Effect of dietary energy restriction on glucose production and substrate utilization in type 2 diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 49; no. 10; pp. 1691 - 1699
• Main Authors: CHRISTIANSEN, Mark P, LINFOOT, Peter A, NEESE, Richard A, HELLERSTEIN, Marc K
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-10-2000
• Subjects: Associated diseases and complications; Biological and medical sciences; Blood Glucose - metabolism; Body Composition; Diabetes; Diabetes Mellitus - diet therapy; Diabetes Mellitus - metabolism; Diabetes Mellitus, Type 2 - diet therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes. Impaired glucose tolerance; Diet therapy; Diet, Reducing; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Energy; Energy Intake; Fasting; Fatty Acids, Nonesterified - blood; Female; Gluconeogenesis; Glucose; Glucose - biosynthesis; Glycerol - blood; Humans; Kinetics; Lipolysis; Male; Medical sciences; Metabolic Clearance Rate; Metabolism; Methods; Middle Aged; Obesity; Type 2 diabetes; Weight Loss; Endocrinopathy; Human; Obesity; Metabolic disorder; Association; Glucose; Mechanism of action; Metabolism; Non insulin dependent diabetes; Glycemia; Feeding; Low calorie diet
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/diabetes.49.10.1691

Effect of dietary energy restriction on glucose production and substrate utilization in type 2 diabetes.
M P Christiansen ,
P A Linfoot ,
R A Neese and
M K Hellerstein
Department of Medicine, University of California, San Francisco, USA.
Abstract
A total of 8 obese subjects with type 2 diabetes were studied while on a eucaloric diet and after reduced energy intake (25
and then 75% of requirements for 10 days each). Weight loss was 2, 3, and 3 kg after 5, 10, and 20 days, respectively; all
of the weight lost was body fat. Fasting blood glucose (FBG) levels fell from 11.9 +/- 1.4 at baseline to 8.9 +/- 1.6, 7.9
+/- 1.4, and 8.8 +/- 1.3 mmol/l at days 5, 10, and 20, respectively (P < 0.05, baseline vs. 5, 10, and 20 days). Endogenous
glucose production (EGP) was 22 +/- 2, 18 +/- 2, 17 +/- 2, and 22 +/- 2 pmol x kg(-1) lean body mass (LBM) x min(-1) (P <
0.05, days 5 and 10 vs. baseline). Gluconeogenesis measured by mass isotopomer distribution analysis provided 31 +/- 4, 41
+/- 5, 40 +/- 4, and 33 +/- 4%, respectively, of the EGP (NS); absolute glycogenolytic contribution to the EGP was 15 +/-
2, 11 +/- 2, 11 +/- 2, and 15 +/- 2 pmol x kg(-1) LBM x min(-1), respectively (P < 0.001, baseline vs. days 5 and 10 and day
10 vs. day 20). The blood glucose clearance rate increased significantly at day 20 (P < 0.05). Neither lipolysis nor flux
of plasma nonesterified fatty acids were altered compared with baseline. In conclusion, severe energy restriction per se independent
of major changes in body composition reduces both FBG concentration and EGP in type 2 diabetes, the reduction in EGP results
entirely from a reduction of glycogenolytic input into blood glucose, and the duration of reduced glycogenolysis is short-lived
after relaxation of energy restriction even without weight gain, but effects on plasma glucose clearance persist and partially
maintain the improvement in fasting glycemia.