Physiological importance of first-phase insulin release in elderly patients with diabetes

To assess the physiological role of first-phase insulin release in obese elderly patients with type 2 diabetes.

Moderately obese elderly patients (n = 14, mean age 77 +/- 2 years, BMI 28.4 +/- 0.7 kg/m2) with type 2 diabetes underwent three 180-min hyperglycemic clamp studies. In the control study, glucose alone was infused. In the first-phase study, human insulin was infused for the first 4 min at 12 mU/m2 to mimic first-phase insulin release. In the first-phase enhanced study, insulin was infused for the first 4 min at 24 mU.m-2 .min-1. Tritiated glucose methodology was used in all studies to measure glucose production and disposal rates.

Glucose values were similar in all studies. In the control study, first-phase insulin response was absent. The peak insulin response occurred at 4 min in the first-phase and first-phase enhanced studies, but insulin values were substantially higher in the latter study (528 +/- 40 vs. 340 +/- 24 pmol/l, P < 0.0001). Second-phase insulin responses were not different among the studies. Glucose production and disposal rates were not significantly different among the studies.

While absent first-phase insulin secretion is a marker of abnormal pancreatic function in obese elderly patients with type 2 diabetes, it is not important in the regulation of hepatic glucose output or peripheral glucose disposal.