Abstract
Recently we have shown that non-obese NIDDM (non-insulin-dependent diabetes mellitus) model rats have an enhanced capacity for ketogenesis in the liver, and that insulin deficiency plays a major role. To apply this result to the clinical management of NIDDM patients, serum levels of ketone bodies were determined in 60 non-obese NIDDM subjects with poor glycemic control on diet or sulphonylurea therapy (HbAi levels above 10 % for more than 3 months). The IR group (Insulin-Requiring group, . 30 patients) consisted of subjects who had been treated with the maximal dose of sulphonylurea and subsequently required insulin therapy for better glycemic control, and the remaining patients formed the NIR group (Non-Insulin-Requiring group, 30 patients). There were no significant differences in HbAi, age, duration of diabetes mellitus, age of onset and Body Mass Index between IR and NIR groups. Fasting plasma glucose levels in the IR group were slightly higher than in the NIR group (214±40, 181±37 mg/dl, mean±SD). Serum total ketone body levels (acetoacetate and 3-hydroxybutyrate) were 225±199μM in the IR group and 95 × 54μM in the NIR group and the difference was statistically significant (p<0.01). Z values above 0 which might express insulin dependency as reported by Kosugi et al were observed in 5 patients in the IR group, but no member of the NIR group had a value of Z>0.
These results suggest that continuously elevated levels in serum concentrations of ketone bodies together with high levels of fasting plasma glucose are important clinical markers for the indication of insulin therapy in non-obese NIDDM subjects who have been treated with the maximal dose of sulphonylurea.
