“…What remains uncertain is whether the striking incretin effect reflects a GLP1/GIP-specific effect, or whether this is a generalised defect in insulin processing and secretion. In favour of the latter, TCF7L2 expression affects the direct effect of glucose both in vitro [12,13] and in vivo [16]; there is an increase in the proinsulin:insulin ratio in carriers of the risk allele [17], suggesting a defect in insulin processing; and the 'maximum' insulin secretory capacity, as assessed by the response to arginine at a constant plasma glucose concentration of 28 mmol/l, is reduced in risk allele carriers with impaired glucose tolerance or type 2 diabetes [10]. It would be interesting to see how the insulin secretory response to tolbutamide is affected in islets with reduced TCF7L2 expression, or, indeed, in humans carrying the TCF7L2 risk allele, as this may help further address this question.…”