TY - JOUR T1 - Postprandial insulin assay as the earliest biomarker for diagnosing pre-diabetes, type 2 diabetes and increased cardiovascular risk JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2017-000656 VL - 4 IS - 2 SP - e000656 AU - James J DiNicolantonio AU - Jaikrit Bhutani AU - James H OKeefe AU - Catherine Crofts Y1 - 2017/11/01 UR - http://openheart.bmj.com/content/4/2/e000656.abstract N2 - Currently, approximately one in eleven US adults have diabetes, and more than one in three are pre-diabetic.1 Additionally, it is estimated that approximately two in five US adults will develop diabetes, with most of these cases being type 2 diabetes (T2D).2 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).3 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.Kraft patternsHyperinsulinaemia is thought to be aetiological in hypertension, obesity, atherosclerosis, microvascular disease, neurodegenerative disorders, idiopathic peripheral neuropathy and certain cancers,4 5 and is associated with idiopathic tinnitus, vertigo and hearing loss.6 A key research paper published in 1975 by Dr Joseph R Kraft comprised 3650 patients who were randomly referred for glucose tolerance testing.7 Dr Kraft described five different insulin patterns in response to a 100 g glucose load administered over 3–5 hours with insulin levels assessed at baseline, 30, 60, 120, and at minimum, 180 min. Further 240 and 300 min insulin levels were also considered in certain instances. Pattern I … ER -