Turkington R W, Weindling H K
JAMA. 1978 Sep 1;240(9):833-6.
The natural history of patients with glucose intolerance was observed in 334 patients during a period of 18 years. Glucose tolerance testing (100 g orally) was characterized by measurement of induced insulin secretion. Diabetic complications of retinopathy, sensory neuropathy, and renal disease developed only in the group of patients in whom the induced serum insulin peak fell below 60 mu U/ml. Preservation of an insulin secretory reserve that permitted serum insulin peaks of 60 muU/ml or greater was not associated with development of these complications or symptoms of insulin deficiency despite the presence of an equal degree of fasting hyperglycemia and glucose intolerance. A critical amount of insulin secretory reserve distinguishes between two qualitatively distinct clinical syndromes: true diabetes mellitus (the development of signs and symptoms of insulin deficiency) and the syndrome of pure resistance to insulin (signs and symptoms of hyperglycemia in the setting of adequate or excessive insulin secretion, frequently with obesity, but without diabetic complication).
在18年的时间里，对334例糖耐量异常患者的自然病史进行了观察。葡萄糖耐量试验（口服100克）的特点是测量诱导胰岛素分泌。视网膜病变、感觉神经病变和肾脏疾病等糖尿病并发症仅在诱导血清胰岛素峰值低于60微单位/毫升的患者组中出现。尽管存在同等程度的空腹高血糖和糖耐量异常，但保留允许血清胰岛素峰值达到60微单位/毫升或更高的胰岛素分泌储备与这些并发症或胰岛素缺乏症状的发生无关。临界量的胰岛素分泌储备区分了两种性质不同的临床综合征：真正的糖尿病（胰岛素缺乏体征和症状的发展）和单纯胰岛素抵抗综合征（在胰岛素分泌充足或过多的情况下出现高血糖体征和症状，常伴有肥胖，但无糖尿病并发症）。
