Natural History of Type 2 Diabetes Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota. ObesityIFG*DiabetesUncontrolled Hyperglycemia.

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Presentation transcript:

Natural History of Type 2 Diabetes Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota. ObesityIFG*DiabetesUncontrolled Hyperglycemia Glucose (mg/dL) Relative Function (%) Years of Diabetes Post-meal Glucose Fasting Glucose Insulin Resistance Insulin Level  -cell Failure *IFG = impaired fasting glucose

Natural History of T2DM OB-DIAB Lo INS LEANNGTOB-DIAB Hi INS OB-IGT OBNGT Insulin- Mediated Glucose Uptake (mg/m 2 min) DeFronzo & Felber Diabetes 37: , 1988 Metabolism 39: , 1990 Mean Plasma Insulin During OGTT (µU/ml) Mean Plasma Glucose During OGTT (mg/dl)

Abnormal Insulin Secretion in T2DM Early responses during meals/OGTT First and second phase insulin responses Pulsatile insulin release Responses to non-glucose stimuli Proinsulin:insulin ratios

NATURAL HISTORY OF BETA CELL FAILURE IN T2DM Beta cell failure occurs much earlier in the natural history of type 2 diabetes and is more severe than previously appreciated

DX DM 2% /yr decline 18%/yr decline Belfast Diet Study-Bi-phasic Loss of B-Cell FUNCTION Deteriorating beta-cell function in type 2 diabetes: a long-term model. Bagust A, Beale S. QJM Apr;96(4):281-8

A model of long-term metabolic progression of type 2 diabetes mellitus for evaluating treatment strategies. Bagust A, Evans M, Beale S, Home PD, Perry AS, Stewart M. Pharmacoeconomics. 2006;24 Suppl 1:5-19.

Potential Causes of Beta Cell Dysfunction Unknown Genetic Factors Intrauterine Nutrition Glucose Toxicity Lipotoxicity Amyloid Cytokines Insulin Resistance

IGT <160 <180 <200 <160 <180 <200 IGT PLASMA GLUCOSE AND INSULIN AUC Glucose AUC (mmol/L  120 min) Insulin AUC (pmol/L  120 min) CON CON T2DM Q1 Q2 Q3Q4Q1Q2Q3Q4 T2DM

IGT <200 <160 <180 INSULIN SECRETION / INSULIN RESISTANCE (DISPOSITION) INDEX DURING OGTT ∆ INS/ ∆ GLU ÷  IR Lean NGT <100 <120 <140 Obese 2-Hour PG (mg/dl)

Log Normalization of the Relationship Between 2-Hour Plasma Glucose and Insulin Secretion / Insulin Resistance Index Ln ∆I/ ∆G ÷  IR (ml/min kg FFM ) Ln 2h-PG (mg/dl) r = 0.91 p < T2DM IGT NGT

Log Normalization of the Relationship Between 2-Hour Plasma Glucose and Insulin Secretion / Insulin Resistance Index Ln ∆I/ ∆G ÷  IR (ml/min kg FFM ) Ln 2h-PG (mg/dl) r = 0.91 p < T2DM IGT NGT

FASTING PLASMA GLUCOSE (FPG) CONCENTRATION AND RELATIVE BETA CELL VOLUME IN OBESE SUBJECTS WITH NGT, IFG, & T2DM Butler et al, Diabetes 52: ,2003 FPG (mg/dl) ß-cell Volume (%) NGT IFG p<0.01 T2DM p<0.001

SUMMARY ● Are maximally/near-maximally insulin resistant ● Have lost ~80% of their beta cell function (DeFronzo) ● Have lost significant beta cell mass (Butler) ● Have an incidence of diabetic retinopathy of ~10% Individuals with IGT: