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Zhang B, Lei H, Ambler G, Werring DJ, Fang S, Li H, Chen R, Wei J, Chen G, Liu N, Du H. Association between Triglyceride-Glucose Index and Early Neurological Outcomes after Thrombolysis in Patients with Acute Ischemic Stroke. J Clin Med 2023; 12:jcm12103471. [PMID: 37240578 DOI: 10.3390/jcm12103471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index is a novel biomarker of insulin resistance which might plausibly influence endogenous fibrinolysis and thus early neurological outcomes in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis using recombinant tissue-plasminogen activator. METHODS We included consecutive AIS patients within 4.5 h of symptom onset undergoing intravenous thrombolysis between January 2015 and June 2022 in this multi-center retrospective observational study. Our primary outcome was early neurological deterioration (END), defined as ≥2 (END2) or ≥ 4 (END4) National Institutes of Health Stroke Scale (NIHSS) score worsening compared to the initial NIHSS score within 24 h of intravenous thrombolysis. Our secondary outcome was early neurological improvement (ENI), defined as a lower NIHSS score at discharge. TyG index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. We evaluated the association of END and ENI with TyG index using a logistic regression model. RESULTS A total of 676 patients with AIS were evaluated. The median age was 68 (Interquartile range, IQR (60-76) years old), and 432 (63.9%) were males. A total of 89 (13.2%) patients developed END2, 61 (9.0%) patients developed END4, and 492 (72.7%) experienced ENI. In multivariable logistic regression analysis, after adjustment for confounding factors, TyG index was significantly associated with increased risks of END2 (categorical variable, vs. lowest tertile, medium tertile odds ratio [OR] 1.05, 95% confidence interval, CI 0.54-2.02, highest tertile OR 2.94, 95%CI 1.64-5.27, overall p < 0.001) and END4 (categorical variable, vs. lowest tertile, medium tertile OR 1.21, 95%CI 0.54-2.74, highest tertile OR 3.80, 95%CI 1.85-7.79, overall p < 0.001), and a lower probability of ENI (categorical variable, vs. lowest tertile, medium tertile OR 1.00, 95%CI 0.63-1.58, highest tertile OR 0.59, 95%CI 0.38-0.93, overall p = 0.022). CONCLUSIONS Increasing TyG index was associated with a higher risk of END and a lower probability of ENI in patients with acute ischemic stroke treated with intravenous thrombolysis.
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Affiliation(s)
- Baixiang Zhang
- Department of Rehabilitation Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364099, China
| | - Hanhan Lei
- Stroke Research Center, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350005, China
| | - Gareth Ambler
- Department of Statistical Science, University College London, London WC1E 6BT, UK
| | - David J Werring
- Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Shuangfang Fang
- Stroke Research Center, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350005, China
| | - Hangfeng Li
- Department of Neurology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364099, China
| | - Ronghua Chen
- Stroke Research Center, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350005, China
| | - Jin Wei
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Guangliang Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Nan Liu
- Stroke Research Center, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350005, China
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Houwei Du
- Stroke Research Center, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350005, China
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Relationship among Insulin Therapy, Insulin Resistance, and Severe Coronary Artery Disease in Type 2 Diabetes Mellitus. J Interv Cardiol 2022; 2022:2450024. [PMID: 36238131 PMCID: PMC9529512 DOI: 10.1155/2022/2450024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives The effect of insulin therapy on coronary artery disease (CAD) remains controversial. This study aimed to analyze the association between insulin resistance and the morbidity of severe CAD in type 2 diabetes mellitus (T2DM). Methods A total of 2044 T2DM patients aged ≥40 years were included in this cross-sectional observational study. Clinical information and laboratory results were collected from the medical records. Those who underwent percutaneous coronary intervention (PCI) were classified as severe CAD, while those who did not have a history of and were not suffering from CAD were classified as patients without CAD. Results T2DM patients with severe CAD and without CAD had no significant differences in glycosylated hemoglobin A1c (8.55% ± 2.10% vs. 8.39% ± 1.77%, P=0.234). The proportion of insulin treatment was also similar between the two groups (56.85% vs. 53.65%, odds ratio = 1.138, P=0.310). In the patients without insulin treatment, the levels of fasting C peptide (FCP) correlated with severe CAD prevalence. FCP was categorized into 3 tertiles (<1.5 ng/mL, 1.5 ng/mL- 3 ng/mL, and ≥3 ng/mL), and the prevalence rates of severe CAD were 7.88%, 14.31%, and 18.28%, respectively (P < 0.05). In the patients with insulin treatment, the body mass index (BMI) was the significant risk factor of severe CAD. The prevalence of severe CAD according to BMI tertiles (<24 kg/m2, 24 kg/m2–28 kg/m2, and ≥28 kg/m2) was 11.22%, 14.61%, and 24.62%, respectively (P < 0.01). Conclusions Our results showed that insulin resistance, rather than insulin therapy, increases the risk of severe CAD in T2DM patients with inadequate glycemic control. Non-insulin treated patients with high FCP and insulin-treated patients with high BMI are at higher risk of severe CAD.
