Disproportionately Elevated Proinsulin Levels Reflect the Degree of Impaired B Cell Secretory Capacity in Patients with Noninsulin-Dependent Diabetes Mellitus

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Abstract
An increased proportion of fasting proinsulin (PI) relative to im- munoreactive insulin (IRI; increased PI/IRI) occurs in noninsulin- dependent diabetes mellitus (NIDDM). To determine whether the magnitude of the increase in PI/IRI is an indicator of the degree of reduced B cell secretory capacity, we measured fasting plasma glu- cose, PI, IRI, and PI/IRI and related them to maximal B cell secretory capacity (AIRmax) in 9 subjects with NIDDM (age, 61 6 3 yr; body mass index (BMI), 27.5 6 1.3 kg/m2; duration of NIDDM, 10.8 6 1.8 yr; mean 6 SEM) and in 10 healthy subjects matched for age and BMI (age, 61 6 6 yr; BMI, 27.9 6 1.5 kg/m2). AIRmax was quantified as the incremental insulin response to iv arginine at maximal glycemic potentiation (plasma glucose .25 mmol/L). Mean fasting plasma glucose was 13.7 6 1.4 mmol/L (range, 7.5-

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