Evidence of increased systemic glucose production and gluconeogenesis in an early stage of NIDDM

• Published in: Diabetes (New York, N.Y.) Vol. 46; no. 6; pp. 1010 - 1016
• Main Authors: Perriello, G., Pampanelli, S., Del Sindaco, P., Lalli, C., Ciofetta, M., Volpi, E., Santeusanio, F., Brunetti, P., Bolli, G. B.
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01-06-1997
• ISSN: 0012-1797; 1939-327X; 0012-1797
• DOI: 10.2337/diabetes.46.6.1010

Evidence of increased systemic glucose production and gluconeogenesis in an early stage of NIDDM.
G Perriello ,
S Pampanelli ,
P Del Sindaco ,
C Lalli ,
M Ciofetta ,
E Volpi ,
F Santeusanio ,
P Brunetti and
G B Bolli
Dipartimento di Medicina Interna e Scienze Endocrine e Metaboliche, Università di Perugia, Italy.
Abstract
To assess the mechanisms of fasting hyperglycemia in NIDDM patients with mild elevation of fasting plasma glucose (FPG) compared
with NIDDM patients with overt hyperglycemia, we studied 29 patients with NIDDM, who were divided in two groups according
to their fasting plasma glucose (<7.8 and > or =7.8 mmol/l for groups A and B, respectively), and 16 control subjects who
were matched with NIDDM patients for age, sex, and body mass index. All subjects were infused with [3-3H]glucose between 10:00
P.M. and 10:00 A.M. during overnight fasting to determine glucose fluxes. In 27 subjects (17 diabetic and 10 control), [U-14C]alanine
was simultaneously infused between 4:00 A.M. and 10:00 A.M. to measure gluconeogenesis (GNG) from alanine. Arterialized-venous
plasma samples were collected every 30 min for measurement of glucose fluxes, GNG, and glucoregulatory hormones. In group
A, plasma glucose, rate of systemic glucose production (SGP), and GNG were greater than in control subjects (7.2 +/- 0.2 vs.
4.9 +/- 0.1 mmol/l, 10.9 +/- 0.2 vs. 9.5 +/- 0.3 micromol x kg(-1) x min(-1), and 0.58 +/- 0.04 vs. 0.37 +/- 0.02 micromol
x kg(-1) x min(-1), respectively, for group A and control subjects; mean value 8:00 A.M.-10:00 A.M., all P < 0.05). Both increased
SGP and GNG correlated with plasma glucose in all subjects (r = 0.77 and r = 0.75, respectively, P < 0.005). Plasma counterregulatory
hormones did not differ in NIDDM patients compared to control subjects. The present studies demonstrate that SGP and GNG are
increased in NIDDM patients without overt fasting hyperglycemia. Thus these metabolic abnormalities primarily contribute to
early development of overnight and fasting hyperglycemia in NIDDM.