Severe insulin-resistant diabetes mellitus in patients with congenital muscle fiber type disproportion myopathy
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Severe insulin-resistant diabetes mellitus in patients with congenital muscle fiber type disproportion myopathy. / Vestergaard, H.; Klein, H. H.; Hansen, T.; Müller, J.; Skovby, F.; Bjørbaek, C.; Røder, M. E.; Pedersen, O.
I: The Journal of Clinical Investigation, Bind 95, Nr. 4, 1995, s. 1925-1932.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Severe insulin-resistant diabetes mellitus in patients with congenital muscle fiber type disproportion myopathy
AU - Vestergaard, H.
AU - Klein, H. H.
AU - Hansen, T.
AU - Müller, J.
AU - Skovby, F.
AU - Bjørbaek, C.
AU - Røder, M. E.
AU - Pedersen, O
PY - 1995
Y1 - 1995
N2 - Congenital muscle fiber type disproportion myopathy (CFTDM) is a chronic, nonprogressive muscle disorder characterized by universal muscle hypotrophy and growth retardation. Histomorphometric examination of muscle shows a preponderance of smaller than normal type 1 fibers and overall fiber size heterogeneity. Concomitant endocrine dysfunctions have not been described. We report the findings of altered insulin secretion and insulin action in two brothers affected with CFTDM and glucose intolerance as well as in their nonconsanguineous glucose-tolerant parents. Results are compared with those of six normoglycemic control subjects. All study participants underwent an oral glucose tolerance test to estimate insulin secretion. The oldest boy and his parents volunteered for studies of whole-body insulin sensitivity consisting of a 4-h euglycemic hyperinsulinemic clamp in combination with indirect calorimetry. Insulin receptor function and glycogen synthase (GS) activity and expression were examined in biopsies of vastus lateralis muscle. Despite a 45-90-fold increase in both fasting and postprandial serum insulin levels, both CFTDM patients had diabetes mellitus. Clamp studies revealed that the oldest boy had severe insulin resistance of both liver and peripheral tissues. The impaired insulin-stimulated glucose disposal to peripheral tissues was primarily due to reduced nonoxidative glucose metabolism. These changes were paralleled by reduced basal values of muscle GS total activity, allosterical activation of GS by glucose-6-phosphate, GS protein, and GS mRNA. The father expressed a lesser degree of insulin resistance, and studies of muscle insulin receptor function showed a severe impairment of receptor kinase activity. In conclusion, CFTDM is a novel form of severe hyperinsulinemia and insulin resistance. Whether insulin resistance is causally related to the muscle disorder awaits to be clarified.
AB - Congenital muscle fiber type disproportion myopathy (CFTDM) is a chronic, nonprogressive muscle disorder characterized by universal muscle hypotrophy and growth retardation. Histomorphometric examination of muscle shows a preponderance of smaller than normal type 1 fibers and overall fiber size heterogeneity. Concomitant endocrine dysfunctions have not been described. We report the findings of altered insulin secretion and insulin action in two brothers affected with CFTDM and glucose intolerance as well as in their nonconsanguineous glucose-tolerant parents. Results are compared with those of six normoglycemic control subjects. All study participants underwent an oral glucose tolerance test to estimate insulin secretion. The oldest boy and his parents volunteered for studies of whole-body insulin sensitivity consisting of a 4-h euglycemic hyperinsulinemic clamp in combination with indirect calorimetry. Insulin receptor function and glycogen synthase (GS) activity and expression were examined in biopsies of vastus lateralis muscle. Despite a 45-90-fold increase in both fasting and postprandial serum insulin levels, both CFTDM patients had diabetes mellitus. Clamp studies revealed that the oldest boy had severe insulin resistance of both liver and peripheral tissues. The impaired insulin-stimulated glucose disposal to peripheral tissues was primarily due to reduced nonoxidative glucose metabolism. These changes were paralleled by reduced basal values of muscle GS total activity, allosterical activation of GS by glucose-6-phosphate, GS protein, and GS mRNA. The father expressed a lesser degree of insulin resistance, and studies of muscle insulin receptor function showed a severe impairment of receptor kinase activity. In conclusion, CFTDM is a novel form of severe hyperinsulinemia and insulin resistance. Whether insulin resistance is causally related to the muscle disorder awaits to be clarified.
KW - Adolescent
KW - Adult
KW - Base Sequence
KW - Blood Glucose
KW - C-Peptide
KW - Child
KW - Diabetes Complications
KW - Female
KW - Glucose
KW - Glucose Clamp Technique
KW - Glucose Tolerance Test
KW - Humans
KW - Insulin
KW - Insulin Resistance
KW - Lipid Metabolism
KW - Male
KW - Molecular Sequence Data
KW - Muscle Fibers, Skeletal
KW - Muscles
KW - Muscular Diseases
KW - Oxidation-Reduction
KW - Proinsulin
U2 - 10.1172/JCI117874
DO - 10.1172/JCI117874
M3 - Journal article
C2 - 7706500
VL - 95
SP - 1925
EP - 1932
JO - Journal of Clinical Investigation
JF - Journal of Clinical Investigation
SN - 0021-9738
IS - 4
ER -
ID: 92193477