Tohru Ohtake, Ikuo Yokoyama, Toshiaki Watanabe, Toshimitsu Momose, Takashi Serezawa,. Junichi Nishikawa and Yasuhito Sasaki. Radiolo@ Department ...
Downloaded from jnm.snmjournals.org by on September 11, 2017. For personal use only.
Myocardial Glucose Metabolism in Noninsulin Dependent Diabetes Mellitus Patients Evaluated by FDG-PET Tohru Ohtake, Ikuo Yokoyama, Toshiaki Watanabe, Toshimitsu Momose, Takashi Serezawa, Junichi Nishikawa and Yasuhito Sasaki Radiolo@ Department and the Second Department oflnternal
Medicine, University of Tokyo, Tokyo, Japan
abetes meffitus (IDDM) without coronary artery disease Disbetesmellitus(DM)is oneof severalf@torsinfluencingthe (CAD) and with normal volunteers as controls, and the other on patients with CAD with and without noninsulin assessmentof myocardialvisbility usingfluonne-l8fluorodeoxy glucose(FDG)PET.Mthods: To comparethemyocardialglu dependent DM (NIDDM) during insulin clamp only. We cose metabolismof normalsubjectsto patientswith DM, we quantified the myocardial glucose metabolism of normal performeda quantitativeFDGstudyduringinsulinclamp,oral subjects and patients with NIDDM without CAD during glucoseloadingandfastingin ninenormalvolunteersandsight insulin clamp, oral glucose loading and fasting. patientsw@inoninsulin-dependent DM(NIDDM).Results:Dur ingoralglucoseloading,mdium4o-background (MB)ratio remarkablydeterioratedin NIDDMpatientscomparedwfthnor METhODS malsbecauseof highplasmaglucoseand low seruminsulin. Sub@ts Myocardial glucose utilization (MGU) rates in NIDDM patients Seventeenpatients—nine nondiabetic,normalmalevolunteers were also lower than those in normal volunteers. MB ratio of (age41.0 ±19.5yr, bodymassindex(BMI)21.4±2.0 kg/m)and FDGremarkab@ improvedw@iinsulinclampin NIDDMpatients eight patientswith DM (age 50.6 ±13.4 yr. BMI 21.5 ±3.8 kg/m) comparedwfthoral glucoseloading.MGUratesduringinsulin butwithouta historyof CADandwithoutwallmotionabnormal clamp were still slightlylowerthan in the normalvolunteers ity evaluatedby echocardiography—participated in this study. despite low plasma glucose and adequateplasma insulin. The ninevolunteerssatisfiedthe criteriaof havinga fasting Conclusion: The insulindamp methodmay be very usefulin glucoselevellowerthan 120mg/dl(89.9±9.0mg/dl)and a normal NIDDM patientsfor improvedmyocardialFDG uptake compared patternof glucosetolerance.Theeightdiabeticpatientssatisfied to oralglucoseloadingor fasting,butalightdecreasesin MGU thecriteriaof havinga fastingglucoselevelatadmission(withina ratesduringinsulindampin NIDDMpatientsmaybebecauseof few weeks before the study) greater than 120mg/dl (195 ±50 insulin resistance (GIuT4abnormality). mg/dl)andglucosetolerancewitha DMpatternandhemoglobin Alc (HbAlc)greaterthan7.0%(10.0%±2.5%,referencevalue Key Words: heart;FDG-PET;diabetesmellitus;glucose 4.0%—6.0%).
J NucI Md 1995; 36:456-463
Of the eight diabeticpatients, five were male and three were female.Twohadnephropathy,threehadretinopathyandfivehad neuropathy.AlleightpatientshadNIDDM.Beforeinformedcon sentwas obtained,each subjectwas informedof the investigative
luorine-18-fluorodeoxyglucose (FDG) was first used in natureof thestudyanditspotentialrisksandbenefits.Thestudy protocolwas approvedby the Universityof Tokyo's Human PET imagingof the myocardiumby Phelps et al. (1). Myo Subject Protection Committee. cardial PET studies were then later used to detect viable Study Design ischemic myocardium in infarct during qualitative evalua tion of regional FDG uptake and its relation to flow (2—7). ThreePET studiesduringfasting,oral glucose loadingand Diabetes meffitus (DM) complicates the evaluation for insulinclampwere performedin randomorderwithina week in myocardial viability by deteriorating image quality during ninenondiabetic,normalvolunteersandeightNIDDMpatients. fasting or oral glucose loading (8,9). Although the insulin Two intravenous catheters were inserted: one in an antecubital vein for a glucoseandinsulininfusionand FDG injection,and clamp and insulin injection methods are recommended (9— anotherina contralateral handveinforvenousbloodsampling.In 11), quantitative analysis of myocardial glucose metabo thefastingstudy,FDGwas injected6—7 hrafterbreakfast.Inthe lism in patients with DM has been performed in only two oralglucoseloadingstudy, subjectshad a halflunch 1—3 hr before studies (1213): one on patients with insulin-dependentdi the studyanddrank50 g of glucosesolution(toleraneG) 1 hr beforethe injectionof FDG.In the insulinclampstudy,subjects hadno lunchbeforethestudy.Plasmaglucosewasstabilized,and ReceIvedFeb. 15, 1994;revIsionaroepted Sept. 1, 1994. For correspondenceor reprintscont@ Tohru Ohtalce,MD,Departmentof Raciology.UniversityofTokyo,3-28-6MejWodai Bunkyo-ku,Tokyo,Japan.
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insulin and glucose infusion was started in the afternoon. At the
beginningof the insulinclampstudy, serum insulinwas raisedby
TheJournalof NudearMedians• Vol.36 • No.3 • March1995
Downloaded from jnm.snmjournals.org by on September 11, 2017. For personal use only. a primed, continuous infusion of short half-life insulin (4 mU/kgl mm) for more than 10 mm. In DM patients, this rate of insulin infusion was continued until plasma glucose decreased below 140
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