title: Multitissue insulin resistance despite near-normoglycemic remission in Africans with ketosis-prone diabetes.
abstract: OBJECTIVE
  To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during remission.
  
  
  METHODS
  At Saint-Louis Hospital, Paris, France, 15 African patients with KPD with an average 10.5-month insulin-free near-normoglycemic remission period (mean A1C 6.2%) were compared with 17 control subjects matched for age, sex, BMI, and geographical origin. Insulin stimulation of glucose disposal, and insulin suppression of endogenous glucose production (EGP) and nonesterified fatty acids (NEFAs), was studied using a 200-min two-step (10 mU x m(-2) body surface x min(-1) and 80 mU x m(-2) x min (-1) insulin infusion rates) euglycemic clamp with [6,6-(2)H(2)]glucose as the tracer. Early-phase insulin secretion was determined during an oral glucose tolerance test.
  
  
  RESULTS
  The total glucose disposal was reduced in patients compared with control subjects (7.5 +/- 0.8 [mean +/- SE] vs. 10.5 +/- 0.9 mg x kg(-1) x min(-1); P = 0.018). EGP rate was higher in patients than control subjects at baseline (4.0 +/- 0.3 vs. 3.0 +/- 0.1 mg x kg(-1) x min(-1); P = 0.001) and after 200-min insulin infusion (10 mU x m(-2) x min(-1): 1.6 +/- 0.2 vs. 0.6 +/- 0.1, P = 0.004; 80 mU x m(-2) x min(-1): 0.3 +/- 0.1 vs. 0 mg x kg(-1) x min(-1), P = 0.007). Basal plasma NEFA concentrations were also higher in patients (1,936.7 +/- 161.4 vs. 1,230.0 +/- 174.1 micromol/l; P = 0.002) and remained higher after 100-min 10 mU x m(-2) x min(-1) insulin infusion (706.6 +/- 96.5 vs. 381.6 +/- 55.9 micromol/l; P = 0.015).
  
  
  CONCLUSIONS
  The triad hepatic, adipose tissue, and skeletal muscle insulin resistance is observed in patients with KPD during near-normoglycemic remission, suggesting that KPD is a form of type 2 diabetes.
authors.affiliation: Department of Diabetes and Endocrinology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris 7, Paris, France.
authors.forename: Simeon-Pierre
authors.initials: SP
authors.lastname: Choukem
authors.forename: Eugene
authors.initials: E
authors.lastname: Sobngwi
authors.forename: Lila-Sabrina
authors.initials: LS
authors.lastname: Fetita
authors.forename: Philippe
authors.initials: P
authors.lastname: Boudou
authors.forename: Eric
authors.initials: E
authors.lastname: De Kerviler
authors.forename: Yves
authors.initials: Y
authors.lastname: Boirie
authors.forename: Isabelle
authors.initials: I
authors.lastname: Hainault
authors.forename: Patrick
authors.initials: P
authors.lastname: Vexiau
authors.forename: Franck
authors.initials: F
authors.lastname: Mauvais-Jarvis
authors.forename: Fabien
authors.initials: F
authors.lastname: Calvo
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gautier
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000378:metabolism / Q000473:pathology; D000328:Adult; D044383:Black People; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000378:metabolism / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000208:ethnology* / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism / Q000473:pathology; D012074:Remission Induction