Abnormalities of endogenous glucagon and insulin in unstable diabetes

• Published in: Diabetes care Vol. 26; no. 1; p. 36
• Main Authors: The Diabetes Prevention Program Research Group, G D Molnar, D L Horwitz, A H Rubenstein, W F Taylor, N S Jiang
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01-01-1977; 01-01-2003
• ISSN: 0012-1797; 0149-5992; 1935-5548; 1939-327X
• DOI: 10.2337/diabetes.26.1.36

Abnormalities of endogenous glucagon and insulin in unstable diabetes.
C Reynolds ,
G D Molnar ,
D L Horwitz ,
A H Rubenstein ,
W F Taylor and
N S Jiang
Abstract
The responses of glucagon, growth hormone, and insulin secretion to the oral administration of glucose and to the intravenous
infusion of saline, arginine, and insulin were measured in seven patients who had stable diabetes, eight who had unstable
diabetes, and seven healthy volunteers. Hyperglycemia suppressed secretion of glucagon in normal subjects but not in diabetics.
The oral glucose and arginine infusion tests demonstrated partial preservation of insulin-secretory ability in stable diabetics
and its virxual absence in unstable diabetics. Glucagon responses to arginine infusion were similar in all three groups. In
response to hypoglycemia induced by insulin infusion, the concentrations of plasma glucagon increased in normal subjects and,
to a lesser extent, in stable diabetics but increased in only two of the unstable diabetics. The impairment in glucagon response
during hypoglycemia in diabetics correlated positively with the degree of diabetic instability and insulin deficiency during
glucose and arginine testing. The severity of the insulin deficiency also correlated with the degree of diabetic instability.
These findings support the hypothesis that inherent abnormalities of insulin and glucagon secretion may account for many of
the clinical characteristics of unstable and stable diabetic patients.
Costs Associated With the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program
The Diabetes Prevention Program Research Group *
From the Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, Rockville, Maryland
Abstract
OBJECTIVE —To describe the costs of the Diabetes Prevention Program (DPP) interventions to prevent or delay type 2 diabetes.
RESEARCH DESIGN AND METHODS —We describe the direct medical costs, direct nonmedical costs, and indirect costs of the placebo, metformin, and intensive
lifestyle interventions over the 3-year study period of the DPP. Resource use and cost are summarized from the perspective
of a large health system and society. Research costs are excluded.
RESULTS —The direct medical cost of laboratory tests to identify one subject with impaired glucose tolerance (IGT) was $139. Over
3 years, the direct medical costs of the interventions were $79 per participant in the placebo group, $2,542 in the metformin
group, and $2,780 in the lifestyle group. The direct medical costs of care outside the DPP were $272 less per participant
in the metformin group and $432 less in the lifestyle group compared with the placebo group. Direct nonmedical costs were
$9 less per participant in the metformin group and $1,445 greater in the lifestyle group compared with the placebo group.
Indirect costs were $230 greater per participant in the metformin group and $174 less in the lifestyle group compared with
the placebo group. From the perspective of a health system, the cost of the metformin intervention relative to the placebo
intervention was $2,191 per participant and the cost of the lifestyle intervention was $2,269 per participant over 3 years.
From the perspective of society, the cost of the metformin intervention relative to the placebo intervention was $2,412 per
participant and the cost of the lifestyle intervention was $3,540 per participant over 3 years.
CONCLUSIONS —The metformin and lifestyle interventions are associated with modest incremental costs compared with the placebo intervention.
The evaluation of costs relative to health benefits will determine the value of these interventions to health systems and
society.
AWP, average wholesale price
CMS, Center for Medicare and Medicaid Services
DPP, Diabetes Prevention Program
IGT, impaired glucose tolerance
LCM, lifestyle case manager
MCM, medication case manager
OGTT, oral glucose tolerance tests
Footnotes
Address correspondence and reprint requests to Diabetes Prevention Program Coordinating Center, Biostatistics Center, George
Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852. E-mail: dppmail{at}biostat.bsc.gwu.edu .
Received for publication 21 March 2002 and accepted in revised form 19 August 2002.
*
↵ * The members of the Diabetes Prevention Program Group are listed in reference 1. The members of this writing group are William
H. Herman MD, MPH; Michael Brandle MD; Ping Zhang PHD; David F. Williamson PHD, MS; Margaret J. Matulik RN, BSN; Robert E.
Ratner MD; John M. Lachin SCD; Michael M. Engelgau MD, MS
↵ A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
↵ See accompanying editorial on p. 240.
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