Came across a nice paper from Bill Lagakos’ recent post (thanks Bill!); it is quite interesting in separating out the quasi-independent properties of Impaired Fasting Glucose (IFG) versus Impaired Glucose Tolerance (IGT) folks: http://care.diabetesjournals.org/content/26/3/868.full.pdf+html These people are in different places on their dysfunctional journey, but many end up at the same sorry destination. They also include a Combined Glucose Intolerance (CGI) view, for the people that have both malady’s.
But there is a better way to look at the big picture than the folks who compiled this paper, where specificity reigns and the noise subsides. This is Kraft’s way. It involves homing in on the key patterns of hyperinsulinemia, which cuts through the noise and arrives at the definitive diagnosis of future issues – arriving at the accurate diagnosis of ‘Diabetes in Situ (=Diabetes)’. Whatever your road to this insulin resistance / hyperinsulinemia dysfunction, you will benefit from this mathematically precise signpost on the journey; it will point inexorably to the various flavors of vascular damage that await you (retinal, renal, cardiac, etc). If you don’t come in with a Pattern I = euinsulinemic/non-diabetes response, then expect some vascular violence down the highway…
I extracted a graph from the paper below, and added some interpretation. Of course after more than 4,000 personally conducted autopsies, and more than16,000 patients characterized fully with full 5-hour insulin assays, Kraft could still be wrong. But the mathematics, mechanisms and microscopic scrutiny stand foursquare behind him. And for what it’s worth, so do I. 🙂
Also, an intro to Kraft’s oeuvre – rightly quoted as ‘unparalleled in medicine’: