These authors contributed equally to this work.
Insulin resistance in multiple tissues in patients with type 1 diabetes mellitus on long-term continuous subcutaneous insulin infusion therapy
Version of Record online: 8 JAN 2013
Copyright © 2012 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews
Volume 29, Issue 1, pages 33–38, January 2013
How to Cite
Donga, E., van Dijk, M., Hoogma, R. P. .L. M., Corssmit, E. P. M. and Romijn, J. A. (2013), Insulin resistance in multiple tissues in patients with type 1 diabetes mellitus on long-term continuous subcutaneous insulin infusion therapy. Diabetes Metab. Res. Rev., 29: 33–38. doi: 10.1002/dmrr.2343
- Issue online: 8 JAN 2013
- Version of Record online: 8 JAN 2013
- Accepted manuscript online: 30 AUG 2012 10:12AM EST
- Manuscript Revised: 1 AUG 2012
- Manuscript Accepted: 1 AUG 2012
- Manuscript Received: 14 OCT 2011
- insulin resistance;
- clamp study;
- insulin pump therapy
The aim of this study was to determine whether insulin resistance is present in lean patients with uncomplicated type 1 diabetes mellitus on long-term continuous subcutaneous insulin infusion (CSII), compared with matched healthy controls.
We studied eight patients (four men and four women) with type 1 diabetes mellitus on continuous subcutaneous insulin infusion and eight healthy controls, matched for age, gender and body mass index. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp studies with infusion of [6,6-2H2] glucose.
Endogenous glucose production did not differ in the basal state between patients and controls. However, endogenous glucose production was less suppressed during clamp conditions in patients compared with controls (64% vs 79%, p = 0.01), indicating decreased hepatic insulin sensitivity. During the clamp study, glucose disposal rate was ~38% lower in patients compared with controls (24.4 ± 2.5 vs 39.7 ± 5.6 µmol/kgLBM/min, p = 0.04). Accordingly, the rate of infusion of glucose was ~51% lower in patients (17.7 ± 2.8 vs 39.7 ± 5.7 µmol/kgLBM/min, p = 0.02). Finally, non-esterified fatty acids levels were ~2.5 times higher in patients during steady state clamp conditions (150 ± 26 vs 58 ± 4 pmol/L, p = 0.01), reflecting decreased insulin sensitivity of lipolysis.
Insulin resistance is a prominent feature of lean patients with type 1 diabetes mellitus, despite long term and stable treatment with continuous subcutaneous insulin infusion. Insulin resistance in type 1 diabetes involves both lipolysis, hepatic and peripheral glucose metabolism. Copyright © 2012 John Wiley & Sons, Ltd.