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Hadwen J, Kim W, Dewar B, Ramsay T, Davis A, Dowlatshahi D, Shamy M. Association between insulin resistance and post-ischaemic stroke outcome in patients without diabetes: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044771. [PMID: 33771829 PMCID: PMC8006852 DOI: 10.1136/bmjopen-2020-044771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Insulin resistance is an independent risk factor for atherosclerosis, coronary artery disease and ischaemic stroke. Currently, insulin resistance is not usually included in post-stroke risk stratification. This systematic review and meta-analysis intends to determine if available scientific knowledge supports an association between insulin resistance and post-stroke outcomes in patients without diabetes. METHODS AND ANALYSIS The authors will conduct a literature search in Medline, Embase, Web of Science and Cochrane Central. The review will include studies that assess the association between elevated insulin homeostasis model of insulin resistance (HOMA-IR) and post-stroke outcome (functional outcome and recurrent stroke). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines will be used. The primary outcome will be post-stroke functional outcome (Modified Rankin Scale), and the secondary outcome will be recurrent ischaemic stroke. Comparison of outcome will be made between highest and lowest HOMA-IR range (as defined in each article included in this systematic review). Risk of bias will be assessed qualitatively. Meta-analysis will be performed if sufficient homogeneity exists between studies. Heterogeneity of outcomes will be assessed by I². ETHICS AND DISSEMINATION No human or animal subjects or samples were/will be used. The results will be published in a peer-reviewed journal, and will be disseminated at local and international neurology conferences. PROSPERO REGISTRATION NUMBER CRD42020173608.
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Affiliation(s)
- Jeremiah Hadwen
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Woojin Kim
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Dewar
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Dar Dowlatshahi
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michel Shamy
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Derakhshan P, Khatibi A, Faiz SHR, Rahimzadeh P, Nouri N. Comparison of the effect of insulin glargine and regular insulin on perioperative glycemic control in patients with type 2 diabetes mellitus under insulin treatment during vitrectomy surgery under general anesthesia: A randomized clinical trial study. Med J Islam Repub Iran 2021; 35:31. [PMID: 34211933 PMCID: PMC8236081 DOI: 10.47176/mjiri.35.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Perioperative glycemic control is an important factor in the clinical management of a patient with diabetes mellitus under surgery. Poorly controlled long-term hyperglycemia not only predisposes individuals to systemic complications of diabetes mellitus and cardiovascular morbidity but also increases the risk of anesthesia and weakens the outcome of the surgery. Given the importance of the issue and the limited studies on glucose control using insulin glargine during surgery, we aimed to investigate the effects of glargine on glucose control in patients with diabetes mellitus during vitrectomy surgery.
