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Liver Fat Content and Hepatic Insulin Sensitivity in Overweight Patients With Type 1 Diabetes

På svenska

Author

  • Gemma Llaurado
  • Ksenia Sevastianova
  • Sanja Sadevirta
  • Antti Hakkarainen
  • Nina Lundbom
  • Marju Orho-Melander
  • Per-Henrik Groop
  • Carol Forsblom
  • Hannele Yki-Jarvinen

Summary, in English

Objectives: Patients with type 1 diabetes mellitus (T1DM) lack the portal/peripheral insulin gradient, which might diminish insulin stimulation of hepatic lipogenesis and protect against development of nonalcoholic fatty liver disease (NAFLD). We compared liver fat content and insulin sensitivity of hepatic glucose production and lipolysis between overweight T1DM patients and nondiabetic subjects. Materials and Methods: We compared 32 overweight adult T1DM patients and 32 nondiabetic subjects matched for age, body mass index (BMI), and gender. Liver fat content was measured using proton magnetic resonance spectroscopy (H-1-MRS), body composition by magnetic resonance imaging, and insulin sensitivity using the euglycemic-hyperinsulinemic clamp technique (insulin 0.4 mU/kg.min combined with infusion of D-[3-H-3] glucose). We also hypothesized that low liver fat might protect from obesity-associated increases in insulin requirements and, therefore, determined insulin requirements across BMI categories in 3164 T1DM patients. Results: Liver fat content was significantly lower in T1DM patients than in nondiabetic subjects (0.6% [25th-75th quartiles, 0.3%-1.1%] vs 9.0% [ 3.0%-18.0%]; P<.001). The endogenous rate of glucose production (R-a) during euglycemic hyperinsulinemia was significantly lower (0.4 [-0.7 to 0.8] mg/kg fat-free mass.min vs 0.9 [0.2-1.6] fat-free mass.min; P=.012) and the percent suppression of endogenous R-a by insulin was significantly greater (89% [78%-112%] vs 77% [50%-94%]; p=.009) in T1DM patients than in nondiabetic subjects. Serum nonesterified fatty acid concentrations during euglycemic hyperinsulinemia were significantly lower (78.5 [33.0-155.0] vs 306 [200.0-438.0] mu mol/L; P<.001) and the percent suppression of nonesterified fatty acids significantly higher (89.1% [78.6%-93.3%] vs 51.4% [36.5%-71.1%]; P<.001) in T1DM patients than in nondiabetic subjects. Insulin doses were similar across BMI categories. Conclusions: T1DM patients might be protected from steatosis and hepatic insulin resistance. Obesity may not increase insulin requirements in T1DM.

Publishing year

2015

Language

English

Pages

607-616

Publication/Series

Journal of Clinical Endocrinology and Metabolism

Volume

100

Issue

2

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Endocrinology and Diabetes

Status

Published

Research group

  • Diabetes - Cardiovascular Disease

ISBN/ISSN/Other

  • ISSN: 1945-7197