Defective regulation of gene expression may be involved in the pathogenesis of type 2 diabetes. We have characterized the concerted regulation by insulin (3-h hyperinsulinemic clamp) of the expression of 10 genes related to insulin action in skeletal muscle and in subcutaneous adipose tissue, and we have verified whether a defective regulation of some of them could be specifically encountered in tissues of type 2 diabetic patients. Basal mRNA levels (determined by reverse transcriptase-competitive polymerase chain reaction) of insulin receptor, insulin receptor substrate-1, p85␣ phosphatidylinositol 3-kinase (PI3K), p110␣PI3K, p110PI3K, GLUT4, glycogen synthase, and sterol regulatory-element-binding protein-1c (SREBP-1c) were similar in muscle of control (n ؍ 17), type 2 diabetic (n ؍ 9), type 1 diabetic (n ؍ 9), and nondiabetic obese (n ؍ 9) subjects. In muscle, the expression of hexokinase II was decreased in type 2 diabetic patients (P < 0.01). In adipose tissue, SREBP-1c (P < 0.01) mRNA expression was reduced in obese (nondiabetic and type 2 diabetic) subjects and was negatively correlated with the BMI of the subjects (r ؍ ؊0.63, P ؍ 0.02). Insulin (؎1,000 pmol/l) induced a two-to threefold increase (P < 0.05) in hexokinase II, p85␣PI3K, and SREBP-1c mRNA levels in muscle and in adipose tissue in control subjects, in insulin-resistant nondiabetic obese patients, and in hyperglycemic type 1 diabetic subjects. Upregulation of these genes was completely blunted in type 2 diabetic patients. This study thus provides evidence for a specific defect in the regulation of a group of important genes in response to insulin in peripheral tissues of type 2 diabetic patients. Diabetes 50: 1134 -1142, 2001 I nsulin resistance is the main metabolic feature of type 2 diabetes (1,2), and several studies indicate that it generally precedes the onset of the disease (2,3). In vivo, skeletal muscle is the major site for insulin-dependent glucose disposal, and type 2 diabetic patients are characterized by a marked decrease in insulinstimulated glucose utilization in muscle mainly due to reduced glucose uptake and storage (1,2). Insulin stimulates glucose uptake by increasing the translocation of GLUT4-containing vesicles to the plasma membrane and by modifying the activity of enzymes involved in glucose metabolism (4). Insulin action is initiated by binding of the hormone to cell membranes and activation of the insulin receptor tyrosine kinase that results in the stimulation of intracellular signaling cascades (4). Among these cascades, the phosphatidylinositol 3-kinase (PI3K) pathway is thought to play a crucial role in the effects of insulin on glucose metabolism (5). Several defects in the insulin signaling pathways have been identified in skeletal muscle of type 2 diabetic patients. Impaired phosphorylation of insulin receptor and insulin receptor substrate (IRS)-1 in response to insulin has been reported (6 -8), and the induction of PI3K and Akt kinase activities have been found to be reduced (8 -10). The stimulat...