Hepatic extraction of insulin is associated with insulin sensitivity in humans. It is unknown if a diurnal pattern of HE exists and if this differs between nondiabetic (ND) and type 2 diabetes (T2D) subjects. Here are data presented for 10 ND (BMI 29.4±1.3 kg/m2, age 57±3 yrs) and 9 T2D subjects (BMI 33±2 kg/m2, age 58±4 yrs, HbA1c 57±4 mM/mol) studied thus far. They ingested identical mixed meals (75 g carbs; 8 kcal/kg) at either breakfast (B), lunch (L) or dinner (D) in randomized Latin square order on three consecutive days with frequent sampling of plasma glucose (G), insulin (I) and C-peptide (C) concentrations. Fasting and post-meal glucose concentrations were higher while fasting and post-meal insulin, C-peptide concentrations were lower during meals in T2D as compared to ND subjects. Total and basal hepatic insulin extraction (HE and HEb, respectively) were estimated using the Oral Insulin and C-peptide Minimal Models. Differences with B, L and D and between ND and T2D were assessed by N-way ANOVA (a p-value<0.05 was considered statistically significant). Results show that both HE and HEb were significantly lower (p=0.009, p=0.011, respectively) throughout the day in T2D than ND subjects (Fig 1). Our initial results suggest an emerging diurnal pattern of HE in T2D subjects with D being lower than other meals. These observations provide novel insights into the diurnal pattern of hepatic extraction throughout the day in T2D subjects.


D. Romeres: None. Y.R. Yadav: None. F. Ruchi: None. C. Cobelli: None. C. Dalla Man: Research Support; Self; Sanofi-Aventis Deutschland GmbH. A. Basu: Consultant; Spouse/Partner; GENFIT. Research Support; Spouse/Partner; AstraZeneca. R. Basu: Consultant; Self; GENFIT. Research Support; Self; AstraZeneca.


National Institutes of Health (R01DK029953 to R.B.), (R01DK085516 to A.B.), (DK059637, DK020593)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.