Methods: This randomized, double-blind trial was conducted in two groups of 35 patients with diabetes mellitus under treatment with insulin. In the control group, the patients received regular insulin based on the blood glucose and the sliding scale, and in the intervention group, they received insulin glargine (0.3 unit/kg) before surgery. From the start of the operation up to 3 hours of the surgery blood glucose of the patients was measured every 45 minutes and once 6 hours after the operation, and if needed, the regular insulin was injected. Data were analyzed using SPSS 16. Frequency, percentage, mean, and standard deviation (SD) were used to describe the data. To compare the quantitative variables, the independent t-test or U-Mann-Whitney test was used. For comparison of the qualitative variables, Chi-square test or Fischer's exact test and repeated measure ANOVA was employed. The significance level (P-value) was considered as p<0.05.
Results: Use of insulin glargine was associated with significantly lower blood glucose levels compared to regular insulin at 90-minutes (p=0.004), 135 minutes (p=0.001), and 6 hours after the operation (p=0.005).
Conclusion: Glycemic control using glargine compared to regular insulin has a better performance with less need for surplus insulin dose administration during surgery.
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Affiliation(s)
- Pooya Derakhshan
- Anesthesiology Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Khatibi
- Anesthesiology Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Anesthesiology Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Poupak Rahimzadeh
- Anesthesiology Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Nouri
- Anesthesiology Department, Fatima Plastic And Reconstructive Surgery Hospital, Iran University of Medical Sciences, Tehran, Iran
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Traunmüller F. Atherosclerosis is a vascular stem cell disease caused by insulin. Med Hypotheses 2018; 116:22-27. [PMID: 29857902 DOI: 10.1016/j.mehy.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
The present article proposes the hypothesis that when multipotent vascular stem cells are exposed to excessive insulin in a rhythmic pattern of sharply rising and falling concentrations, their differentiation is misdirected toward adipogenic and osteogenic cell lineages. This results in plaque-like accumulation of adipocytes with fat and cholesterol deposition from adipocyte debris, and osteogenic (progenitor) cells with a calcified matrix in advanced lesions. The ingrowth of capillaries and infiltration with macrophages, which upon uptake of lipids turn into foam cells, are unspecific pro-resolving reactions. Epidemiological, histopathological, pharmacological, and experimental evidence in favour of this hypothesis is summarised.
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Srivastava PK, Pradhan AD, Cook NR, Ridker PM, Everett BM. Randomized Trial of the Effects of Insulin and Metformin on Myocardial Injury and Stress in Diabetes Mellitus: A Post Hoc Exploratory Analysis. J Am Heart Assoc 2017; 6:JAHA.117.007268. [PMID: 29275373 PMCID: PMC5779039 DOI: 10.1161/jaha.117.007268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Subclinical myocardial injury, as measured by high‐sensitivity cardiac troponin T (hsTnT), and myocardial stress, as measured by N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), are related to glycemic control in patients with type 2 diabetes mellitus, and are strong predictors of adverse cardiovascular outcomes. We sought to determine whether antihyperglycemic therapy improves measures of myocardial injury and myocardial stress in patients with type 2 diabetes mellitus. Methods and Results We randomized, in a 2×2 factorial fashion, 438 patients with type 2 diabetes mellitus to insulin glargine, metformin, the combination, or placebo and measured changes in NT‐proBNP and hsTnT after 12 weeks of therapy. At baseline, the median (Q1–Q3) plasma concentration was 35.4 (15.7–86.3) ng/L for NT‐proBNP and 6.7 (4.6–10.1) ng/L for hsTnT. The adjusted (95% confidence interval) change in NT‐proBNP concentration was 20.7% (7.9–35.0) in the insulin arm compared with 0.13% (−10.8 to 12.5) in the no‐insulin arm (P=0.03 for comparison). These changes were not related to changes in fasting or postprandial glucose, glycated hemoglobin, weight, blood pressure, or inflammation. In the metformin arm, the adjusted change in NT‐proBNP was 7.8% (−3.7 to 20.7) compared with 13.0% (0.72–26.8) in the no‐metformin arm (P=0.58). No significant changes in hsTnT concentrations were observed for any of the treatment arms. Conclusions Insulin glargine was associated with a significant 20.7% increase in NT‐proBNP, a marker of myocardial stress, after 12 weeks of therapy. No change in hsTnT, a marker of myocardial injury, was observed. The changes were independent of substantial improvements in glucose control. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00366301.
