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Cited by 188Pancreatic function and diabetesDiabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic Diseases

Insulin Sensitivity and Insulin Binding to Monocytes in Maturity-Onset Diabetes

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Defronzo, Ralph, Deibert, David, Hendler, Rosa, Felig, Philip, Soman, Vijay·1979·Journal of Clinical Investigation
DOI 10.1172/jci109394PMC PMC372035
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Abstract

Tissue sensitive to insulin and insulin binding to monocytes were evaluated in 15 nonobese maturity-onset diabetics and in 16 healthy controls. Insulin sensitivity was determined by the insulin clamp technique in which the plasma insulin is acutely raised and maintained 100 muU/ml above the fasting level and plasma glucose is held constant at fasting levels by a variable glucose infusion. The amount of glucose infused is a measure of overall tissue sensitivity to insulin. In the diabetic group, the fasting plasma glucose concentration (168+/-4 mg/dl) was 85% greater than controls (P < 0.01) whereas the plasma insulin level (15+/-1 muU/ml) was similar to controls. During the insulin clamp study, comparable plasma insulin levels were achieved in the diabetics (118+/-5) and the controls (114+/-5 muU/ml). However, the glucose infusion rate in the diabetics (4.7+/-0.4 mg/kg.min) was 30% below controls (P < 0.01). Among the diabetics, the glucose infusion rate correlated directly with the fasting plasma glucose level (r = 0.57, P < 0.05). In five diabetic subjects, glucose metabolism was similar to controls, and these diabetics had the highest fasting glucose levels. When they were restudied after prior normalization (with insulin) of the fasting plasma glucose (100+/-1 mg/dl), the glucose infusion rate during the insulin clamp was 30% lower than observed in association with hyperglycemia (P < 0.01). Studies that employed tritiated glucose to measure endogenous glucose production indicated comparable 90-95% inhibition of hepatic glucose production during hyperinsulinemia in the diabetic and control subjects.(125)I-insulin binding to monocytes in the diabetics (5.5+/-0.6%) was 30% below that in controls (P < 0.01). Insulin binding to monocytes and insulin action as determined with the insulin clamp were highly correlated in both control (r = 0.67, P < 0.01), and diabetic subjects (r = 0.88, P < 0.001). We conclude that (a) tissue sensitivity to physiologic hyperinsulinemia is reduced in most maturity-onset diabetics; (b) this decrease in sensitivity is located, at least in part, in extrahepatic tissues; (c) the resistance to insulin may be mediated by a reduction in insulin binding; and (d) in maturity-onset diabetics with normal tissue sensitivity to insulin, hyperglycemia may be a contributing factor to the normal rates of insulin-mediated glucose uptake.

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  • Using the euglycaemic hyperinsulinaemic clamp, lean and obese type 2 diabetic subjects show a greater than 50% decrease in whole-body glucose disposal during insulin infusion.

    “Using the gold standard euglycemic hyperinsulinemic clamp technique to quantify insulin-stimulated glucose uptake, they demonstrated that both lean and obese T2DM subjects have marked decrease (>50%) in whole body glucose disposal during the insulin clamp.”

    From Pathogenesis of insulin resistance in skeletal muscle (2010) · cites this paper as [27]

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Related

Authors
Defronzo, R., Deibert, D., Hendler, R., Felig, P., & Soman, V.
Affiliations
Yale University (US)
ORCID
Defronzo, Ralph
Venue
Journal of Clinical Investigation
Publisher
American Society for Clinical Investigation
Published
1979-05-01
Volume
63
Issue
5
Pages
939-946
ISSN
0021-9738 (ISSN-L)
DOI
10.1172/jci109394
PMC
PMC372035
OpenAlex
W2145525161
Cited by
188
References
37
Citations by year
2024: 2 · 2023: 2 · 2022: 1 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 5 · 2014: 1 · 2013: 2 · 2012: 2
FWCI
27.02
Type
journal article
Language
en
Status
Retracted
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Diabetes Association
  • National Institutes of Health (5r01am013526-16, 5r01am024092-06)
Topics
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
maturity-onset diabetes, type 2 diabetes, insulin sensitivity, insulin binding, monocytes, hyperinsulinemic-euglycemic clamp, hepatic glucose production, hyperglycemia, insulin resistance, glucose infusion
MeSH terms
Adult, Aged, Blood Glucose, Diabetes Mellitus, Female, Glucose, Humans, Infusions, Parenteral, Insulin, Insulin Resistance, Male, Middle Aged, Monocytes, Receptor, Insulin

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