Insulin-mediated suppression of fatty acid release predicts whole-body insulin resistance of glucose uptake and skeletal muscle insulin receptor activation

To examine factors underlying why most, but not all adults with obesity exhibit impaired insulin-mediated glucose uptake, we compared: 1) rates of fatty acid (FA) release from adipose tissue, 2) skeletal muscle lipid droplet (LD) characteristics, and 3) insulin signaling events in skeletal muscle collected from cohorts of adults with obesity with “HIGH” versus “LOW” insulin sensitivity for glucose uptake. Seventeen adults with obesity (BMI: 36±3kg/m ² ) completed a 2h hyperinsulinemic-euglycemic clamp with stable isotope tracer infusions to measure glucose rate of disappearance (glucose Rd) and FA rate of appearance (FA Ra). Skeletal muscle biopsies were collected at baseline and 30min into the insulin infusion. Participants were stratified into HIGH (n=7) and LOW (n=10) insulin sensitivity cohorts by their glucose Rd during the hyperinsulinemic clamp (LOW<400; HIGH>550 nmol/kgFFM/min/[µU/mL]). Insulin-mediated suppression of FA Ra was lower in LOW compared with HIGH (p<0.01). In skeletal muscle, total intramyocellular lipid content did not differ between cohorts. However, the size of LDs in the subsarcolemmal region (SS) of type II muscle fibers was larger in LOW compared with HIGH (p=0.01). Additionally, insulin receptor (IR) interactions with regulatory proteins CD36 and Fyn were lower in LOW versus HIGH (p<0.01), which aligned with attenuated insulin-mediated Tyr phosphorylation of IRβ and downstream insulin-signaling proteins in LOW. Collectively, reduced ability for insulin to suppress FA mobilization, with accompanying modifications in intramyocellular LD size and distribution, and diminished IR interaction with key regulatory proteins may be key contributors to impaired insulin-mediated glucose uptake commonly found in adults with obesity.