[Detection of diabetes in obese patients. Systematic study of induced hyperglycemia with assays of blood insulin, glycosylated hemoglobin A1c and cutaneous biopsy in 46 patients].

Glycoregulation and insulin secretion abnormalities and micro-angiopathy were systematically investigated in 46 patients (6 men and 40 women; mean age 34.8) seeking medical attention for obesity. In all patients, a three-hour oral glucose tolerance test (OGTT) with 50 g glucose, with concomitant plasma insulin determinations, Hb A1c assay and skin biopsy (SB) at the medial aspect of the arm (optic microscopy study, PAS stain) were performed. We obtained 46 Hb A1c assays, 45 OGTT, 43 insulin determinations and 42 SB. In 40 patients, all four studies were available. We consider as abnormal blood glucose greater than 7.8 mmol at 120 mn with intermediate measurement greater than 10.1, insulin greater than 64 mcU with a maximum delayed after the 60th mn, Hb A1c greater than 6.3% and SB score greater than 10 (evaluating basement membrane thickness, endothelium swelling, aspect of pericytes, perivascular infiltration and percentage of capillaries involved). We observed 6 abnormal OGTT, 12 dysinsulinisms (DI), 5 Hb A1c greater than 6.3% and 17 SB greater than or equal to 10 with typical diabetic microangiopathy. Out of 40 fully investigated patients, 14 were normal for all criteria, 12 had only one abnormality (12 SB, 5 DI, 1 OGTT), 6 had 2 abnormalities (2 SB + DI, OGTT + DI, SB + OGTT, SB + Hb A1c, DI + Hb A1c) and 2 had 3 abnormalities (SB + DI + Hb A1c, OGTT + DI + Hb A1c).(ABSTRACT TRUNCATED AT 250 WORDS)