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Exogenous and Endogenous Postprandial Lipid Abnormalities in Type 2 Diabetic Patients with Optimal Blood Glucose Control and Optimal Fasting Triglyceride Levels

Department of Clinical and Experimental Medicine (A.A.R., C.D.N., L.D.M., L.P., C.I., S.C., G.R., G.A.), Federico II University, 80131 Naples, Italy; and Department of Endocrinology and Metabolism, University of Pisa (S.D.P.), 56124 Pisa, Italy

Address all correspondence and requests for reprints to: Dr. Angela A. Rivellese, Department of Clinical and Experimental Medicine, Medical School, Federico II University, Via S. Pansini 5, 80131 Naples, Italy. E-mail: rivelles{at}unina.it.

The aim of this study was to evaluate exogenous and endogenous lipoprotein responses to a standard fat-rich meal in type 2 diabetic patients with optimal fasting triglyceridemia and optimal blood glucose control. Seven type 2 diabetic patients and five nondiabetic controls (age, 49 ± 7 and 48 ± 4 yr; body mass index, 28.3 ± 3.6 and 25.1 ± 3.6 kg/m²; mean ± SD) were given, after at least 12 h of fasting, a standard fat-rich meal. Before and over the 6 h after the meal, serial blood samples were taken for determination of glucose, insulin, lipids, lipoproteins, apolipoprotein B-48 (apo B-48), apo B-100, free fatty acids, and lipoprotein lipase activity. The main abnormality in the postprandial lipid response of diabetic patients involved large very low density lipoproteins. In these particles, apo B-48, apo B-100, cholesterol, and triglyceride incremental areas were, in fact, significantly higher in diabetics compared with controls [7.08 ± 2.65 vs. 1.17 ± 0.88 mg/liter·h, 65.5 ± 11.5 vs. 12.4 ± 1.77 mg/liter·h, 29.7 ± 3.9 vs. 13.1 ± 3.1 mg/dl·h (0.77 ± 0.10 vs. 0.34 ± 0.08 mmol/liter·h), 170 ± 31 vs. 94 ± 22 mg/dl·h (1.93 ± 0.35 vs. 1.06 ± 0.25 mmol/liter·h)] (all P < 0.05; mean ± SEM). Postprandial preheparin lipoprotein lipase plasma activity was, if anything, higher in diabetic patients. In conclusion, even with fasting normotriglyceridemia and optimal blood glucose control, type 2 diabetic patients are characterized, in the postprandial period, by a significant increase in large very low density lipoproteins of both endogenous and exogenous origins.

This work was supported by a grant from the Ministry of Health (ICS 110.1/RF 98.97).

Abbreviations: apo, Apolipoprotein; FFA, free fatty acid; HDL, high-density lipoprotein; HL, hepatic lipase; IDL, intermediate-density lipoprotein; LDL, low-density lipoprotein; LPL, lipoprotein lipase; Sf, Svedberg flotation unit; VLDL, very LDL.

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