Adult cats determined by clinical laboratory evaluations to be normal, impaired glucose tolerant, or overtly diabetic were used to explore prospectively the relationships among pancreatic beta cell islet amyloid polypeptide (IAPP) immunoreactivity, islet amyloid (IA) deposition, and diabetogenesis. IAPP-derived IA was found in 11 of 14 (79%) diabetic cats, in four of nine (44%) impaired glucose tolerant cats, and in two of eight (25%) normal adult cats. The presence of IA even in very small amounts, therefore, predicts a very high probability (88%) that an animal has either impaired glucose tolerance or overt DM. Although all overtly diabetic cats had a marked decrease or absence of beta cell IAPP immunoreactivity, six of six cats with impaired glucose tolerance retained IAPP immunoreactivity with 1:15,000 dilutions of antisynthetic IAPP 7-17, whereas only one of seven normal cats had IAPP immunoreactivity beyond 1:10,000 dilutions. These findings suggest that increased IAPP production preceding the development of overt DM is linked to the progressive formation of insoluble IA deposits that are apparent in most overtly diabetic individuals. Of most importance, in that IAPP has been reported to inhibit both basal and insulin-stimulated rates of glycogen synthesis, is the possibility that increased production and release of IAPP by pancreatic beta cells plays a key role in the development of the insulin resistance and impaired glucose tolerance, both of which occur in Type 2 DM.