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Figueiredo ID, Lima TFO, Carlstrom PF, Assis RP, Brunetti IL, Baviera AM. Lycopene in Combination with Insulin Triggers Antioxidant Defenses and Increases the Expression of Components That Detoxify Advanced Glycation Products in Kidneys of Diabetic Rats. Nutrients 2024; 16:1580. [PMID: 38892513 PMCID: PMC11173891 DOI: 10.3390/nu16111580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Biochemical events provoked by oxidative stress and advanced glycation may be inhibited by combining natural bioactives with classic therapeutic agents, which arise as strategies to mitigate diabetic complications. The aim of this study was to investigate whether lycopene combined with a reduced insulin dose is able to control glycemia and to oppose glycoxidative stress in kidneys of diabetic rats. METHODS Streptozotocin-induced diabetic rats were treated with 45 mg/kg lycopene + 1 U/day insulin for 30 days. The study assessed glycemia, insulin sensitivity, lipid profile and paraoxonase 1 (PON-1) activity in plasma. Superoxide dismutase (SOD) and catalase (CAT) activities and the protein levels of advanced glycation end-product receptor 1 (AGE-R1) and glyoxalase-1 (GLO-1) in the kidneys were also investigated. RESULTS An effective glycemic control was achieved with lycopene plus insulin, which may be attributed to improvements in insulin sensitivity. The combined therapy decreased the dyslipidemia and increased the PON-1 activity. In the kidneys, lycopene plus insulin increased the activities of SOD and CAT and the levels of AGE-R1 and GLO-1, which may be contributing to the antialbuminuric effect. CONCLUSIONS These findings demonstrate that lycopene may aggregate favorable effects to insulin against diabetic complications resulting from glycoxidative stress.
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Affiliation(s)
- Ingrid Delbone Figueiredo
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara 14800-903, SP, Brazil; (I.D.F.); (T.F.O.L.); (P.F.C.); (R.P.A.); (I.L.B.)
| | - Tayra Ferreira Oliveira Lima
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara 14800-903, SP, Brazil; (I.D.F.); (T.F.O.L.); (P.F.C.); (R.P.A.); (I.L.B.)
| | - Paulo Fernando Carlstrom
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara 14800-903, SP, Brazil; (I.D.F.); (T.F.O.L.); (P.F.C.); (R.P.A.); (I.L.B.)
| | - Renata Pires Assis
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara 14800-903, SP, Brazil; (I.D.F.); (T.F.O.L.); (P.F.C.); (R.P.A.); (I.L.B.)
- Institute of Health Sciences, Paulista University (Unip), Araraquara 14804-300, SP, Brazil
| | - Iguatemy Lourenço Brunetti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara 14800-903, SP, Brazil; (I.D.F.); (T.F.O.L.); (P.F.C.); (R.P.A.); (I.L.B.)
| | - Amanda Martins Baviera
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara 14800-903, SP, Brazil; (I.D.F.); (T.F.O.L.); (P.F.C.); (R.P.A.); (I.L.B.)
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An J, Choi H, Choi J, Lim H, Huh W, Oh Y, Park JS, Han J, Lim S, Lim C, Kim T, Moon J, Youn H. Effect of the sodium-glucose cotransporter-2 inhibitor, DWP16001, as an add-on therapy to insulin for diabetic dogs: A pilot study. Vet Med Sci 2024; 10:e1454. [PMID: 38686463 PMCID: PMC11058604 DOI: 10.1002/vms3.1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of anti-hyperglycaemic agents. OBJECTIVE This study aimed to evaluate the safety and the adjuvant glycaemic control effect of an SGLT2 inhibitor, DWP16001, in diabetic dogs receiving insulin treatment. METHODS Nineteen diabetic dogs receiving insulin treatment (NPH, porcine lente and glargine insulin) were divided into two groups according to dosing frequency: DWP TOD group (n = 10) and DWP SID group (n = 9). In the DWP TOD group, 0.025 mg/kg of DWP16001 was administered once every 3 days, whereas, in the DWP SID group, 0.025 mg/kg of DWP16001 was administered once a day. Food intake was maintained during the trial period. Hypoglycaemia, ketoacidosis or unexpected life-threatening reactions were assessed as adverse effects before and after DWP16001 administration. We compared insulin requirement reduction and blood glucose level control between two groups. RESULTS No specific adverse effects were observed during the clinical trial, and haematological parameter remained unchanged. Moreover, the fasting glucose levels and daily insulin dose in the DWP TOD group were lower than the pre-administration values, but not significantly different for 8 weeks. Systolic blood pressure, fructosamine and insulin dose decreased significantly in the DWP SID group compared to the DWP TOD group at 8 weeks (p < 0.05) without affecting food consumption. Among these patients, 10 patients were monitored while receiving DWP16001 for 12 months (DWP TOD group n = 5, DWP SID group n = 5). The fasting glucose and fructosamine levels and daily insulin dose were reduced in both groups at 12 months compared with those before receiving DWP16001. CONCLUSION When DWP16001, an SGLT2 inhibitor, was supplied to dogs with type 1 diabetes, no adverse effects were observed, and it was confirmed that the administered insulin dose can be reduced in controlling blood glucose.
