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1 Department of Medicine, Division of Diabetes, University of Helsinki, Helsinki, Finland
2 Minerva Research Institute, University of Helsinki, Department of Medicine, Division of Diabetes, Helsinki, Finland
3 Department of Oncology, University of Helsinki, Helsinki, Finland
4 Helsinki University of Technology, Helsinki, Finland
* To whom correspondence should be addressed. E-mail: ykijarvi{at}cc.helsinki.fi.
We determined whether insulin therapy changes liver fat content (LFAT) or hepatic insulin sensitivity in type 2 diabetes. Fourteen patients with type 2 diabetes (age 51±2 yrs, BMI 33.1±1.4 kg/m2) treated with metformin alone received additional basal insulin for 7 months. Liver fat (proton magnetic resonance spectroscopy), fat distribution (MRI), fat free and fat mass, whole body and hepatic insulin sensitivity (6-hour euglycemic hyperinsulinemic clamp combined with infusion of [3-3H]-glucose) were measured. The insulin dose averaged 75±10 IU/day (0.69±0.08 IU/kg, range 24-132 IU/day). HbA1c decreased from 8.9±0.3 to 7.4±0.2 % (p<0.001). Whole body insulin sensitivity increased from 2.21±0.38 to 3.08±0.40 mg/kg ffm·min (p<0.05). This improvement could be attributed to enhanced suppression of hepatic glucose production (HGP) by insulin (HGP 1.04±0.28 vs. 0.21±0.19 mg/kg ffm·min, p<0.01). The % suppression of HGP by insulin increased from 72±8 to 105±11 % (p<0.01). LFAT decreased from 17±3 to 14±3 % (p<0.05). The change in LFAT was significantly correlated with that in hepatic insulin sensitivity (r=0.56, p<0.05). Body weight increased by 3.0±1.1 kg (p<0.05). Of this, 83% was due to an increase in fat free mass (p<0.01). Fat distribution and serum adiponectin concentrations remained unchanged while serum FFA decreased significantly. Conclusions: Insulin therapy improves hepatic insulin sensitivity and slightly but significantly reduces liver fat content, independent of serum adiponectin.
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