While most studies to date have relied on cross-sectional designs, the prevailing evidence from West Africa, the UK and the USA has shown that low hepatic insulin clearance is the main driver of hyperinsulinaemia in adults [16, 18, 19], with insulin clearance being proposed as the primary defect underlying the development of type 2 diabetes [8, 14]. Here, INS is linked to type 2 diabetes mellitus.