The role of plasma fatty acid composition in endogenous glucose production in patients with type 2 diabetes mellitus

Hepatic insulin resistance and increased endogenous glucose production (EGP) are associated with increased plasma free fatty acids (FFA). However, the contribution of FFA composition to the regulation of EGP is not known. Six obese nondiabetic subjects and 6 patients with type 2 diabetes mellitus (DM2) were studied after an overnight and a 3-day fast. Plasma insulin concentrations after an overnight fast were similar in the DM2 and nondiabetic patients (88.8 [plusmn] 26.4 v 57.6 [plusmn] 12.6 pmol/L, not significant [NS]) despite increased plasma glucose (9.9 [plusmn] 1.8 v 5.1 [plusmn] 0.1 mmol/L, P [lt ] .01) and EGP (510.3 [plusmn] 77.7 v 298.3 [plusmn] 18.3 [mu ]mol [middot] m^{[minus ]-2} [middot] min^{[minus ]1}, P [lt ] .05) in the patients with DM2. Absolute rates of gluconeogenesis using the heavy water method were also increased in the patients with DM2 (346.8 [plusmn] 74.9 v 198.8 [plusmn] 16.4 [mu ]mol [middot] m^{[minus ]2} [middot] min^{[minus ]1}, P [lt ] .05). No differences were observed in plasma polyunsaturated fatty acids (PUFA) between the diabetic and nondiabetic subjects. However, total saturated fatty acid (SFA) concentrations (350 [plusmn] 37.4 v 230.9 [plusmn] 33.3 [mu ]mol/L, P [lt ] .02) were significantly increased in the diabetic subjects. Rates of EGP were correlated with total plasma FFA concentration (r = .71, P [lt ] .01) and the concentration of SFA (r = .71, P [lt ] .01), but not monounsaturated fatty acids or PUFA. Rates of gluconeogenesis were also correlated with plasma FFA (r = .64, P [lt ] .05) and SFA (r = .67, P [lt ] .05). We observed no relationship between EGP and either total FFA or fatty acid composition after a 3-day fast. We conclude that increases in EGP are associated with concentrations of plasma SFA after an overnight fast.