Multitissue insulin resistance despite near-normoglycemic remission in Africans with ketosis-prone diabetes.

Abstract

OBJECTIVE:

To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during remission.

RESEARCH DESIGN AND METHODS:

At Saint-Louis Hospital, Paris, France, 15 African patients with KPD with an average 10.5-month insulin-free near-normoglycemic remission period (mean A1C 6.2%) were compared with 17 control subjects matched for age, sex, BMI, and geographical origin. Insulin stimulation of glucose disposal, and insulin suppression of endogenous glucose production (EGP) and nonesterified fatty acids (NEFAs), was studied using a 200-min two-step (10 mU x m(-2) body surface x min(-1) and 80 mU x m(-2) x min (-1) insulin infusion rates) euglycemic clamp with [6,6-(2)H(2)]glucose as the tracer. Early-phase insulin secretion was determined during an oral glucose tolerance test.

RESULTS:

The total glucose disposal was reduced in patients compared with control subjects (7.5 +/- 0.8 [mean +/- SE] vs. 10.5 +/- 0.9 mg x kg(-1) x min(-1); P = 0.018). EGP rate was higher in patients than control subjects at baseline (4.0 +/- 0.3 vs. 3.0 +/- 0.1 mg x kg(-1) x min(-1); P = 0.001) and after 200-min insulin infusion (10 mU x m(-2) x min(-1): 1.6 +/- 0.2 vs. 0.6 +/- 0.1, P = 0.004; 80 mU x m(-2) x min(-1): 0.3 +/- 0.1 vs. 0 mg x kg(-1) x min(-1), P = 0.007). Basal plasma NEFA concentrations were also higher in patients (1,936.7 +/- 161.4 vs. 1,230.0 +/- 174.1 micromol/l; P = 0.002) and remained higher after 100-min 10 mU x m(-2) x min(-1) insulin infusion (706.6 +/- 96.5 vs. 381.6 +/- 55.9 micromol/l; P = 0.015).

CONCLUSIONS:

The triad hepatic, adipose tissue, and skeletal muscle insulin resistance is observed in patients with KPD during near-normoglycemic remission, suggesting that KPD is a form of type 2 diabetes.

• Authors: Simeon-Pierre Choukem, Eugene Sobngwi, Lila-Sabrina Fetita, Philippe Boudou, Eric De Kerviler, Yves Boirie, Isabelle Hainault, Patrick Vexiau, Franck Mauvais-Jarvis, Fabien Calvo, Jean-François Gautier
• Journal: Diabetes care (Diabetes Care) Vol. 31 Issue 12 Pg. 2332-7 (Dec 2008) ISSN: 1935-5548 [Electronic] United States
• PMID: 18809633 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Absorptiometry, Photon
• Adipose Tissue (metabolism, pathology)
• Adult
• Black People
• Diabetes Mellitus (ethnology, metabolism, physiopathology)
• Diabetes Mellitus, Type 1 (ethnology, metabolism, physiopathology)
• Diabetes Mellitus, Type 2 (ethnology, metabolism, physiopathology)
• Diabetic Ketoacidosis (ethnology, metabolism, physiopathology)
• Female
• Glucose Clamp Technique
• Glucose Tolerance Test
• Humans
• Insulin Resistance (physiology)
• Liver (metabolism, pathology)
• Male
• Middle Aged
• Muscle, Skeletal (metabolism, pathology)
• Remission Induction