@article{3e34106ce17140ee8b6d66fcfccbad31,
title = "Determinants of glucose tolerance in impaired glucose tolerance at baseline in the Actos Now for Prevention of Diabetes (ACT NOW) study",
abstract = "Aims/hypothesis: The aim of the study was to examine the determinants of oral glucose tolerance in 602 persons with impaired glucose tolerance (IGT) who participated in the Actos Now for Prevention of Diabetes (ACT NOW) study. Methods: In addition to the 602 IGT participants, 115 persons with normal glucose tolerance (NGT) and 50 with impaired fasting glucose (IFG) were identified during screening and included in this analysis. Insulin secretion and insulin sensitivity indices were derived from plasma glucose and insulin during an OGTT. The acute insulin response (AIR) (0-10 min) and insulin sensitivity (SI) were measured with the frequently sampled intravenous glucose tolerance test (FSIVGTT) in a subset of participants. Results: At baseline, fasting plasma glucose, 2 h postprandial glucose (OGTT) and HbA1c were 5.8 ± 0.02 mmol/l, 10.5 ± 0.05 mmol/l and 5.5 ± 0.04%, respectively, in participants with IGT. Participants with IGT were characterised by defects in early (ΔI 0-30/ΔG 0-30 × Matsuda index, where ΔI is change in insulin in the first 30 min and ΔG is change in glucose in the first 30 min) and total (ΔI0-120/ΔG0-120 × Matsuda index) insulin secretion and in insulin sensitivity (Matsuda index and SI). Participants with IGT in whom 2 h plasma glucose was 7.8-8.3 mmol/l had a 63% decrease in the insulin secretion/insulin resistance (disposition) index vs participants with NGT and this defect worsened progressively as 2 h plasma glucose rose to 8.9-9.94 mmol/l (by 73%) and 10.0-11.05 mmol/l (by 80%). The Matsuda insulin sensitivity index was reduced by 40% in IGT compared with NGT (p < 0.005). In multivariate analysis, beta cell function was the primary determinant of glucose AUC during OGTT, explaining 62% of the variance. Conclusion: Our results strongly suggest that progressive beta cell failure is the main determinant of progression of NGT to IGT.",
keywords = "ACT NOW, Impaired fasting glucose, Impaired glucose tolerance, Insulin resistance, Insulin secretion, Normal glucose tolerance, Type 2 diabetes pathogenesis",
author = "Defronzo, {R. A.} and Banerji, {M. A.} and Bray, {G. A.} and Buchanan, {T. A.} and S. Clement and Henry, {R. R.} and Kitabchi, {A. E.} and S. Mudaliar and N. Musi and R. Ratner and P. Reaven and Schwenke, {D. C.} and Stentz, {F. D.} and D. Tripathy",
note = "Funding Information: Acknowledgements The authors thank our volunteers, who participated selflessly in this study. We are grateful to our nurses and support staff for their effort in recruitment and follow-up of participants and for their assistance in performing the multiple studies described here. This investigator-initiated study was supported by a grant from Takeda Pharmaceuticals. Funding Information: Conflict of interest R. A. DeFronzo is on the advisory boards of Takeda, Amylin, Eli Lilly, Roche, Novartis, Johnson and Johnson and Bristol Meyers Squibb. R. A. DeFronzo has grant support from Takeda, Amylin, Eli Lilly, Roche, Novartis, BMS, Merck and Pfizer, is a member of the speakers bureau of Takeda, Eli Lilly and Amylin, and is a consultant for Takeda, Amylin, Eli Lilly, Roche, Novartis and BMS. S. Mudaliar has grant support from GSK, sanofi-aventis and Intercept Pharm. R. R. Henry has grant support from Amylin, Biodel, BMS, GSK, Keryx, Lifescan, Eli Lilly, Merck, Novartis, Novo, Pfizer, Roche, Sankyo and Veralight, is a consultant for Amylin, Astra Zeneca, BMS, Diobex, GSK, Isis, Eli Lilly, Merck, Novartis, Novo, Roche, Sankyo, sanofi-aventis and Takeda, and is a member of the speakers bureau of Amylin, GSK and Eli Lilly. N. Musi has no conflicts of interest to declare. M. A. Banerji has research grants from Novartis, Takeda and Pfizer, is a consultant for BMS and Boehringer Ingelheim, and is a speaker for Novartis, Takeda, Pfizer, Merck and sanofi-aventis. R. Ratner has grant support from AstraZenica, Bayhill Therapeutics, Boehringer Ingelheim, GSK, Merck, Pfizer, Takeda and Veralight, is on the Advisory Board of Amylin, AstraZenica, Eli Lilly, GSK, Lifescan, NovoNordisk, sanofi-aventis, Takeda and Tethys Bioscience, and owns stock in Merck, Johnson & Johnson and Abbott. F. D. Stentz. has no conflict of interest. A. E. Kitabchi is on the Advisory Board for Merck, is a member of the Speakers Bureau for Takeda, and has grant support from Takeda and sanofi-aventis. D. C. Schwenke has grant support from Takeda. D. Tripathy has grant support from Takeda. S. Clement has no conflict of interest. T. A. Buchanan has grant support from Takeda and is a member of the speakers bureau and on the advisory board for Takeda. P. Reaven has grant support from Takeda and Amylin/Lilly, and is a member of the speakers bureau for Takeda and Merck.",
year = "2010",
month = mar,
doi = "10.1007/s00125-009-1614-2",
language = "English (US)",
volume = "53",
pages = "435--445",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",
number = "3",
}