Evidence that insulin resistance may drive HDL subclass distribution towards smaller particles in patients with type 2 diabetes has also been obtained from a small cohort of patients in whom insulin sensitivity was evaluated by hyperinsulinemic clamp, and another prospective study in which HOMA-IR and small HDLs were positively associated with incident diabetes over 7.7-years [54,58]. This evidence concerns the gene INS and type 2 diabetes mellitus.