The Relationship Between β-Cell Function and Glycated Hemoglobin Results from the Veterans Administration Genetic Epidemiology Study

OBJECTIVE-The study objective was to assess the relationship between beta-cell function and HbA(1c). RESEARCH DESIGN AND METHODS-A total of 522 Mexican American subjects participated in this study. Each subject received a 75-g oral glucose tolerance test (OGTT) after a 10- to 12-h overnight fast. Insulin sensitivity was assessed with the Matsuda index. Insulin secretory rate was quantitated from deconvolution of the plasma C-peptide concentration. beta-Cell function was assessed with the insulin secretion/insulin resistance (IS/IR) (disposition) index and was related to the level of HbA(1c). RESULTS-At HbA(1c) levels < 5.5%, both the Matsuda index of insulin sensitivity and IS/IR index were constant. However, as the HbA(1c) increased > 5.5%, there was a precipitous decrease in both the Matsuda index and the IS/IR index. Subjects with HbA(1c) = 6.0-6.4% had a 44 and 74% decrease in the Matsuda index and the IS/IR index, respectively, compared with subjects with HbA(1c) < 5.5% (P < 0.01 for both indices). Subjects with normal glucose tolerance and HbA(1c) < 5.7% had beta-cell function comparable to that of subjects with normal glucose tolerance with HbA(1c) = 5.7-6.4%. However, subjects with impaired fasting glucose or impaired glucose tolerance had a marked decrease in beta-cell function independent of their HbA(1c) level. CONCLUSIONS-The results of the current study demonstrate that in Mexican Americans, as HbA(1c) increases > 6.0%, both insulin sensitivity and beta-cell function decrease markedly. Performing an OGTT is pivotal for accurate identification of subjects with impaired beta-cell function.