We tested the hypothesis of a lower respiratory capacity per mitochondrion in skeletal muscle of type 2 diabetic patients compared with obese subjects. Muscle biopsies obtained from 10 obese type 2 diabetic and 8 obese nondiabetic male subjects were used for assessment of 3-hydroxy-Acyl-CoA-dehydrogenase (HAD) and citrate synthase activity, uncoupling protein (UCP)3 content, oxidative stress measured as 4-hydroxy-2-nonenal (HNE), fiber type distribution, and respiration in isolated mitochondria. Respiration was normalized to citrate synthase activity (mitochondrial content) in isolated mitochondria. Maximal ADPstimulated respiration (state 3) with pyruvate plus malate and respiration through the electron transport chain (ETC) were reduced in type 2 diabetic patients, and the proportion of type 2X fibers were higher in type 2 diabetic patients compared with obese subjects (all P < 0.05). There were no differences in respiration with palmitoyl-Lcarnitine plus malate, citrate synthase activity, HAD activity, UCP3 content, or oxidative stress measured as HNE between the groups. In the whole group, state 3 respiration with pyruvate plus malate and respiration through ETC were negatively associated with A1C, and the proportion of type 2X fibers correlated with markers of insulin resistance (P < 0.05). In conclusion, we provide evidence for a functional impairment in mitochondrial respiration and increased amount of type 2X fibers in muscle of type 2 diabetic patients. These alterations may contribute to the development of type 2 diabetes in humans with obesity. Diabetes 56:1592-1599, 2007 T ype 2 diabetes is characterized by insulin resistance in major metabolic tissues such as skeletal muscle, liver, and adipose tissue, as well as failure of the pancreatic -cells to compensate for this abnormality (1). Skeletal muscle is the major site of glucose disposal in response to insulin and, correspondingly, the major site of insulin resistance in type 2 diabetes (1,2). Despite extensive research, the mechanisms underlying insulin resistance are not fully understood. Indeed, several abnormalities have been identified in insulinresistant muscle including impaired insulin activation of glycogen synthase (1,3), impairment of the proximal components of the insulin signaling cascade (2), and increased intramuscular triglyceride content (4,5). Another important component of insulin resistance appears to be a decreased ability of insulin to regulate fuel utilization (6 -8). In insulin-resistant subjects, this impaired ability to switch from lipid to carbohydrate oxidation in response to insulin has been described as "metabolic inflexibility" of skeletal muscle (8).Being the site of fuel oxidation, the mitochondrion has gained increasing interest in type 2 diabetes research during the last decade. Several studies have indicated a role for mitochondrial dysfunction in the pathogenesis of insulin resistance and type 2 diabetes. This includes reports of a decreased leg lipid oxidation in type 2 diabetes and obesity (9) and a strong neg...