Postprandial insulin assay as the earliest biomarker for diagnosing pre-diabetes, type 2 diabetes and increased cardiovascular risk

1 DiNicolantonio JJ, et al. Open Heart 2017;4:e000656. doi:10.1136/openhrt-2017-000656 IntroductIon Currently, approximately one in eleven US adults have diabetes, and more than one in three are pre-diabetic. Additionally, it is estimated that approximately two in five US adults will develop diabetes, with most of these cases being type 2 diabetes (T2D). According to data (2011–2012) recently published by Menke et al, 3 14.3% of US adults (over 20 years of age) were diabetic (9.1% were diagnosed as being diabetic, 5.2% having undiagnosed diabetes) and 38% were pre-diabetic, totalling 52.3% of US adults having pre-diabetes or diabetes.The burden of undiagnosed diabetes seems to have increased in parallel to the above estimates. Among people with diabetes, more than one-third went undiagnosed overall (36.4% (95% CI 30.5% to 42.7%)). Additionally, this burden was even higher among non-Hispanic Asian participants (50.9%; P = 0.004) and Hispanic participants (49.0%; P = 0.02). In view of this, it can be concluded that using fasting glucose, oral glucose tolerance test (OGTT) or A1c may not be the most effective early screening tool for T2D. Thus, incorporating fasting insulin and especially insulin assay after an OGTT as enhanced screening methods may help to increase the ability to detect diabetes and pre-diabetes, allowing earlier intervention to prevent diabetic complications.