Substrate source utilisation in long-term diagnosed type 2 diabetes patients at rest, and during exercise and subsequent recovery

Abstract

Aims/hypothesis: Disturbances in substrate source metabolism and, more particularly, in fatty acid metabolism, play an important role in the aetiology and progression of type 2 diabetes. However, data on substrate source utilisation in type 2 diabetes are inconclusive. Methods: [U- 13C]palmitate and [6,6-2H2]glucose tracers were used to assess plasma NEFA and glucose oxidation rates and to estimate the use of muscle- and/or lipoprotein-derived triacylglycerol and muscle glycogen. Subjects were ten male patients who had a long-term (7 ± 1 years) diagnosis of type 2 diabetes and were overweight, and ten matched healthy, male control subjects. Muscle biopsy samples were collected before and after exercise to assess muscle fibre type-specific intramyocellular lipid and glycogen content. Results: At rest and during exercise, the diabetes patients had greater values than the controls for palmitate rate of appearance (Ra) (rest, 2.46 ± 0.18 and 1.85 ± 0.20 respectively; exercise, 3.71 ± 0.36 and 2.84 ± 0.20 μmol kg-1 min-1) and rate of disappearance (Rd) (rest, 2.45 ± 0.18 and 1.83 ± 0.20; exercise, 3.64 ± 0.35 and 2.80 ± 0.20 μmol kg-1 min -1 respectively). This was accompanied by significantly higher fat oxidation rates at rest and during recovery in the diabetes patients (rest, 0.11 ± 0.01 in diabetes patients and 0.09 ± 0.01 in controls; recovery, 0.13 ± 0.01 and 0.11 ± 0.01 g/min respectively), despite significantly greater plasma glucose Ra, Rd and circulating plasma glucose concentrations. Furthermore, exercise significantly lowered plasma glucose concentrations in the diabetes patients, as a result of increased blood glucose disposal. Conclusion: This study demonstrates that substrate source utilisation in long-term-diagnosed type 2 diabetes patients, in whom compensatory hyperinsulinaemia is no longer present, shifts towards an increase in whole-body fat oxidation rate and is accompanied by disturbances in fat and carbohydrate handling. © 2006 Springer-Verlag.