A biomarker concept for assessment of insulin resistance, beta-cell function and chronic systemic inflammation in type 2 diabetes mellitus

The classification of patients with type 2 diabetes by means of the classical clinical and laboratory markers (HbA1c, glucose, lipids, BMI and blood pressure) is a classification by symptoms and does not provide an insight into the underlying pathophysiological disorders, insulin resistance, beta-cell dysfunction and adipogenesis. However, a better understanding of these disorders may be helpful for the selection of appropriate and successful therapeutic interventions. The assessment of beta-cell dysfunction has become of special interest as more drugs have been developed that are supposed to protect these cells or preserve their functional capacity, such as GLP-1 analogs or DPPIV-inhibitors. Next to conventional means of beta-cell function assessment, HOMA-score and meal related functional parameters, the determination of fasting intact proinsulin or the proinsulin/insulin ratio have become popular methods to describe the impact of new drugs on the insulin secreting cells. They have been investigated and validated in multiple cross-sectional and interventional controlled clinical studies. Routine assessment of these markers in addition to adiponectin and hsCRP may allow for a better understanding of the underlying disease conditions and optimization of the anti-diabetic and anti-atherosclerotic therapy targeting beyond simple glucose control.