Relationship Between Hepatic Glucose Production and Fasting Plasma Glucose Concentration in Patients With NIDDM

Abstract

This study was initiated to reevaluate the changes in basal hepatic glucose production (HGP) rate that occur in patients with non-insulin-dependent diabetes mellitus (NIDDM). Measurements were made in 51 volunteers: 18 with normal glucose tolerance and 33 with newly diagnosed NIDDM of varying degrees of severity. To avoid the methodological problems associated with quantifying HGP over short time periods, using non-steady-state isotopic kinetics, radiolabeled glucose was infused for a 12-h period, from 10 P.M. to 10 A.M. with HGP quantified from 9 to 10 A.M.. The results showed that fasting plasma glucose (FPG) concentration and HGP were significantly correlated (r = 0.68, P < 0.001) in patients with NIDDM. However, when the 33 patients with NIDDM were divided into three groups of 11 each on the basis of FPG concentration, it became clear that the relationship between FPG and HGP was complex. Thus, values for HGP in patients with NIDDM and FPG < 180 mg/dl were not higher than in the normal population (1.67 ± 0.07 vs. 1.69 ± 0.04 mg.kg−1 · min−1, NS). Significant increases (P < 0.01) in HGP above normal were seen in the 11 patients with NIDDM and FPG concentrations between 180 and 250 mg/dl (2.05 ± 0.07 mg.kg−1 · min−1), as well as in those with FPG > 250 mg/dl (2.18 ± 0.13 mg.kg−1 · min−1). Although those with the highest FPG concentrations tended to have the greatest values for HGP, the difference between the latter two groups of patients with NIDDM was not statistically significant. Finally, HGP rates in the 11 patients with FPG concentrations > 250 mg/dl were only 29% higher than values in the control population. These data indicate that HGP rates determined under steady-state isotopic conditions are not higher than normal until FPG concentration is >180 mg/dl, and that the increase in HGP is still relatively modest in magnitude (∼29%) in patients with the most severe degree of fasting hyperglycemia (FPG >250 mg/dl).