The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia.
BACKGROUND
Predictive equations have been reported to overestimate resting energy expenditure (REE) for obese persons. The presence of hyperglycemia results in elevated REE in obese persons with type 2 diabetes, and its effect on the validity of these equations is unknown.


OBJECTIVE
We tested whether (1) indicators of diabetes control were independent associates of REE in type 2 diabetes and (2) their inclusion would improve predictive equations.


METHODS
A cross-sectional study of 65 (25 men, 40 women) obese type 2 diabetic subjects. Variables measured were: REE by ventilated-hood indirect calorimetry, body composition by bioimpedance analysis, body circumferences, fasting plasma glucose (FPG) and hemoglobin A(1c). Data were analyzed using stepwise multiple linear regression.


RESULTS
REE, corrected for weight, fat-free mass, age and gender, was significantly greater with FPG>10 mmol/l (P=0.017) and correlated with FPG (P=0.013) and hemoglobin A(1c) as percentage upper limit of normal (P=0.02). Weight was the main determinant of REE. Together with hip circumference and FPG, it explained 81% of the variation. FPG improved the predictability of the equation by >3%. With poor glycemic control, it can represent an increase in REE of up to 8%.


CONCLUSIONS
Our data indicate that in a population of obese subjects with type 2 diabetes mellitus, REE is better predicted when fasting plasma glucose is included as a variable.
Gougeon
R
R
McGill Nutrition and Food Science Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.
Lamarche
M
M
Yale
J-F
JF
Venuta
T
T
D000328:Adult; D000368:Aged; D001481:Basal Metabolism; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D002153:Calorimetry, Indirect; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D017097:Electric Impedance; D004734:Energy Metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009765:Obesity; D011237:Predictive Value of Tests
D001786:Blood Glucose; D006442:Glycated Hemoglobin