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Reduced Skeletal Muscle Oxygen Uptake and Reduced ß-Cell Function

Two early abnormalities in normal glucose-tolerant offspring of patients with type 2 diabetes

¹ Department of Endocrinology and Metabolism, Eberhard-Karls-University, Tübingen, Germany
² Center of Internal Medicine, Department of Rehabilitative & Preventive Sports Medicine, University of Freiburg, Freiburg, Germany
³ Deutsche Klinik für Diagnostik, Wiesbaden, Germany

Address correspondence and reprint requests to PD Dr. med. Andreas Fritsche, Medizinische Universitätsklinik, Otfried-Müller-Str. 10, D-72076 Tübingen, Germany. E-mail: andreas.fritsche{at}med.uni-tuebingen.de.

OBJECTIVE—Studies on insulin sensitivity and insulin secretion in subjects with a familial predisposition for type 2 diabetes mellitus (T2DM) traditionally produce inconsistent results. This may be due to small sample size, subject selection, matching procedures, and perhaps lack of a measure of physical fitness.

RESEARCH DESIGN AND METHODS—In the present study, we specifically tested the hypothesis that a family history of T2DM is associated with reduced VO_2max, measured by incremental bicycle ergometry, independent of insulin sensitivity estimated from an oral glucose tolerance test (OGTT; n = 424) and measured by a euglycemic-hyperinsulinemic clamp (n = 185). Subjects included in the study were young (34 ± 10 years), healthy, and normal glucose tolerant with either a first-degree relative (FDR) with T2DM (n = 183), a second-degree relative with T2DM (n = 94), or no family history of T2DM (control subjects, n = 147). BMI, percent body fat, waist-to-hip ratio (WHR), and habitual physical activity (HPA; standard questionnaire) were comparable among groups. FDRs had significantly lower VO_2max than control subjects: 40.5 ± 0.6 vs. 45.2 ± 0.9 ml O₂/kg lean body mass, P = 0.01 after adjusting for sex, age, BMI, HPA, and insulin sensitivity (euglycemic-hyperinsulinemic clamp).

RESULTS—BMI, percent body fat, waist-to-hip ratio (WHR), and habitual physical activity (HPA; standard questionnaire) were comparable among groups. FDRs had significantly lower VO_2max than control subjects: 40.5 ± 0.6 vs. 45.2 ± 0.9 ml O₂/kg lean body mass, P = 0.01 after adjusting for sex, age, BMI, HPA, and insulin sensitivity (euglycemic-hyperinsulinemic clamp). Insulin sensitivity per se was not affected by family history of T2DM after adjusting for age, sex, BMI, and percent body fat (P = 0.76). The appropriateness of ß-cell function for the individual insulin sensitivity (disposition index: product of a validated secretion parameter [OGTT] and sensitivity [clamp]) was significantly lower in FDRs (87 ± 4 units) versus control subjects (104 ± 6 units, P = 0.02 after adjusting for sex, age, and BMI). Analyses of the larger OGTT group produced essentially the same results.

CONCLUSIONS—In conclusion, these data are compatible with the hypothesis that familial predisposition for T2DM impairs maximal oxygen consumption in skeletal muscle. Because habitual physical activity was not different, genetic factors may be involved. Conceivably, reduced VO_2max precedes skeletal muscle insulin resistance, providing a partial explanation for discrepancies in the literature.

Abbreviations: FDR, first-degree relative • FHD, family history of diabetes • GIR, glucose infusion rate • HPA, habitual physical activity • ISI, insulin sensitivity index • OGTT, oral glucose tolerance test • T2DM, type 2 diabetes mellitus • WHR, waist-to-hip ratio

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