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Affiliation(s)
- Pratyaksh K Srivastava
- Division of General Internal Medicine, University of California Los Angeles, Los Angeles, CA
| | - Aruna D Pradhan
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Cardiovascular Medicine, Veterans Affairs Boston Medical Center, West Roxbury, MA
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brendan M Everett
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA .,Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Herman ME, O'Keefe JH, Bell DSH, Schwartz SS. Insulin Therapy Increases Cardiovascular Risk in Type 2 Diabetes. Prog Cardiovasc Dis 2017; 60:422-434. [PMID: 28958751 DOI: 10.1016/j.pcad.2017.09.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
Insulin therapy increased cardiovascular (CV) risk and mortality among type 2 diabetes (T2D) patients in several recently reported clinical outcomes trials. To assess whether this association is causative or coincidental, PubMed searches were used to query the effects of insulin therapy for T2D on CV health and longevity from large-scale outcomes trials, meta-analyses, and patient registry studies, as well as basic research on insulin's direct and pleiotropic actions. Although several old studies provided conflicting results, the majority of large observational studies show strong dose-dependent associations for injected insulin with increased CV risk and worsened mortality. Insulin clearly causes weight gain, recurrent hypoglycemia, and, other potential adverse effects, including iatrogenic hyperinsulinemia. This over-insulinization with use of injected insulin predisposes to inflammation, atherosclerosis, hypertension, dyslipidemia, heart failure (HF), and arrhythmias. These associations support the findings of large-scale evaluations that strongly suggest that insulin therapy has a poorer short- and long-term safety profile than that found to many other anti-T2D therapies. The potential adverse effects of insulin therapy should be weighed against proven CV benefits noted for select other therapies for T2D as reported in recent large randomized controlled trials.
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Affiliation(s)
- Mary E Herman
- Montclair State University, New Jersey, United States; Social Alchemy Ltd. Building Global Research Competency, United States
| | - James H O'Keefe
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, United States; Saint Luke's Mid America Heart Institute, United States.
| | | | - Stanley S Schwartz
- Main Line Health System, Wynnewood, PA, United States; University of Pennsylvania, Philadelphia, PA, United States
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Schwartz SS, Epstein S, Corkey BE, Grant SFA, Gavin JR, Aguilar RB. Response to Comment on Schwartz et al. The Time Is Right for a New Classification System for Diabetes: Rationale and Implications of the β-Cell-Centric Classification Schema. Diabetes Care 2016;39:179-186. Diabetes Care 2016; 39:e129-30. [PMID: 27457644 DOI: 10.2337/dci16-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Stanley S Schwartz
- Main Line Health System, Wynnewood, PA, and University of Pennsylvania, Philadelphia, PA
| | - Solomon Epstein
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Mount Sinai Hospital, New York, NY
| | - Barbara E Corkey
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Struan F A Grant
- Division of Human Genetics and Center for Applied Genomics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Schwartz SS, Jellinger PS, Herman ME. Obviating much of the need for insulin therapy in type 2 diabetes mellitus: A re-assessment of insulin therapy’s safety profile. Postgrad Med 2016; 128:609-19. [DOI: 10.1080/00325481.2016.1191955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Spectre G, Stålesen R, Östenson CG, Hjemdahl P. Meal-induced platelet activation in diabetes mellitus type 1 or type 2 is related to postprandial insulin rather than glucose levels. Thromb Res 2016; 141:93-7. [PMID: 26994470 DOI: 10.1016/j.thromres.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/14/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
AIM Postprandial platelet activation was related to postprandial insulin rather than glucose levels in a previous meal insulin study in type 2 diabetes mellitus (T2DM). We therefore compared postprandial platelet activation in type 1 (T1DM) patients without insulin secretion and T2DM patients with high postprandial insulin levels. MATERIAL AND METHODS Patients with T1DM (n=11) and T2DM (n=12) were studied before and 90min after a standardized meal without premeal insulin. Five T1DM patients volunteered for a restudy with their regular premeal insulin. Platelet activation was assessed by flow cytometry, with and without the thromboxane analogue U46619 or ADP, and by whole blood aggregometry (Multiplate®). Effects of insulin (100μU/mL) in vitro were also studied. RESULTS Before the meal, glucose, insulin and platelet activation markers other than platelet-leukocyte aggregates (PLAs) were similar in T1DM and T2DM; PLAs were higher in T1DM. Postprandial glucose levels increased more markedly in T1DM (to 22.1±1.4 vs. 11.2±0.6mmol/L) while insulin levels increased only in T2DM (from 24.4±4.4 to 68.8±12.3μU/mL). Platelet P-selectin expression, fibrinogen binding and PLA formation stimulated by U46619 were markedly enhanced (approximately doubled) and whole blood aggregation stimulated by U46619 was increased (p<0.05 for all) after the meal in T2DM patients but not in T1DM patients. The pilot study with premeal insulin in T1DM patients showed postprandial platelet activation when postprandial insulin levels increased. In vitro insulin mildly activated platelets in both groups. CONCLUSION Postprandial platelet activation via the thromboxane pathway is related to postprandial hyperinsulinemia and not to postprandial hyperglycaemia in patients with diabetes.
