Potential Identification of Type 2 Diabetes with Elevated Insulin Clearance

Area of Science:

• Endocrinology
• Metabolic Disorders
• Diabetes Research

Background:

• Impaired glucose metabolism in diabetes can stem from reduced insulin secretion and increased insulin clearance (IC).
• A prior report detailed a type 2 diabetes mellitus (T2DM) patient with low insulin levels and high IC.
• This study investigates a potential subgroup of T2DM patients exhibiting elevated IC.

Purpose of the Study:

• To identify and characterize T2DM patients with elevated insulin clearance (IC).
• To determine the clinical features associated with elevated IC in newly diagnosed, treatment-naïve T2DM.

Main Methods:

• Recruited 101 treatment-naïve T2DM patients.
• Measured metabolic clearance rate of insulin (MCRI) using hyperinsulinemic-euglycemic clamp.
• Defined elevated IC as MCRI > 700 ml/min/m² to identify patient subgroups.

Main Results:

• 44 patients (43.6%) met the criteria for elevated IC (median MCRI 842 ml/min/m²).
• Patients with elevated IC were non-obese (median BMI 22.9 kg/m²) and had lower fasting insulin levels (4.2 mU/l) compared to those without (median BMI 27.3 kg/m², insulin 9.6 mU/l).
• No significant differences in renal or hepatic function were observed between groups.

Conclusions:

• A distinct group of T2DM patients with elevated insulin clearance (IC) exists.
• These patients are typically non-obese and exhibit decreased blood insulin concentrations.
• This novel T2DM phenotype may necessitate tailored therapeutic approaches.