Insulin resistance shows selective metabolic and hormonal targets in the elderly

There has been no simultaneous evaluation of different aspects of insulin action in ageing; We studied 12 elderly (77 ± 2 years) and 12 young (26 ± 1 years) subjects with normal glucose tolerance and matched for sex, body mass index, lean body mass (LBM), blood pressure and physical activity, using a euglycaemic-hyperinsulinaemic clamp at about 350 pmol L-1 in combination with [3H]-glucose infusion. In the elderly group, hepatic glucose production was normal, fasting serum insulin and C-peptide were significantly increased (P = 0.001) and glucose utilization (34.4 ± 2.1 vs. 44.4 ± 3.2 μmol kg-1 LBM min-1 P = 0.02) and the percentage maximal suppression of C-peptide (58 ± 6% vs. 79 ± 5%, P = 0.02) during the clamp were reduced. Fasting plasma free fatty acid (FFA) and glycerol levels were similar in the two groups, but their percentage maximal suppression during the clamp was reduced in the elderly group (FFA 45 ± 5% vs. 77 ± 6%, P = 0001; glycerol 43 ± 5% vs. 76 ± 3%, P = 0.001). Branched-chain amino acids (valine, leucine, isoleucine) and glucagon levels were similar in the two groups, both while fasting and during the clamp. Thus, insulin resistance in ageing appears selective on glucose utilization, inhibition of lipolysis and feedback inhibition of the B-cell secretion.