Impact of endogenous and exogenous insulin on basal energy expenditure in patients with type 2 diabetes under standard treatment

Abstract

Background: Factors that affect resting energy expenditure or basal energy expenditure (BEE) in patients with type 2 diabetes under standard treatment have not been evaluated in detail. Objective: We determined the clinical factors that affected BEE in addition to body composition in patients with type 2 diabetes under standard treatment. Design: BEE was measured by using indirect calorimetry under a strict basal condition in 58 Japanese patients with type 2 diabetes after .7 d as inpatients under management of diabetes with medical nutrition therapy and medications. Insulin secretion was measured with a glucagon test. Stepwise regression was applied to explore determinants of BEE. Results: In the stepwise estimation, insulin secretion (P = 0.015), insulin therapy (P = 0.012), and pulse rate (P = 0.011) were selected in addition to fat-free mass (FFM) (P , 0.001) and fat mass (P = 0.006) as significant independent determinants of BEE. Standardized partial regression coefficients of the additional 3 factors were 20.16, 20.15, and 0.15, respectively, whereas those for FFM and fat mass were 0.82 and 0.19, respectively. The additional 3 factors explained another 3.9% of the variability of BEE, and the adjusted coefficient of determination was 83.4%. Age, sex, other medications, and parameters of glycemic control were not significant determinants beyond the combined contribution of body composition, endogenous and exogenous insulin, and pulse rate. Conclusion: Endogenous insulin secretion and exogenous insulin administered in treatment have significant independent effects in the lowering of BEE in patients with diabetes under standard management with medical nutrition therapy and medications.Am J Clin Nutr 2011;94:1513-8.

Basal metabolic rate in Brazilian patients with type 2 diabetes: comparison between measured and estimated values

“…In fact, the association of poor glycemic control with a high BMR, as evaluated by high A1c values, has already been demonstrated (22). In addition, the reduction of BMR has been negatively associated with both endogenous and exogenous insulin values, as demonstrated in a study conducted in 58 patients with type 2 diabetes (23).…”

Relationship of insulin dynamics to body composition and resting energy expenditure following weight loss

“…This relationship remained significant after adjustment for changes in body composition during the Run In diet ( Supporting Information Table). Notably, diet sequence order was a strong effect modifier of the relationship between insulin-30 and REE (standardized b 5 21.104, 10th-90th difference 2991 kcal day 21 when starting with high-carbohydrate diet, standardized b 5 20.883, 10th-90th difference 2793 kcal day 21 when starting with moderate-carbohydrate diet, and standardized b 5 20.269, 10th-90th difference 2241 kcal day 21 when starting with lowcarbohydrate diet, P 5 0.005 for effect modification, Figure 2). That is, consuming the low-carbohydrate diet first strongly attenuated the relationship between insulin-30 and REE.…”

“…Moreover, high endogenous insulin secretion arising from genetic variation (18), pancreatic tumor, hypothalamic damage, or other causes (19) is prospectively associated with weight gain, whereas drugs that inhibit insulin secretion attenuate weight gain (20). Indeed, among patients with type 2 diabetes receiving standard treatment, high insulin action may adversely affect energy expenditure (21). Therefore, we aimed to examine the associations of baseline insulin dynamics with changes in body composition during weight loss and changes in resting energy expenditure (REE) during weight loss maintenance.…”

Variable factors of total daily energy expenditure in humans

“…Ganpule et al 8) , using Japanese subjects, reported that fat-free mass (FFM) accounts for 82.2% of the variation in RMR, and fat mass (FM) accounts for 0.5%. Several other studies have also reported that FFM and FM account for more than 60% of the variation in RMR and SMR [9][10][11][12][13][14] . Furthermore, body composition can be separated into skeletal muscle, adipose, and organ tissues, such as liver, brain, heart, and kidneys.…”

“…As mentioned above, body size and body composition can explain a large part of RMR variation. Other factors for residual variation in RMR are thought to be genes 16,17) , menstrual cycle 18) , disease (e.g., type 2 diabetes 10,12,19,20) and cystic fibrosis 21) ), and hormones (e.g., leptin 22,23) and thyroid 24,25) ) status, and sympathetic nervous system activity 26) . In addition, a progressive decline of RMR is associated with aging 27) .…”