Reduction in Global Myocardial Glucose Metabolism in Subjects With 1-Hour Postload Hyperglycemia and Impaired Glucose Tolerance.

Objective: Impaired insulin-stimulated myocardial glucose uptake has occurred in patients with type 2 diabetes with or without coronary artery disease. Whether cardiac insulin resistance is present remains uncertain in subjects at risk for type 2 diabetes, such as individuals with impaired glucose tolerance (IGT) or those with normal glucose tolerance (NGT) and 1-h postload glucose ≥155 mg/dL during an oral glucose tolerance test (NGT 1-h high). This issue was examined in this study.

Research Design And Methods: The myocardial metabolic rate of glucose (MRGlu) was measured by using dynamic F-fluorodeoxyglucose positron emission tomography combined with a euglycemic-hyperinsulinemic clamp in 30 volunteers without coronary artery disease. Three groups were studied: ) those with 1-h postload glucose <155 mg/dL (NGT 1-h low) ( = 10), ) those with NGT 1-h high ( = 10), ) and those with IGT ( = 10).

Results: After adjusting for age, sex, and BMI, both subjects with NGT 1-h high (23.7 ± 6.4 mmol/min/100 mg; = 0.024) and those with IGT (16.4 ± 6.0 mmol/min/100 mg; < 0.0001) exhibited a significant reduction in global myocardial MRGlu; this value was 32.8 ± 9.7 mmol/min/100 mg in subjects with NGT 1-h low. Univariate correlations showed that MRGlu was positively correlated with insulin-stimulated whole-body glucose disposal ( = 0.441; = 0.019) and negatively correlated with 1-h ( = -0.422; = 0.025) and 2-h ( = -0.374; = 0.05) postload glucose levels, but not with fasting glucose.

Conclusions: This study shows that myocardial insulin resistance is an early defect that is already detectable in individuals with dysglycemic conditions associated with an increased risk of type 2 diabetes, such as IGT and NGT 1-h high.