalence of
insulin resistance and its association with metabolic syndrome
criteria among Boivian children and adolescents with obesity.
BMC Paediatr 2008;8:31. doi: 10.1186/1471-2431-8-31.
Weber P, Ambrosova P, Canov P, Weberova D, Kulkilnek P,
Meluzinova H, et al. GAD antibodiesin T1D and LADA relation
to age, BMI, c-peptide, IA-2 and HLA-DRB103 and DRB 104
alleles. Adv Gerontol 2011;24(2):312–8.
Das S, Bhoi SK, Baliarsinha AK, Baig MA. Autoimmunity,
insulin resistance and cell function in subjects with low body
weight, type 2 diabetes mellitus. Metab Synd Relat Disord
;5(2):136–41.
Chen C, Tsai ST, Chou P. Correlation of fasting serum calcium
peptide and insulin with markers of metabolic syndrome in a
homogenous Chinese population with normal glucose tolerance.
Int J Cardiol 1999;68(2):179–86.
Gupta S, Kapse A. Lipid profile pattern in diabetics from central
India: Int J Diab Dev Countires 2001;21:138–45.
Unnikrishnam AG, Singh SK, Sanjeen CB. Prevalence of GAD
antibodies in lean subjects with type 2 diabetes. Ann NY Acad
Sci 2004;1037:118–21.
Nasution IR, Setiati S, Trisnohadi HB, Oemardi M. Insulin
resistance and metabolic syndrome in elderly women living in
nursing homes. Acta Med Indones 2006;38(1):17–22.
Fawwad A, Qasim R, Hydrie MIZ, Basit A, Miyan Z, Gul A.
Correlation of fasting insulin resistance indices with clinical
parameters of metabolic syndrome in type 2 diabetic subjects.
Pak J Med Sci 2006;22:433–7.
Bano KA, Begum M, Hussain R. Fasting blood levels of insulin
in non-obese and non-diabetic patients with essential
hypertension. Pak J Med Res 2004;43(1):5–7.
Yatsuya H, Tamakoshi K, Yoshida T, Hori Y, Zhang H,
Ishikawa M, et al. Association between weight fluctuation and
fasting insulin concentration in Japanese men. Int J Obes Relat
Metab Disord 2003;27:483–7.
Hettihewa LM, Dharmasiri LP, Ariyaratne CD, Jayasinghe SS,
Weerarathna TP, Kotapola IG. Significant correlation between
BMI/BW with insulin resistance by McAuley, HOMA and
QUICKI indices after 3 months of pioglitazone in diabetic
population. Int J Diab Dev Ctries 2007;27(3):87–92.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.