(Circulation. 2001;103:1734.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Non–Insulin-Dependent Diabetes Mellitus on Myocardial Insulin Responsiveness in Patients With Ischemic Heart Disease
From the Section of Cardiovascular Medicine, VA Connecticut Healthcare System and Yale University School of Medicine, New Haven, Connecticut.
Correspondence to Patrick H. McNulty, MD, Section of Cardiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, MC H047, PO Box 850, Hershey PA 17033. E-mail pmcnulty{at}psu.edu
Background—Patients with non–insulin-dependent diabetes mellitus (NIDDM) exhibit poor clinical outcomes from myocardial ischemia. This may reflect an impairment in their cardiac insulin-response system.
Methods and Results—We
used AV balance and intracoronary infusion techniques to compare the
intrinsic cardiac responsiveness to insulin in 26 coronary disease
patients with (n=13) and without (n=13) NIDDM. During fasting, NIDDM
hearts demonstrated lower fractional extraction of glucose from
arterial plasma than controls (1.0±0.5% versus 2.1±0.5%,
P<0.05) despite higher
circulating insulin levels (26±5 versus 13±4 µU · mL,
P<0.05). This was compensated
for by higher circulating glucose levels, so that net cardiac glucose
uptake in the 2 groups was equivalent (5.2±1.1 versus 5.3±1.1 µmol
· min). Intracoronary insulin infusion produced an 
3-fold increase
in fractional extraction and net uptake of glucose across the heart in
both groups (to 3.7±0.4% and 18.3±3.5 µmol · min in NIDDM and to
5.4±0.7% and 17.7±4.3 µmol · min in controls) accompanied by an
30% increase in net lactate uptake, suggesting preserved insulin
action on both glucose uptake and glucose oxidation in the NIDDM heart.
In nondiabetics, insulin consistently increased coronary blood flow,
but this effect was absent in NIDDM.
Conclusions—In contrast to their peripheral tissues and coronary vasculature, the myocardium of patients with NIDDM expresses a competent insulin-response system with respect to glucose metabolism. This suggests that insulin resistance is mediated at the level of individual organs and that different mechanisms are involved in muscle and vascular tissue.
Key Words: diabetes mellitus • myocardium • insulin • arteries
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