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Multitissue Insulin Resistance Despite Near-Normoglycemic Remission in Africans With Ketosis-Prone Diabetes

Lookup NU author(s): Dr Eugene Sobngwi

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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 AlC 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.m(-2) body surface.min(-1) and 80 mU.m(-2).min(-1) insulin infusion rates) euglycemic clamp with [6, 6-H-2(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.kg(-1).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.kg(-1).min(-1); P = 0.001) and after 200-min insulin infusion (10 mU.m(-2).min(-1): 1.6 +/- 0.2 vs. 0.6 +/- 0.1, P = 0.004; 80 mU.m(-2).min(-1): 0.3 +/- 0.1 vs. 0 mg.kg(-1).min(-1), P = 0.007). Basal plasma NEFA concentrations were also higher in patients (1,936.7 +/- 161.4 vs. 1,230.0 +/- 1.74.1 mu mol/l; P = 0.002) and remained higher after 100-min 10 mU.m(-2).min(-1) insulin infusion (706.6 +/- 96.5 vs. 381.6 +/- 55.9 mu mol/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.

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Author(s): Choukem SP, Sobngwi E, Fetita LS, Boudou P, De Kervile E, Boirie Y, Hainault I, Vexiau P, Mauvais-Jarvis F, Calvo F, Gautier JF

Publication type: Article

Publication status: Published

Journal: Diabetes Care

Year: 2008

Volume: 31

Issue: 12

Pages: 2332-2337

ISSN (print): 0149-5992

ISSN (electronic): 1935-5548

Publisher: American Diabetes Association

URL: http://dx.doi.org/10.2337/dc08-0914

DOI: 10.2337/dc08-0914

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