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Whole‐body ‘insulin resistance’ can be estimated from the amount of glucose that needs to be infused intravenously in order to maintain a constant blood glucose level during a simultaneous intravenous infusion of insulin. This (euglycaemic hyperinsulinaemic ‘clamp’) method is cumbersome, so for studying populations the HOMA (homeostasis model assessment) methods are more practical for estimating steady‐state beta‐cell function (HOMA B) and insulin sensitivity (HOMA S) as percentages of normal. These estimates can be derived from a single fasting measurement of plasma C‐peptide, insulin and glucose concentrations.

Figure 7.7 Deaths attributable to diabetes are highest in low‐ and middle‐income countries. IDF Diabetes Atlas. © 2017 International Diabetes Federation.

Figure 7.8 The relationship between HbA1c and the incidence of cardiovascular disease. This is a linear relationship which extends down into the prediabetic range (i.e HbA1c<6.5%). Bain et al. Diabetes, Obesity and Metabolism, 2016; 18(12): 1157–1166.

Insulin resistance (or, more correctly, diminished insulin sensitivity) precedes the onset of diabetes and can worsen with increasing duration (Figure 7.13). Insulin resistance is a major factor in the aetiology of type 2 diabetes, and affects the muscle, liver, and adipose tissues (Figure 7.14).

Figure 7.9 Varying prevalence rates of type 2 diabetes by ethnicity/region and location (red, rural; blue, urban) for 2007. UAE, United Arab Emirates.

Data from Diabetes Atlas.