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Insulin resistance, intramyocellular lipid content, and plasma adiponectin in patients with type 1 diabetes

Sections of ¹Nutrition/Metabolism and ²Organ Transplantation, Internal Medicine, ³Division of Nuclear Medicine, ⁴Division of Diagnostic Radiology, and ⁵Unit of Clinical Spectroscopy, Università Vita e Salute San Raffaele IRCCS H San Raffaele, 20132 Milan; and ⁶International Center for the Assessment of Nutritional Status, and ⁷Faculty of Exercise Sciences, Università degli Studi di Milano, 20100 Milan, Italy

Submitted 19 June 2003 ; accepted in final form 19 August 2003

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 intramyocellular lipid (IMCL) content 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 also associated with the severity of insulin resistance in T1DM. We studied 18 patients with T1DM, 7 older and overweight/obese patients with T2DM, and 15 nondiabetic, insulin-resistant offspring of T2DM 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 [6,6-²H₂]glucose and ¹H magnetic resonance 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 ml · kg^–1 · min^–1) similar to OFF (5.3 ± 0.4 ml · kg^–1 · min^–1) compared with NOR (8.5 ± 0.5 ml · kg^–1 · min^–1, P < 0.001). Soleus IMCL content was increased in T1DM (112 ± 15 AU), T2DM (108 ± 10 AU) and OFF (82 ± 13 AU) compared with NOR (52 ± 7 AU, P < 0.05) and the result was inversely proportional to the MCR (R² = 0.27, P < 0.001); an association between IMCL content and Hb A_1c 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, 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 to the reduced levels found in patients with T2DM and in OFF, demonstrated that the relationship of adiponectin to insulin resistance in humans is still unclear.

intramyocellular triglyceride content; leptin; magnetic resonance spectroscopy

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