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Affiliation(s)
- Galia Spectre
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden; Department of Hematology, Coagulation Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Hematology Institute, Thrombosis and Heamostasis Unit, Rabin Medical Center, Beilinsn Hospital, Petach Tikva, Israel
| | - Ragnhild Stålesen
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Endocrinology and Diabetology Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden.
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Transdermal delivery of insulin by amidated pectin hydrogel matrix patch in streptozotocin-induced diabetic rats: effects on some selected metabolic parameters. PLoS One 2014; 9:e101461. [PMID: 24987850 PMCID: PMC4079503 DOI: 10.1371/journal.pone.0101461] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/05/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Studies in our laboratory are concerned with developing optional insulin delivery routes based on amidated pectin hydrogel matrix gel. We therefore investigated whether the application of pectin insulin (PI)-containing dermal patches of different insulin concentrations sustain controlled release of insulin into the bloodstream of streptozotocin (STZ)-induced diabetic rats with concomitant alleviation of diabetic symptoms in target tissues, most importantly, muscle and liver. METHODS Oral glucose test (OGT) responses to PI dermal matrix patches (2.47, 3.99, 9.57, 16.80 µg/kg) prepared by dissolving pectin/insulin in deionised water and solidified with CaCl2 were monitored in diabetic rats given a glucose load after an 18-h fast. Short-term (5 weeks) metabolic effects were assessed in animals treated thrice daily with PI patches 8 hours apart. Animals treated with drug-free pectin and insulin (175 µg/kg, s.c.) acted as untreated and treated positive controls, respectively. Blood, muscle and liver samples were collected for measurements of selected biochemical parameters. RESULTS After 5 weeks, untreated diabetic rats exhibited hyperglycaemia and depleted hepatic and muscle glycogen concentrations. Compared to untreated STZ-induced diabetic animals, OGT responses of diabetic rats transdermally applied PI patches exhibited lower blood glucose levels whilst short-term treatments restored hepatic and muscle glycogen concentrations. Plasma insulin concentrations of untreated diabetic rats were low compared with control non-diabetic rats. All PI treatments elevated plasma insulin concentrations of diabetic rats although the levels induced by high doses (9.57 and 16.80 µg/kg) were greater than those caused by low doses (2.47 and 3.99 µg/kg) but comparable to those in sc insulin treated animals. CONCLUSIONS The data suggest that the PI hydrogel matrix patch can deliver physiologically relevant amounts of pharmacologically active insulin. NOVELTY OF THE WORK A new method to administer insulin into the bloodstream via a skin patch which could have potential future applications in diabetes management is reported.
