OBJECTIVE -The role of gut-derived incretin, glucose-dependent insulinotropic polypeptide (also known as gastric inhibitory peptide [GIP]), in compensatory -cell hypersecretion during insulin-resistant states and in transition to -cell failure in type 2 diabetes is unknown.RESEARCH DESIGN AND METHODS -We carried out oral glucose tolerance testing followed by blood sampling 10 times for 2 h on 68 age-and BMI-matched participants of the Baltimore Longitudinal Study on Aging (BLSA) with normal glucose tolerance (34 subjects), impaired glucose tolerance (IGT) (18 subjects with both impaired fasting and 2-h plasma glucose levels), and type 2 diabetes (16 subjects with both diabetic fasting and 2-h plasma glucose levels). We assayed plasma glucose, insulin, C-peptide, glucagon, and intact and total GIP levels and quantitated glucose and hormone responses to the oral glucose tolerance test. We also compared GIP and insulin release and sensitivity indexes between groups.RESULTS -After glucose ingestion, subjects with IGT had both hyperinsulinemia and hyperemia, while subjects with type 2 diabetes had both -and GIP-cell deficiency. In the former group, there was also a significant positive correlation between the augmented plasma intact and total GIP levels and both fasting and post-oral glucose load plasma insulin levels.CONCLUSIONS -Elevated plasma GIP levels are correlated with hyperinsulinemia in the impaired glucose-tolerant state, whereas type 2 diabetes is associated with a failure to secrete adequate amounts of both GIP and insulin, indicating a common pathway of resistance to and eventually failure of glucose responsiveness in -and GIP-cells.
Diabetes Care 27:1692-1698, 2004I n patients with type 2 diabetes, -cells within the islets of Langerhans in the pancreas fail to meet the increased need for insulin created by the insulinresistant state (1). Before -cell failure occurs, however, subjects compensate for insulin resistance for many years by increasing their secretory capacity, resulting in hyperinsulinemia (2). The failure of -cells to continue to hypersecrete insulin underlies the conversion to clinical diabetes. The term enteroinsular axis (3) encompasses the neuro-humoral interactions long thought to exist between the endocrine pancreas and gut cell populations. In fact, the enteroendocrine system constitutes the largest system of endocrine cells in humans, both in terms of number of cells and variety of hormones produced (4). Islets of Langerhans also lie in this system, as well as the incretinproducing cells of the gut, which synthesize and release vital mediators of foodstimulated, glucose-dependent insulin secretion, which account for up to 60% of the insulin secretory response following an oral glucose load (5). The two main, if not the only physiologically relevant, incretins are glucose-dependent insulinotropic polypeptide (also known as gastric inhibitory peptide [GIP]) and glucagonlike peptide-1 (GLP-1) (6,7). The proGIP gene is expressed in gut K-cells, the majority of which are located i...