ArticleDiabetologia2026
Diminished arginine bioavailability during hyperglycaemia distinguishes individuals with A
Article in Diabetologia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03566524 (Arginine and Nitric Oxide Synthesis in the Pathogenesis of Ketosis-prone Diabetes), which is not on this map. Not yet cited in PubMed.
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Arginine and Nitric Oxide Synthesis in the Pathogenesis of Ketosis-prone Diabetes
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9 authors.
Funding
Abstract
aims/hypothesisIndividuals with A
methodsIn Protocol 1, participants with KPD and type 2 diabetes and non-diabetic control participants were studied under euglycaemic and hyperglycaemic conditions. Kinetics of arginine, citrulline, ornithine and phenylalanine were measured using stable isotope tracer infusions with mass spectrometric analyses, together with quantification of insulin secretion in response to glucose and arginine. In Protocol 2, ten participants with KPD (adults diagnosed after an episode of unprovoked DKA, lacking islet autoantibodies, with substantial beta cell functional reserve and HbA
resultsIn Protocol 1, under hyperglycaemic conditions, arginine flux decreased in KPD but not in type 2 diabetes. This resulted in 42.5% greater decline of arginine bioavailability between the euglycaemic and hyperglycaemic conditions in KPD (p=0.035), due primarily to less arginine derived from protein breakdown. KPD and type 2 diabetes groups did not differ in arginine de novo synthesis, arginine hydrolysis, NO synthesis or ornithine flux. Following hyperglycaemia, both diabetes groups exhibited blunted insulin response to a glucose bolus, but KPD showed increased insulin response to arginine. In Protocol 2, supplementation with citrulline but not with alanine elicited increased arginine flux (effect size 0.746; 95% CI 0.258, 0.931), arginine synthesis and NO synthesis in the KPD participants, without adverse effects. CONCLUSIONS/
interpretationArginine potentiates insulin secretion during sustained hyperglycaemia, hence its diminished bioavailability in individuals with KPD could contribute to the development of ketoacidosis during a hyperglycaemic crisis. Individuals with KPD retain responsiveness to exogenous arginine during hyperglycaemia and normalise endogenous arginine availability with citrulline supplementation, suggesting therapeutic options for ameliorating or preventing their episodes of DKA.
trial registrationClinicalTrials.gov NCT03566524 (for Protocol 2).
fundingThis work was supported by R01-DK101411 from the National Institutes of Health.
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