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1 Internal Medicine - Section of Nutrition/Metabolism, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy; Unit of Clinical Spectroscopy, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy
2 Internal Medicine - Section of Nutrition/Metabolism, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy
3 Division of Nuclear Medicine, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy; Division of Diagnostic Radiology, Universita' Vita e Salute San Raffaele IRCCS H San Raffaele, Milan, Italy; Unit of Clinical Spectroscopy, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy
4 Internal Medicine - Section of Organ Transplantation, Universita' Vita e Salute San Raffaele IRCCS H San Raffaele, Milan, Italy
5 Division of Diagnostic Radiology, Universita' Vita e Salute San Raffaele IRCCS H San Raffaele, Milan, Italy; Unit of Clinical Spectroscopy, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy
6 Internal Medicine - Section of Nutrition/Metabolism, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy; Internal Medicine - Section of Nutrition/Metabolism, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy
7 Internal Medicine - Section of Nutrition/Metabolism, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy; Unit of Clinical Spectroscopy, Universita' Vita e Salute IRCCS H San Raffaele, Milan, Italy; International Center for the Assessment of Nutritional Status, Universita' degli Studi di Milano, Milan, Italy
* To whom correspondence should be addressed. E-mail: perseghin.gianluca{at}hsr.it.
Insulin resistance is a key pathogenic factor of type 2 diabetes (T2DM); in contrast, in type 1 diabetes (T1DM), it is considered a secondary alteration. Increased IMCL accumulation and reduced plasma adiponectin were suggested to be pathogenic events of insulin resistance in T2DM. This study was designed to assess whether IMCL content and plasma adiponectin were associated with the severity of insulin resistance also in T1DM. We studied 18 patients with T1DM, 7 older and overweight/obese patients with T2DM, and 15 non-diabetic, insulin resistant offspring of type 2 diabetic parents (OFF) and 15 healthy individuals (NOR) as appropriate control groups matched for anthropometric features with T1DM patients by means of the euglycemic hyperinsulinemic clamp combined with the infusion of [6,6-d2]-glucose and 1H-MR spectroscopy of the calf muscles. T1DM and T2DM patients showed reduced insulin-stimulated glucose metabolic clearance rate (MCR: 5.1±0.6 and 3.2±0.8) similarly to OFF (5.3±0.4) in comparison with NOR (8.5±0.5 ml/[kg min]; P<0.001). The soleus IMCL content was increased in T1DM (112±15 AU), T2DM (108±10 AU) and OFF (82±13 AU) with respect to NOR (52±7; P<0.05) and resulted inversely proportional to the MCR (R2=0.27; P<0.001); an association between IMCL content and HbA1c was found only in T1DM (R2=0.57, P<0.001). Fasting plasma adiponectin was reduced in T2DM (7±1 µg/ml; P=0.01) and OFF (11±1 µg/ml; P=0.03) but not in T1DM (25±6 µg/ml) whose plasma level was increased with respect to both OFF (P=0.03) and NOR (16±2 µg/ml; P=0.05). In conclusion, in T1DM, T2DM and OFF, the IMCL content was associated with insulin resistance, demonstrating that IMCL accretion is a marker of insulin resistance common to both primary genetically-determined and secondary metabolic (chronic hyperglycemia) alterations. The increased adiponectin levels in insulin resistant patients with T1DM, in contrast with the reduced levels found in patients with T2DM and in their OFF, demonstrated that the relationship adiponectin/insulin resistance in humans is still unclear.
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