Diminished effect of caloric restriction on control of hyperglycemia with increasing known duration of type ii diabetes mellitus

The effect of weight loss and caloric restriction on plasma glucose concentrations and insulin and glucagon secretion in response to oral and iv glucose and arginine infusions was examined in 8 subjects with type II diabetes mellitus of greater than 5 yr duration (long term diabetes). The findings of this study were compared to previous results in 10 subjects with similar degrees of obesity and fasting hyperglycemia but diabetes of less than 2 yr duration (recent-onset diabetes; fasting plasma glucose, 267 ± 16.5 mg/dl in long term diabetics and 259 ± 8.0 mg/dl in recent onset diabetics) and to a control group of 8 similarly obese but nondiabetic subjects. Both diabetic groups had impaired insulin responses on initial and final tests compared to control subjects. Response to dietary therapy was significantly poorer in the diabetics of longer duration (final fasting plasma glucose, 175 ± 18.9 mg/dl in long term vs. 119 ± 6.2 mg/dl in recent-onset subjects; P < 0.01) despite a similar degree of weight loss and duration of diet therapy in the 2 groups. This difference in glucose tolerance occurred despite similar final insulin and glucagon responses in the diabetic groups. Subjects with type II diabetes of long duration appear to have a relatively greater degree of insulin resistance than subjects with more recent onset of the disease.