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Insulin, proinsulin, proinsulin:insulin ratio, and the risk of developing type 2 diabetes mellitus in women.
Am J Med 2003; 114(6):438-44AJ

Abstract

PURPOSE

To assess the associations among baseline levels of fasting insulin and proinsulin, proinsulin:insulin ratio, and the development of type 2 diabetes mellitus in apparently healthy middle-aged women.

METHODS

In a nested case-control study involving a nationwide cohort of 27,628 participants from the Women's Health Study, 126 women with diabetes diagnosed during a 4-year follow-up period were compared with 225 age-matched controls. Fasting insulin level and proinsulin:insulin ratio were assessed in quartiles, and proinsulin level was assessed in categories (< or =4.0 pmol/L, 4.01 to 6.99 pmol/L, > or =7.0 pmol/L). The risk of developing type 2 diabetes was determined using conditional logistic regression analysis that adjusted for body mass index and other diabetes risk factors.

RESULTS

Baseline insulin and proinsulin levels and proinsulin:insulin ratios were significantly higher among cases than among controls. Women with elevated insulin levels in the highest as compared with the lowest quartile were more likely to develop diabetes (odds ratio [OR] = 5.6; 95% confidence interval [CI]: 1.8 to 17.6), as were women with elevated (> or =7.0 pmol/L vs. < or =4.0 pmol/L) proinsulin levels (OR = 16.4; 95% CI: 5.8 to 46.8) and women with proinsulin:insulin ratios in the highest quartile (OR = 9.6; 95% CI: 3.1 to 30.8). Similar results were observed among women with a baseline hemoglobin A(1c) level < or =6.0%. In time-trend analyses, fasting insulin was a consistent predictor of long-term risk. Proinsulin and proinsulin:insulin ratio, although predictive throughout the study, were especially strong predictors of rapid progression to type 2 diabetes.

CONCLUSION

Elevated fasting insulin and proinsulin levels and proinsulin:insulin ratio are associated with an increased risk of developing type 2 diabetes in apparently healthy middle-aged women.

Authors+Show Affiliations

Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02215, USA. apradhan@rics.bwh.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12727576

Citation

Pradhan, Aruna D., et al. "Insulin, Proinsulin, Proinsulin:insulin Ratio, and the Risk of Developing Type 2 Diabetes Mellitus in Women." The American Journal of Medicine, vol. 114, no. 6, 2003, pp. 438-44.
Pradhan AD, Manson JE, Meigs JB, et al. Insulin, proinsulin, proinsulin:insulin ratio, and the risk of developing type 2 diabetes mellitus in women. Am J Med. 2003;114(6):438-44.
Pradhan, A. D., Manson, J. E., Meigs, J. B., Rifai, N., Buring, J. E., Liu, S., & Ridker, P. M. (2003). Insulin, proinsulin, proinsulin:insulin ratio, and the risk of developing type 2 diabetes mellitus in women. The American Journal of Medicine, 114(6), pp. 438-44.
Pradhan AD, et al. Insulin, Proinsulin, Proinsulin:insulin Ratio, and the Risk of Developing Type 2 Diabetes Mellitus in Women. Am J Med. 2003 Apr 15;114(6):438-44. PubMed PMID: 12727576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insulin, proinsulin, proinsulin:insulin ratio, and the risk of developing type 2 diabetes mellitus in women. AU - Pradhan,Aruna D, AU - Manson,JoAnn E, AU - Meigs,James B, AU - Rifai,Nader, AU - Buring,Julie E, AU - Liu,Simin, AU - Ridker,Paul M, PY - 2003/5/3/pubmed PY - 2003/5/14/medline PY - 2003/5/3/entrez SP - 438 EP - 44 JF - The American journal of medicine JO - Am. J. Med. VL - 114 IS - 6 N2 - PURPOSE: To assess the associations among baseline levels of fasting insulin and proinsulin, proinsulin:insulin ratio, and the development of type 2 diabetes mellitus in apparently healthy middle-aged women. METHODS: In a nested case-control study involving a nationwide cohort of 27,628 participants from the Women's Health Study, 126 women with diabetes diagnosed during a 4-year follow-up period were compared with 225 age-matched controls. Fasting insulin level and proinsulin:insulin ratio were assessed in quartiles, and proinsulin level was assessed in categories (< or =4.0 pmol/L, 4.01 to 6.99 pmol/L, > or =7.0 pmol/L). The risk of developing type 2 diabetes was determined using conditional logistic regression analysis that adjusted for body mass index and other diabetes risk factors. RESULTS: Baseline insulin and proinsulin levels and proinsulin:insulin ratios were significantly higher among cases than among controls. Women with elevated insulin levels in the highest as compared with the lowest quartile were more likely to develop diabetes (odds ratio [OR] = 5.6; 95% confidence interval [CI]: 1.8 to 17.6), as were women with elevated (> or =7.0 pmol/L vs. < or =4.0 pmol/L) proinsulin levels (OR = 16.4; 95% CI: 5.8 to 46.8) and women with proinsulin:insulin ratios in the highest quartile (OR = 9.6; 95% CI: 3.1 to 30.8). Similar results were observed among women with a baseline hemoglobin A(1c) level < or =6.0%. In time-trend analyses, fasting insulin was a consistent predictor of long-term risk. Proinsulin and proinsulin:insulin ratio, although predictive throughout the study, were especially strong predictors of rapid progression to type 2 diabetes. CONCLUSION: Elevated fasting insulin and proinsulin levels and proinsulin:insulin ratio are associated with an increased risk of developing type 2 diabetes in apparently healthy middle-aged women. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/12727576/Insulin_proinsulin_proinsulin:insulin_ratio_and_the_risk_of_developing_type_2_diabetes_mellitus_in_women_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002934303000615 DB - PRIME DP - Unbound Medicine ER -