The Relationship Between {beta}-cell Function and Glycated Hemoglobin: Results from the Veterans Administration Genetic Epidemiology Study

Objective: The study objective was to assess the relationship between β-cell function and HbA(1c).

Research Design And Methods: A total of 522 Mexican American subjects participated in this study. Each subject received a 75-g oral glucose tolerance test (OGTT) after a 10- to 12-h overnight fast. Insulin sensitivity was assessed with the Matsuda index. Insulin secretory rate was quantitated from deconvolution of the plasma C-peptide concentration. β-Cell function was assessed with the insulin secretion/insulin resistance (IS/IR) (disposition) index and was related to the level of HbA(1c).

Results: At HbA(1c) levels <5.5%, both the Matsuda index of insulin sensitivity and IS/IR index were constant. However, as the HbA(1c) increased >5.5%, there was a precipitous decrease in both the Matsuda index and the IS/IR index. Subjects with HbA(1c) = 6.0-6.4% had a 44 and 74% decrease in the Matsuda index and the IS/IR index, respectively, compared with subjects with HbA(1c) <5.5% (P < 0.01 for both indices). Subjects with normal glucose tolerance and HbA(1c) <5.7% had β-cell function comparable to that of subjects with normal glucose tolerance with HbA(1c) = 5.7-6.4%. However, subjects with impaired fasting glucose or impaired glucose tolerance had a marked decrease in β-cell function independent of their HbA(1c) level.

Conclusions: The results of the current study demonstrate that in Mexican Americans, as HbA(1c) increases >6.0%, both insulin sensitivity and β-cell function decrease markedly. Performing an OGTT is pivotal for accurate identification of subjects with impaired β-cell function.