Glucose production and gluconeogenesis in adults with uncomplicated falciparum malaria

Although glucose production is increased in severe malaria, the influence of uncomplicated malaria on glucose production is unknown. Therefore, we measured in eight adult Vietnamese patients with uncomplicated falciparum malaria and eight healthy Vietnamese controls glucose production (by infusion of [6,6-H-2(2)]glucose) and the fractional contribution of gluconeogenesis (by oral ingestion of (H2O)-H-2); glycogenolysis was calculated as the difference between the two. After 20 h of fasting, plasma glucose was 4.7 +/- 0.2 mmol/l in the patients and 4.3 +/- 0.2 mmol/l in the controls (not significant). Glucose production was similar to 25% higher in the patients (16.9 +/- 1.3 vs. 13.4 +/- 0.3 mu mol.kg(-1).min(-1), P = 0.01). Fractional and absolute gluconeogenesis were increased in the patients (similar to 87 vs. similar to 59%, P < 0.001; and 14.6 +/- 1.3 vs. 7.9 +/- 0.2 mu mol.kg(-1).min(-1), P < 0.001, respectively). The contribution of glycogenolysis to total glucose production was decreased in the patients: 2.3 +/- 0.5 vs. 5.5 +/- 0.4 mu mol.kg(-1).min(-1) (P < 0.002). In conclusion, in adult patients with uncomplicated falciparum malaria, glucose production is increased by similar to 25% due to an increased rate of gluconeogenesis, whereas glycogenolysis is decreased. The mechanism by which these changes occur is uncertain. However, counterregulatory hormone and cytokine concentrations were increased in the patients.