The predictive value of intact proinsulin measurement in the diagnosis of type 2 diabetes has been confirmed in a number studies. This predictive value stems from its identification of a primary manifestation of type 2 diabetes - namely insulin resistance.

Insulin Resistance in Type 2 Diabetes

Type 2 diabetes is achieving notoriety as one of the scourges of the developed and developing world. The number of people in the UK alone who have been diagnosed with diabetes is over 2.5 million. It is estimated that by 2025, this number will have risen to more than 4 million (Diabetes UK). Moreover, it is estimated that over 1 million of the population have the disease but remain, as yet, undiagnosed. Worldwide there are over 300 million suffering with the disease (World Health Organisation). Currently, diabetes accounts for about 5% of all deaths globally each year and, without intervetion, this is likely to increase by more than 50% over the next 10 years.

Type 2 diabetes is essentially a disease of insulin resistance - a condition in which insulin becomes less effective at controlling blood glucose. As a consequence blood glucose may become chronically elevated, leading to many of the adverse health effects associated with type 2 diabetes.

Intact Proinsulin as an early indicator of type 2 diabetes

A formal diagnosis of type 2 diabetes relies primarily on the demonstration of glucose intolerance. However, in many patients the disease may be well advanced at the time the diagnosis is made. Such patients are already at an increased risk of cardiovascular disease and may require therapeutic intervention. Early detection of the disease provides an opportunity to initiate changes in lifestyle (e.g. diet and exercise) that can prevent or delay the onset of disease symptoms and in doing so impact significantly on patient life quality - as well as reducing treatment costs.

A 4.5 year population-based longitudinal study published in 1999 demonstrated an association between elevated fasting proinsulin concentrations at the beginning of the study and a subsequent progression to diabetes. This predictive value of proinsulin measurement has been confirmed in other studies (2,3) and may derive from its identification of a primary manifestation of type 2 diabetes - namely insulin resistance. A raised fasting proinsulin concentration has been confirmed as a highly specific marker of insulin resistance (4).

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