Insulin resistance and  cell dysfunction contribute to the pathogenesis of type 2 diabetes. Unlike insulin resistance,  cell dysfunction remains difficult to predict and monitor, because of the inaccessibility of the endocrine pancreas, the integrated relationship with insulin sensitivity, and the paracrine effects of incretins. The goal of our study was to survey the plasma response to a metabolic challenge in order to identify factors predictive of  cell dysfunction. To this end, we combined (i) the power of unbiased iTRAQ (isobaric tag for relative and absolute quantification) mass spectrometry with (ii) direct sampling of the portal vein following an intravenous glucose/arginine challenge (IVGATT) in (iii) mice with a genetic  cell defect. By so doing, we excluded the effects of peripheral insulin sensitivity as well as those of incretins on  cells, and focused on the first phase of insulin secretion to capture the early pathophysiology of  cell dysfunction. We compared plasma protein profiles with ex vivo islet secretome and transcriptome analyses. We detected changes to 418 plasma proteins in vivo, and detected changes to 262 proteins ex vivo. The impairment of insulin secretion was associated with greater overall changes in the plasma response to IVGATT, possibly reflecting metabolic instability. Reduced levels of proteins regulating redox state and neuronal stress markers, as well as increased levels of coagulation factors, antedated the loss of insulin secretion in diabetic mice. These results suggest that a reduced complement of antioxidants in response to a mixed secretagogue challenge is an early correlate of future  cell failure.The incidence of diabetes has increased considerably (1). Type 2 diabetes is characterized by insulin resistance and impaired  cell function (2). Both abnormalities contribute to the onset and progression of the disease. However, progression from pre-diabetes to diabetes is characterized by a steep decrease of insulin secretory function, whereas insulin resistance remains relatively constant (3, 4). It appears that even modest elevations of plasma glucose levels are toxic to  cells (5). In addition, outcome studies have consistently demonstrated that diabetic patients treated with sulfonylurea-type secretagogues experience faster therapeutic failure rates that require the addition of a second medication, when compared with those treated with insulin sensitizers (6). These facts point to two conclusions: (i) that there is an intrinsic impairment of  cell function in diabetes; and (ii) that promoting insulin secretion does not redress the problem.To develop better therapies and increase the sensitivity of probing  cell function, it would be desirable to have markers predictive of  cell failure. Sensitive tests of insulin secretion are rarely applicable as routine diagnostics, and have limited predictive value of response to treatment. Given the renewed focus on durability as a key criterion to develop more efficacious diabetes treatments (7), it is essential to eva...