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Insulin Resistance Is Associated with Impaired Nitric Oxide Synthase Activity in Skeletal Muscle of Type 2 Diabetic Subjects

Diabetes Division (S.R.K., M.B., S.S., R.Bel., R.Ber., R.A.D.) and Departments of Biochemistry (L.J.R., J.L., B.S.S.M.) and Geriatrics (D.L.K., Y.L.), University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229

Address all correspondence and requests for reprints to: Ralph A. DeFronzo, M.D., The University of Texas Health Science Center at San Antonio, Diabetes Division, 7703 Floyd Curl Drive, San Antonio, Texas 78229.

Type 2 diabetes is an insulin-resistant state characterized by hyperinsulinemia and accelerated atherosclerosis. In vitro and in vivo studies in rodents have suggested that nitric oxide generation plays an important role in glucose transport and insulin action. We determined nitric oxide synthase (NOS) activity in skeletal muscle of 10 type 2 diabetic (hemoglobin A_1C = 6.8 ± 0.1%) and 11 control subjects under basal conditions and during an 80 mU/m²·min euglycemic insulin clamp performed with vastus lateralis muscle biopsies before and after 4 h of insulin. In diabetics, insulin-stimulated glucose disposal (Rd) was reduced by 50%, compared with controls (5.4 ± 0.3 vs. 10.4 ± 0.5 mg/kg·min, P < 0.01). Basal NOS activity was markedly reduced in the diabetic group (101 ± 33 vs. 457 ± 164 pmol/min·mg protein, P < 0.05). In response to insulin, NOS activity increased 2.5-fold in controls after 4 h (934 ± 282 pmol/min·mg protein, P < 0.05 vs. basal), whereas insulin failed to stimulate NOS activity in diabetics (86 ± 28 pmol/min·mg protein, P = NS from basal). Basal NOS protein content in muscle was similar in controls and diabetics and did not change following insulin. In controls, insulin-stimulated NOS activity correlated inversely with fasting plasma insulin concentration (r = –0.58, P = 0.05) and positively with Rd (r = 0.71, P = 0.03). In control and diabetic groups collectively, Rd correlated with insulin-stimulated NOS activity (r = 0.52, P = 0.02). We conclude that basal and insulin-stimulated muscle NOS activity is impaired in well-controlled type 2 diabetic subjects, and the defect in insulin-stimulated NOS activity correlates closely with the severity of insulin resistance. These results suggest that impaired NOS activity may play an important role in the insulin resistance in type 2 diabetic individuals.

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