OBJECTIVE -To investigate fructose metabolic changes in patients with diabetes.RESEARCH DESIGN AND METHODS -Serum and urinary fructose concentrations were determined in healthy subjects (n ϭ 23) and in nondiabetic (n ϭ 23) and diabetic patients (n ϭ 26). Fructose was measured using our newly developed method, and 13 C 6 -fructose was used as the internal standard. After adding sample to a fixed amount of internal standard, ion-exchange resins and high-performance liquid chromatography pretreatments were performed. Then, the amount of fructose in the sample was measured by gas chromatography-mass spectrometry.RESULTS -Serum fructose concentrations in patients with diabetes (12.0 Ϯ 3.8 mol/l) were significantly higher than those in healthy subjects (8.1 Ϯ 1.0 mol/l, P Ͻ 0.001) and nondiabetic patients (7.7 Ϯ 1.6 mol/l, P Ͻ 0.001), and daily urinary fructose excretion was significantly greater in patients with diabetes (127.8 Ϯ 106.7 mol/day) than in nondiabetic patients (37.7 Ϯ 23.0 mol/day, P Ͻ 0.001). In patients with diabetes (n ϭ 20), serum fructose concentrations (8.6 Ϯ 1.8 mol/l, P Ͻ 0.001) and daily urinary fructose excretion (63.4 Ϯ 63.8 mol/day, P Ͻ 0.01) significantly decreased by week 2 after admission.CONCLUSIONS -The present results differed from those of previous studies in that we found that the serum and urinary fructose concentrations decreased rapidly, concomitant with an improvement in glycemia. Therefore, hyperglycemia was associated with increased serum and urinary fructose concentrations in patients with diabetes.
Diabetes Care 25:353-357, 2002F ructose is an important dietary source of carbohydrates. In Western countries, daily intake of fructose by adults is ϳ100 g (1). Due to its unique metabolic properties, fructose promotes adverse metabolic changes, including glucose intolerance (2,3), hyperlipidemia (2,3), and hyperuricemia (4). Moreover, in light of nonenzymatic fructosylation of proteins (5), polyol pathway, and carbonyl stress, fructose is inferred to have an important role in the pathogenesis of diabetic complications. Therefore, if the measurement of serum fructose levels is clinically significant and available as a biomarker, it could be greatly useful. However, previous studies have reported no significant difference in serum fructose concentrations between diabetic and nondiabetic patients (6 -8). In these studies, the pretreatment of samples was insufficient to remove glucose, which interfered with the measurement of fructose. In this study, we report serum and urinary fructose concentrations measured by a newly developed method that overcomes this problem of glucose interference, and we describe fructose kinetic changes in patients with diabetes.
RESEARCH DESIGN ANDMETHODS -Three subsets comprised the present study. First, serum fructose concentrations were determined in 23 healthy subjects and in 26 diabetic (diabetes group) and 23 nondiabetic (nondiabetic group) inpatients. Daily urinary fructose excretion was examined in the diabetes group and in the nondiabetic group. Ser...