IntroductionInsulin resistance and type 2 diabetes are characterized by hyperglycemia with hyperinsulinemia, elevated plasma FFA levels, a reduced ability to oxidize fat, and an accumulation of fat within skeletal muscle (1,2). This increase in muscle fat content is highly associated with insulin resistance (3, 4). Therefore, a better understanding of the mechanisms that lead to these metabolic alterations is important in order to develop interventions to improve insulin sensitivity in type 2 diabetic patients.We have previously shown that during a hyperinsulinemic (∼250 µU/ml) and hyperglycemic (∼140 mg/dl) clamp, whole-body entry of long-chain fatty acids (LCFAs) into the mitochondria is inhibited (5) in healthy human volunteers. In addition, when the metabolic profile of insulin resistance was simulated by inducing physiological hyperglycemia (∼150 mg/dl) with hyperinsulinemia (∼35 µU/ml), maintaining FFA concentrations resulted in an inhibition of LCFA oxidation across the leg, splanchnic region, and at the whole-body level (6). The mechanism responsible for the decrease in LCFA oxidation in human muscle is not known, but most likely it involves inhibition of carnitine palmitoyltransferase-1 (CPT-1), the enzyme responsible for the transfer of LCFA into the mitochondria.Malonyl coenzyme A (malonyl-CoA), the product of the acetyl coenzyme A carboxylase (ACC) reaction, is found in a variety of tissues including heart, liver, adipose, and skeletal muscle (7). In lipogenic tissues such as liver and adipose, malonyl-CoA is the first interme- Physiological hyperglycemia with hyperinsulinemia reduces fat oxidation in skeletal muscle. The mechanism responsible for this decrease in fat oxidation in human muscle is not known and may contribute to the development of insulin resistance. We hypothesized that the transfer of long-chain fatty acids (LCFAs) into the mitochondria via carnitine palmitoyltransferase-1 (CPT-1) is inhibited by increased malonyl coenzyme A (malonyl-CoA) (a known potent inhibitor of CPT-1) in human muscle during hyperglycemia with hyperinsulinemia. We studied six healthy subjects after an overnight fast and during an induced 5-hour period of hyperglycemia with hyperinsulinemia. Muscle fatty acid oxidation was calculated using stable isotope methodology combined with blood sampling from the femoral artery and vein of one leg. Muscle functional CPT-1 activity was assessed by concurrently infusing an LCFA tracer and a CPT-independent medium-chain fatty acid tracer. Muscle biopsies were obtained from the vastus lateralis after the periods of fasting and hyperglycemia with hyperinsulinemia. Hyperglycemia with hyperinsulinemia decreased LCFA oxidation, but had no effect on LCFA uptake or medium-chain fatty acid oxidation across the leg. Malonyl-CoA concentration significantly increased from 0.13 ± 0.01 to 0.35 ± 0.07 nmol/g during hyperglycemia with hyperinsulinemia. We conclude that hyperglycemia with hyperinsulinemia increases malonyl-CoA, inhibits functional CPT-1 activity, and shunts LCFA away from o...