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Type: Journal article
Title: Metabolic flexibility in response to glucose is not impaired in type 2 diabetes after controlling for glucose disposal rate
Author: Galgani, J.
Heilbronn, L.
Azuma, K.
Kelley, D.
Albu, J.
Pi-Sunyer, F.
Smith, S.
Ravussin, E.
Citation: Diabetes, 2008; 57(4):841-845
Publisher: Amer Diabetes Assoc
Issue Date: 2008
ISSN: 0012-1797
Statement of
Jose E. Galgani, Leonie K. Heilbronn, Koichiro Azuma, David E. Kelley, Jeanine B. Albu, Xavier Pi-Sunyer, Steven R. Smith, Eric Ravussin and the Look AHEAD Adipose Research Group
Abstract: OBJECTIVE—Compared with nondiabetic subjects, type 2 diabetic subjects are metabolically inflexible with impaired fasting fat oxidation and impaired carbohydrate oxidation during a hyperinsulinemic clamp. We hypothesized that impaired insulin-stimulated glucose oxidation is a consequence of the lower cellular glucose uptake rate in type 2 diabetes. Therefore, we compared metabolic flexibility to glucose adjusted for glucose disposal rate in nondiabetic versus type 2 diabetic subjects and in the latter group after 1 year of lifestyle intervention (the Look AHEAD [Action For Health in Diabetes] trial). RESEARCH DESIGN AND METHODS—Macronutrient oxidation rates under fasting and hyperinsulinemic conditions (clamp at 80 mU/m2 per min), body composition (dual-energy X-ray absorptiometry), and relevant hormonal/metabolic blood variables were assessed in 59 type 2 diabetic and 42 nondiabetic individuals matched for obesity, sex, and race. Measures were repeated in diabetic participants after weight loss. RESULTS—Metabolic flexibility to glucose (change in respiratory quotient [RQ]) was mainly related to insulin-stimulated glucose disposal rate (R2 = 0.46, P < 0.0001) with an additional 3% of variance accounted for by plasma free fatty acid concentration at the end of the clamp (P = 0.03). The impaired metabolic flexibility to glucose observed in type 2 diabetic versus nondiabetic subjects (ΔRQ 0.06 ± 0.01 vs. 0.10 ± 0.01, respectively, P < 0.0001) was no longer observed after adjusting for glucose disposal rate (P = 0.19). Additionally, the increase in metabolic flexibility to glucose after weight loss was accounted for by the concomitant increase in insulin-stimulated glucose disposal rate. CONCLUSIONS—This study suggests that metabolic inflexibility to glucose in type 2 diabetic subjects is mostly related to defective glucose transport.
Keywords: Look AHEAD Adipose Research Group; Humans; Diabetes Mellitus, Type 2; Hyperinsulinism; Insulin; Glucose; Blood Glucose; Body Mass Index; Glucose Clamp Technique; Metabolic Clearance Rate; Infusions, Intravenous; Body Composition; Biological Transport; Oxygen Consumption; Reference Values; Middle Aged; Female; Male
Rights: © 2008 by the American Diabetes Association
RMID: 0020106981
DOI: 10.2337/db08-0043
Appears in Collections:Molecular and Biomedical Science publications

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