A defect in cell-mediated immune function in insulin-resistant diabetic and obese subjects.

In this study, we have evaluated one aspect of the cellular immune process--in vitro release of MIF by lymphocytes obtained from controls; well-controlled, ketosis-prone, insulin-dependent diabetic patients; nonketotic diabetic patients; and nonhyperglycemic obese patients. The results showed that MIF release by cells from well-controlled, insulin-dependent diabetic, nonketotic diabetic, and nonhyperglycemic obese subjects was 100% +/- 8, 48% +/- 17, and 36% +/- 17 of control values, respectively. Thus insulin-sensitive, ketosis-prone diabetic patients have normal MIf release while well-controlled on insulin therapy, whereas insulin-resistant, nonketotic diabetic and nonhyperglycemic obese patients have impaired MIF release. It is possible that this in vitro defect in a cellular immune process is related to the insulin-resistant state and that it may play a role in enhanced susceptibility to infection in insulin-resistant diabetic patients.