Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database

Diabetes Res Clin Pract. 2016 Aug;118:50-7. doi: 10.1016/j.diabres.2016.06.007. Epub 2016 Jun 17.

Abstract

Objective: Hyperinsulinaemia is associated with development of chronic metabolic disease and is emerging as a health risk independent to that of insulin resistance. However, little is known to what extent hyperinsulinaemia occurs with normal glucose tolerance in lean subjects.

Method: Oral glucose tolerance tests with concurrent insulin assay were conducted during the 1970s-1990s. Participants were classified according to glucose tolerance and insulin response pattern. Analysis of variance compared differences in plasma glucose, plasma insulin, and demographic and metabolic risk factors between groups.

Results: Participants with normal glucose tolerance comprised 54% (n=4185) of the total cohort. Of these, just over half (n=2079) showed hyperinsulinaemia despite normal glucose clearance. Obesity had a modest association with hyperinsulinaemia in people with normal glucose tolerance. Fasting insulin had limited value in diagnosing hyperinsulinaemia. The majority of participants (93%) with impaired glucose tolerance or diabetes had concurrent hyperinsulinaemia.

Conclusion: Hyperinsulinaemia in the absence of impaired glucose tolerance may provide the earliest detection for metabolic disease risk and likely occurs in a substantial proportion of an otherwise healthy population. Dynamic insulin patterning may produce more meaningful and potentially helpful diagnoses. Further research is needed to investigate clinically useful hyperinsulinaemia screening tools.

Keywords: Diabetes; Hyperinsulinaemia; Insulin; Oral glucose tolerance test.

MeSH terms

  • Blood Glucose / metabolism*
  • Databases, Factual
  • Fasting / blood
  • Female
  • Glucose Intolerance / blood
  • Glucose Intolerance / diagnosis*
  • Glucose Intolerance / epidemiology
  • Glucose Tolerance Test
  • Humans
  • Hyperinsulinism / blood
  • Hyperinsulinism / diagnosis*
  • Hyperinsulinism / epidemiology
  • Illinois / epidemiology
  • Incidence
  • Insulin / blood*
  • Insulin Resistance*
  • Male
  • Middle Aged
  • Risk Factors

Substances

  • Blood Glucose
  • Insulin