Influence of Diabetogenic Factors on Fasting and Postprandial Glucose Levels in Patients with Type 2 Diabetes Mellitus

Background: This study evaluated the relative influence of insulin resistance (IR), first-phase insulin secretion (FPIS), second-phase insulin secretion (SPIS), and glucose effectiveness (GE) in determining the difference between fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) (Delta PG), in a Chinese population with type 2 diabetes (T2D) mellitus. Methods: In total, we enrolled 1213 participants with T2D (479 women). IR, FPIS, SPIS, and GE were estimated by using equations we built previously. Delta PG was defined as FPG - PPG. Results: The relative contribution of the four diabetogenic factors (DFs) was analyzed by multiple linear regression, and GE was the greatest contributor in the Delta PG value (beta = 0.171, P < 0.001), whereas IR had the least influence on Delta PG (beta = -0.040, P = 0.439). DFs were analyzed by using binary logistic regression to ascertain if Delta PG >= 0 (high fasting plasma glucose, HFG). Three models were built: Model 0: SPIS, Model 1: SPIS + FPIS, and Model 2: Model 1 + GE. Model 2 had the most accurate predictive power; the equation for Model 2 is P = 1/(1 - e(-x)), where x = -11.88 + 312.89 x (GE) -1.22 x log(SPIS) +1.63 x log(FPIS). In this equation, P refers to the risk of HFG. Conclusions: For Chinese patients, GE had the most profound effect in determining Delta PG, followed by FPIS, SPIS, and IR. The model suggested that participants with high FPIS, SPIS, and GE would have a high incidence of HFG.