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Objective: To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type II diabetes.Design: Cohort analytic study of persons with normal glucose tolerance but with a high risk for developing type II diabetes (average follow-up time, 13 years).Setting: Outpatients had an intravenous glucose tolerance test and were contacted periodically to ascertain diagnoses of diabetes.Participants: One hundred and fifty-five normal offspring, ranging in age from 16 to 60 years, of two parents with type II diabetes and 186 normal control subjects in the same age range who had no family history of diabetes.Measurements and Main Results: Two phenotypic characteristics distinguished the offspring of diabetic parents from control subjects. They had slower glucose removal rates (Kg) (P less than 0.01) and higher insulin levels (fasting and during the second phase of insulin response to intravenous glucose; P less than 0.0001) than did control subjects, even after adjustment for differences in obesity. Sixteen percent of the offspring developed type II diabetes. Mean Kg at baseline was 1.7%/min among offspring who subsequently developed diabetes, 2.2%/min among offspring who remained nondiabetic, and 2.3%/min among control subjects. Corresponding means for first-phase insulin were 498, 354, and 373 pM, respectively, whereas second-phase insulin means were 329, 117, and 87 pM, respectively. In multivariate analysis, low Kg and high serum insulin levels independently increased the risk for developing diabetes among the offspring of diabetic parents.Conclusions: One to two decades before type II diabetes is diagnosed, reduced glucose clearance is already present. This reduced clearance is accompanied by compensatory hyperinsulinemia, not hypoinsulinemia, suggesting that the primary defect is in peripheral tissue response to insulin and glucose, not in the pancreatic beta cell. [ABSTRACT FROM AUTHOR]

Examines receptors for peptide hormones. Details on the radioreceptor assays of nonimmunoassayable hormones; Regulation of hormone receptors in vivo; Regulation of hormone receptors in vitro.

Focuses on a case study which investigated the levels of serum lactate dehydrogenase activity in an aged woman. Methods; Case report; Results; Discussion.

Presents a prospective study which examined cardiovascular disorders on patient with acromegaly. Diagnosis and treatment of acromegaly; Discussion on diagnostic criteria for cardiovascular disease; Presentation of postmortem findings in acromegalic patients involved in the study.

Discusses concepts and management of islet cell tumors. Prevalence of islet cell carcinomas; Clinical spectrum of islet cell tumors; Laboratory diagnosis of insulinoma; Major clinical features of the diarrheogenic syndrome.

Presents a case report on a patient who developed symptomatic reactive hypoglycemia and insulin autoantibodies in drug-induced lupus erythematosus. Information on autoimmune insulin syndrome; Medical history of the patient; Clinical manifestations and treatment.

Presents a study which determined the cause of necrolytic migratory erythema in patients with glucagonoma. Methodology; Results; Discussion.