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American Journal of Epidemiology Vol. 145, No. 1: 18-23
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Fasting Insulin Level Underestimates Risk of Non-lnsulin-dependent Diabetes Mellitus Due to Confounding by Insulin Secretion

Edward J. Boyko1,2,, Donna L. Leonetti3, Richard W. Bergstrom1 and Wilfred Y. Fujimoto1

1Department of Medicine, University of Washington School of Medicine, Seattle, WA
2Medical Service, Veterans Affairs Medical Center, Seattle, WA
3Department of Anthropology, University of Washington, Seattle, WA

Reprint requests to Dr. Edward J. Boyko, VA Medical Center (111M), 1660 S. Columbian Way, Seattle, WA 98108.

Fasting insulin has been used as a surrogate measure of insulin sensitivity in studies of non-insulin-dependent diabetes mellitus (NIDDM) risk, but the fasting insulin-NIDDM association may be confounded by insulin secretion, which correlates negatively with NIDDM risk and positively with fasting insulin level. In a prospective 5-year study of 137 nondiabetic Japanese-American men in King County, Washington State, higher fasting insulin was not strongly related to NIDDM (odds ratio (OR) = 1.37, 95% confidence interval (Cl 0.80–2.34), but this odds ratio increased substantially after adjustment for insulin secretion (OR = 2.92, 95% Cl 1.41–6.06). Research on NIDDM risk in relation to fasting insulin may yield biased effect measures unless adjusted for insulin secretion. Am J Epidemiol 1997; 145: 18–23.

bias (epidemiology); C-peptides; diabetes mellitus, non-insulin-dependent; insulin; prospective studies


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