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Li CJ, Zhang JY, Yu DM, Zhang QM. Adding glimepiride to current insulin therapy increases high-molecular weight adiponectin levels to improve glycemic control in poorly controlled type 2 diabetes. Diabetol Metab Syndr 2014; 6:41. [PMID: 24650537 PMCID: PMC3994470 DOI: 10.1186/1758-5996-6-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/14/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To observe the efficacy and safety of adding glimepiride to established insulin therapy in poorly controlled type 2 diabetes (T2D) and to assess the relationship of changes in the serum high-molecular weight (HMW) adiponectin levels and glycemic control after glimepiride treatment. METHODS Fifty-six subjects with poorly controlled insulin-treated T2D were randomly assigned to either the glimepiride-added group (the group A, n = 29) or the insulin-increasing group (the group B, n = 27) while continuing current insulin-based therapy. Glycosylated hemoglobin (HbA1c) value, daily insulin dose, body weight, waist circumference, plasma lipid concentration, serum HMW adiponectin level and the number of hypoglycemic events were evaluated before and after treatment. RESULTS At the end of study, insulin doses were significantly reduced, and the mean HbA1c, fasting blood glucose (FBG) and 2-hour postprandial blood glucose (P2BG) were improved greater in the group A compared with the group B. The serum HMW adiponectin levels were significantly increased in the group A compared with the group B. Most importantly, we found that changes in HbA1c were inversely correlated with changes in serum HMW adiponectin in the group A (r = -0.452, p = 0.02). CONCLUSIONS Adding glimepiride to current insulin treatment led to better improvement in glycemic control with a significant smaller daily insulin dose, and the increases in the serum HMW adiponectin levels may directly contribute to improvement glycemic control.
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Affiliation(s)
- Chun-Jun Li
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - Jing-Yun Zhang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - De-Min Yu
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - Qiu-Mei Zhang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
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Morgan CL, Poole CD, Evans M, Barnett AH, Jenkins-Jones S, Currie CJ. What next after metformin? A retrospective evaluation of the outcome of second-line, glucose-lowering therapies in people with type 2 diabetes. J Clin Endocrinol Metab 2012; 97:4605-12. [PMID: 23076348 DOI: 10.1210/jc.2012-3034] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT After failure of metformin monotherapy, many second-line, glucose-lowering therapies are available to treat people with type 2 diabetes. OBJECTIVE The objective of the study was to compare clinical outcomes using common alternative regimens. DESIGN AND SETTING This was a retrospective cohort study using data from the U.K.-based General Practice Research Database. PATIENTS These were primary care patients with type 2 diabetes who had metformin monotherapy as their first treatment and who then initiated on relevant second-line, glucose-lowering regimens during the study period 2000-2010. A total of 27,457 patients were prescribed a second-line therapy, of whom 26,278 (95.7%) were prescribed a regimen with 1,000 or more observations. MAIN OUTCOME MEASURES All-cause mortality, major adverse cardiovascular events (MACE), cancer, and a combined end point of any of these were measured. Secondary end points were change in glycosylated hemoglobin between baseline and 12 months. Time to clinical end points was compared using Cox proportional hazards models. RESULTS Sulfonylurea monotherapy had significantly higher hazard ratios (HRs) for all-cause mortality (HR 1.459, 1.207-1.763); MACE (HR 1.578, 1.187-2.099); stroke (HR 1.444, 1.050-1.987); and the combined end point (HR 1.381, 1.194-1.597). Metformin plus pioglitazone had significantly lower adjusted HRs for all-cause mortality (HR 0.707, 0.515-0.970) and the combined end point (HR 0.747, 0.612-0.911). Mean glycosylated hemoglobin improved between baseline and 12 months for all regimens other than sulfonylurea monotherapy. CONCLUSION The combination of metformin plus pioglitazone appears to provide superior clinical outcomes compared with the most commonly used regimen, metformin plus sulfonylurea. Sulfonylurea monotherapy resulted in worse outcome.
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Affiliation(s)
- Christopher Ll Morgan
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff CF14 4UJ, United Kingdom
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Vigneri R, Vigneri P, Frittitta L. Basal insulin and cardiovascular and other outcomes. N Engl J Med 2012; 367:1763; author reply 1763-4. [PMID: 23113494 DOI: 10.1056/nejmc1210553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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