{
  "abstract": "Declining insulin with longer type 2 diabetes (T2D) duration is commonly interpreted as beta-cell failure. We analyzed NHANES data from 2003-August 2023 cross-sectionally and 2007-2018 with mortality linkage. The primary harmonized analysis included 2,072 adults with diagnosed T2D, calculable duration, and no exogenous insulin, and 9,050 normoglycemic adults. Across durations of <5, 5-14, and [≥]15 years, adjusted insulin ratios versus normoglycemia were 2.39 (95% CI 2.20-2.60), 1.88 (1.76-2.00), and 1.71 (1.58-1.86). A sensitivity restricted to current laboratory diabetes without exogenous insulin or secretagogues (n=808) yielded ratios of 2.21, 1.86, and 1.88. Among adults aged [≥]75 years with HbA1c-confirmed T2D for [≥]15 years and no exogenous insulin or secretagogue, the ratio was 1.73 (1.36-2.21; n=37). In the prespecified primary mortality analysis of the most recent six-cycle NDI-linked window, 2007-2018, insulin was associated with cardiovascular mortality in prediabetes (hazard ratio 2.95, 1.70-5.11). Hyperinsulinemia persisted across T2D duration and advanced age, arguing against uniform insulin deficiency in long-duration non-insulin-treated T2D. Mortality associations differed by disease stage and survey period.",
  "abstract_shown": true,
  "affiliations": [
    "University of California Davis"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "name": "S. Mirza"
    },
    {
      "name": "N. Ernst"
    },
    {
      "affs": [
        0
      ],
      "name": "J. Moen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9k3yzbk8k0myz.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.27.26358997",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.07.27.26358997v2.full",
  "id": "9k3yzbk8k0myz",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.07.27.26358997v2",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "endocrinology"
    ],
    [
      "openalex",
      "2712|Diabetes Treatment and Management"
    ]
  ],
  "openalex": "W7171710540",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.07.27.26358997v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/9k3yzbk8k0myz.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:39Z",
      "native_id": "10.64898/2026.07.27.26358997",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.07.27.26358997v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:endocrinology",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Fasting hyperinsulinemia persists across type 2 diabetes duration without exogenous insulin",
  "title_text": "Fasting hyperinsulinemia persists across type 2 diabetes duration without exogenous insulin",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:39Z",
  "url": "https://research.draconitic.com/paper/9k3yzbk8k0myz",
  "venue": "medRxiv",
  "versions": []
}