OBJECTIVE-The precise molecular mechanisms contributing to the development of insulin resistance, impaired glucose tolerance (IGT), and type 2 diabetes are largely unknown. Altered endogenous glucocorticoid metabolism, including 11-hydroxysteroid dehydrogenase type 1 (11-HSD1), which generates active cortisol from cortisone, and 5␣-reductase (5␣R), which inactivates cortisol, has been implicated.
RESEARCH DESIGN AND METHODS-A total of 101 obese patients (mean age 48 Ϯ 7 years, BMI 34.4 Ϯ 4.3 kg/m 2 , 66 women, 35 men) underwent 75-g oral glucose tolerance testing (OGTT), body composition analysis (dual-energy X-ray absorptiometry), assessment of glucocorticoid metabolism (24-h urine steroid metabolite analysis by gas chromatography/mass spectrometry), and subcutaneous abdominal adipose tissue biopsies.RESULTS-A total of 22.7% of women had IGT compared with 34.2% of men. Two women and five men were diagnosed with type 2 diabetes. In women, adipose 11-HSD1 expression was increased in patients with IGT and correlated with glucose levels across the OGTT (R ϭ 0.44, P Ͻ 0.001) but was independent of fat mass. Total glucocorticoid secretion was higher in men with and without IGT (normal 13,743 Ϯ 863 vs. 7,453 Ϯ 469 g/24 h, P Ͻ 0.001; IGT 16,871 Ϯ 2,113 vs. 10,133 Ϯ 1,488 g/24 h, P Ͻ 0.05), and in women, it was higher in those with IGT (7,453 Ϯ 469 vs. 10,133 Ϯ 1,488 g/24 h, P Ͻ 0.001). In both sexes, 5␣R activity correlated with fasting insulin (men R ϭ 0.53, P ϭ 0.003; women R ϭ 0.33, P ϭ 0.02), insulin secretion across an OGTT (men R ϭ 0.46, P ϭ 0.01; women R ϭ 0.40, P ϭ 0.004), and homeostasis model assessment of insulin resistance (men R ϭ 0.52, P ϭ 0.004; women R ϭ 0.33, P ϭ 0.02).