Circulating proinsulin in patients with maturity onset diabetes.

The contribution of proinsulin to the total serum immunoreactive insulin (IRI) was measured in 59 patients with maturity onset diabetes (23 being treated with diet alone and 36 with oral sulfonylurea agents) and compared to that in 44 control subjects. The percentage of proinsulin was increased in 11 patients and correlated with plasma glucose, but not with IRI. There was no difference between the drug-treated group and diet-treated group, or between patients taking different sulfonylurea agents. Sequential studies in one patient showed normalization of the proportion of proinsulin following lowering of the plasma glucose level. It is probably that the increased circulating proportion of proinsulin in hyperglycemic diabetic patients is secondary to beta cell exhaustion with release of less mature granules.