Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus Silvio Buscemi a, * , Maria Donatelli a , Giuseppe Grosso b , Sonya Vasto c , Fabio Galvano b , Flavia Costa d , Giuseppe Rosafio a , Salvatore Verga a a Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Nutrizione Clinica, University of Palermo, Italy b Dipartimento di Scienze del Farmaco, University of Catania, Italy c Dipartimento di Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche (DIBIMEF), University of Palermo, Italy d Servizio di Ingegneria Clinica, AOU Policlinico ‘‘P. Giaccone’’, Palermo, Italy 1. Introduction Type 2 diabetes (T2D) is often associated with obesity, a condition that follows a sufficiently prolonged period in which energy intake exceeds energy expenditure. It cannot be excluded that in diabetes-prone people genetic factors may be responsible for a relative low energy expenditure that facilitates the appearance of obesity [1–3]. Nevertheless, reducing energy intake with diet is the first, and probably d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e x x x ( 2 0 1 4 ) x x x – x x x a r t i c l e i n f o Article history: Received 4 March 2014 Received in revised form 26 August 2014 Accepted 15 September 2014 Available online xxx Keywords: Diabetes Insulin Lactate Neoglucogenesis Resting energy expenditure Indirect calorimetry a b s t r a c t Aims: Resting energy expenditure (REE) plays a critical role in the regulation of body weight, with important implications in type 2 diabetes (T2D). However, the relationships between REE and T2D have not been extensively evaluated. We compared REE in persons with diabetes and in persons without diabetes. We also investigated the acute effect of insulin on REE and venous lactate, the latter an indirect measure of neoglucogenetic activity. Methods: REE was measured using indirect calorimetry in 14 newly diagnosed, untreated T2D adults and in 14 non-diabetic age-, gender- and body mass index-matched persons. The REE and lactate venous concentrations were also measured in a subgroup of 5 T2D patients in the hour following an IV insulin bolus. Results: The REE normalized for fat-free mass (FFM) was significantly higher in T2D patients than in the group without diabetes (mean  SD: 27.6  1.9 vs. 25.8  1.9 kcal/kg-FFM24 h; P = 0.02). REE normalized for FFM was correlated with fasting plasma glucose concentration (r = 0.51; P = 0.005). Following the insulin venous bolus REE (0 0 : 2048  242; 10 0 : 1804  228; 20 0 : 1684  230; 30 0 : 1634  212; 45 0 : 1594  179; 60 0 : 1625  197 kcal/24 h; P < 0.001) and both glucose (P < 0.001) and lactate (P < 0.001) concentrations progressively declined in the ensuing hour. Conclusions: Patients with diabetes have a higher energy expenditure, likely a consequence of higher gluconeogenetic activity. This study may contribute to recognizing the nature of body weight reduction that occurs in concomitance with poorly controlled diabetes, and of body weight gain as commonly observed when hypoglycemic treatment is started. # 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Nutrizione Clinica, P. Giaccone Policlinico, Via del Vespro 129, 90127 Palermo, Italy. Tel.: +39 091 6554580; fax: +39 091 6554580. E-mail address: silbus@tin.it (S. Buscemi). DIAB-6171; No. of Pages 6 Please cite this article in press as: Buscemi S, et al. Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus. Diabetes Res Clin Pract (2014), http://dx.doi.org/10.1016/j.diabres.2014.09.016 Contents available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres http://dx.doi.org/10.1016/j.diabres.2014.09.016 0168-8227/# 2014 Elsevier Ireland Ltd. All rights reserved.