Insulin resistance, beta cell dysfunction and visceral adiposity as predictors of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS) Family Study

• Published in: Diabetologia Vol. 52; no. 10; pp. 2079 - 2086
• Main Authors: Hanley, A. J. G, Wagenknecht, L. E, Norris, J. M, Bryer-Ash, M, Chen, Y. I, Anderson, A. M, Bergman, R, Haffner, S. M
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.10.2009; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Adiposity - physiology; Adult; African Americans; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Black or African American; Blood and lymphatic vessels; Body fat; Cardiology. Vascular system; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - etiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Ethnicity; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glucose; Health care; Health sciences; Hispanic Americans; Hispanic or Latino; Human Physiology; Humans; Insulin - metabolism; Insulin - physiology; Insulin resistance; Insulin Resistance - physiology; Insulin-Secreting Cells - metabolism; Insulin-Secreting Cells - pathology; Internal Medicine; Intra-Abdominal Fat - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolic disorders; Middle Aged; Obesity; Preventive medicine; Sex Factors; Tomography; Los Angeles California; United States > US; Oklahoma; Type 2 diabetes; Hispanic-Americans; African-Americans; Insulin sensitivity; Visceral adipose tissue; Prospective studies; Epidemiology; Insulin secretion; Endocrinopathy; Pancreatic hormone; Adipose tissue; Cardiovascular disease; Vascular disease; Prospective; Adiposity; Atherosclerosis; β Cell; Endocrine pancreas; Family study; Secretion; Langerhans islet; Metabolic diseases; Insulin; Target tissue resistance; Sensitivity; Dysfunction; Insulin resistance; African American
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-009-1464-y

Aims/hypothesis Central obesity, insulin resistance and beta cell dysfunction are independent risk factors for incident type 2 diabetes, although few studies have used detailed measures of these disorders. Our objective was to study the association of directly measured visceral and subcutaneous adipose tissue (VAT, SAT), insulin sensitivity (S I) and the acute insulin response (AIR) with incident type 2 diabetes. Methods Participants were 1,230 Hispanic-Americans and African-Americans in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study who were free of type 2 diabetes at baseline (2000-2002). S I and AIR were determined from frequently sampled IVGTTs with minimal model analysis. VAT and SAT were determined by computed tomography. Impaired fasting glucose and type 2 diabetes were defined according to American Diabetes Association criteria. Results Incident type 2 diabetes was diagnosed in 90 participants after 5 years. After adjustment for age, sex, ethnicity, centre, impaired fasting glucose, triacylglycerol, HDL-cholesterol and systolic BP, both SI and AIR were inversely associated with type 2 diabetes (S I, OR 0.53, 95% CI 0.39-0.73; AIR, OR 0.22, 95% CI 0.14-0.34 per SD; both p < 0.001), while both VAT and SAT were positively associated with type 2 diabetes (VAT, OR 1.68, 95% CI 1.22-2.33; SAT, OR 1.49, 95% CI 1.13-1.99; both p < 0.01). In a model including all four factors, S I and AIR (S I, OR 0.55, 95% CI 0.37-0.80; AIR, OR 0.21, 95% CI 0.13-0.33; both p < 0.01) were significant predictors of type 2 diabetes, although associations with VAT and SAT were no longer significant. A significant sex x VAT interaction indicated a stronger association of VAT with type 2 diabetes in women than in men. Conclusions/interpretation Insulin resistance, beta cell dysfunction and VAT predicted incident type 2 diabetes, with evidence of a stronger association of VAT with type 2 diabetes among women.