Crofts 2016: Hyperinsulinemia in the Kraft Database

Background

Dr. Catherine Crofts and colleagues from AUT University, New Zealand, analyzed Dr. Joseph Kraft's remarkable database of over 14,000 oral glucose tolerance tests with insulin measurements. Published in Diabetes Research and Clinical Practice (PMID: 27344544).

Study Design

Database: 4,416 subjects from Dr. Kraft's clinical practice (1972-1998) Method: 5-hour OGTT with insulin measured at 0, 30, 60, 120, 180, 240, and 300 minutes Analysis: Applied Kraft patterns to identify hyperinsulinemia with and without glucose abnormalities

Key Findings

Glucose Status	Hyperinsulinemia Present
Normal glucose tolerance	53%
Impaired glucose tolerance	75%
Diabetic glucose tolerance	85%

Critical insight: Over half of people with completely normal glucose responses already have hyperinsulinemia—the earliest detectable metabolic abnormality.

Fasting insulin alone missed 75% of hyperinsulinemia cases. Only the full insulin response pattern revealed dysfunction.

Mechanistic Insights

Hyperinsulinemia precedes glucose abnormalities by years to decades. The pancreas compensates for insulin resistance by producing more insulin, maintaining normal glucose until compensation fails.

Clinical Implications

Fasting glucose and A1C are late markers of metabolic disease. Earlier detection requires:

1. •Fasting insulin (imperfect but accessible)
2. •TG/HDL ratio as proxy
3. •Full OGTT with insulin (gold standard but rarely done)

Metabolic Health Perspective

This study validates the metabolic optimization approach: identify and address hyperinsulinemia before glucose ever becomes abnormal. Prevention is far more effective than reversal of established diabetes.