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Affiliation(s)
- Ju‐Hyun An
- Department of Veterinary Emergency and Critical Care Medicine and Institute of Veterinary ScienceCollege of Veterinary MedicineKangwon National UniversityChuncheon‐siRepublic of Korea
| | - Han‐Sol Choi
- Laboratory of Veterinary Internal MedicineDepartment of Veterinary Clinical ScienceCollege of Veterinary MedicineSeoul National UniversityGwanak‐guSeoulRepublic of Korea
| | - Ji‐Soo Choi
- Daewoong PharmaceuticalLife Science InstituteYonginGyeonggi‐doRepublic of Korea
| | - Hyun‐Woo Lim
- Daewoong PharmaceuticalLife Science InstituteYonginGyeonggi‐doRepublic of Korea
| | - Wan Huh
- Daewoong PharmaceuticalLife Science InstituteYonginGyeonggi‐doRepublic of Korea
| | - Ye‐In Oh
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Joon Seok Park
- Daewoong PharmaceuticalLife Science InstituteYonginGyeonggi‐doRepublic of Korea
| | - Jumi Han
- Daewoong PharmaceuticalLife Science InstituteYonginGyeonggi‐doRepublic of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Chae‐Young Lim
- Nowon 24 hours N Animal Medical CenterNowon‐guSeoulRepublic of Korea
| | - Tae‐Hee Kim
- Laboratory of Veterinary Internal MedicineDepartment of Veterinary Clinical ScienceCollege of Veterinary MedicineSeoul National UniversityGwanak‐guSeoulRepublic of Korea
| | - Jae‐Bong Moon
- Daewoong petBoneunsa‐roGangnam‐guSeoulRepublic of Korea
| | - Hwa‐Young Youn
- Laboratory of Veterinary Internal MedicineDepartment of Veterinary Clinical ScienceCollege of Veterinary MedicineSeoul National UniversityGwanak‐guSeoulRepublic of Korea
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Varney MJ, Benovic JL. The Role of G Protein-Coupled Receptors and Receptor Kinases in Pancreatic β-Cell Function and Diabetes. Pharmacol Rev 2024; 76:267-299. [PMID: 38351071 PMCID: PMC10877731 DOI: 10.1124/pharmrev.123.001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Type 2 diabetes (T2D) mellitus has emerged as a major global health concern that has accelerated in recent years due to poor diet and lifestyle. Afflicted individuals have high blood glucose levels that stem from the inability of the pancreas to make enough insulin to meet demand. Although medication can help to maintain normal blood glucose levels in individuals with chronic disease, many of these medicines are outdated, have severe side effects, and often become less efficacious over time, necessitating the need for insulin therapy. G protein-coupled receptors (GPCRs) regulate many physiologic processes, including blood glucose levels. In pancreatic β cells, GPCRs regulate β-cell growth, apoptosis, and insulin secretion, which are all critical in maintaining sufficient β-cell mass and insulin output to ensure euglycemia. In recent years, new insights into the signaling of incretin receptors and other GPCRs have underscored the potential of these receptors as desirable targets in the treatment of diabetes. The signaling of these receptors is modulated by GPCR kinases (GRKs) that phosphorylate agonist-activated GPCRs, marking the receptor for arrestin binding and internalization. Interestingly, genome-wide association studies using diabetic patient cohorts link the GRKs and arrestins with T2D. Moreover, recent reports show that GRKs and arrestins expressed in the β cell serve a critical role in the regulation of β-cell function, including β-cell growth and insulin secretion in both GPCR-dependent and -independent pathways. In this review, we describe recent insights into GPCR signaling and the importance of GRK function in modulating β-cell physiology. SIGNIFICANCE STATEMENT: Pancreatic β cells contain a diverse array of G protein-coupled receptors (GPCRs) that have been shown to improve β-cell function and survival, yet only a handful have been successfully targeted in the treatment of diabetes. This review discusses recent advances in our understanding of β-cell GPCR pharmacology and regulation by GPCR kinases while also highlighting the necessity of investigating islet-enriched GPCRs that have largely been unexplored to unveil novel treatment strategies.
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Affiliation(s)
- Matthew J Varney
- Department of Biochemistry and Molecular Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey L Benovic
- Department of Biochemistry and Molecular Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Sekiya M, Kainoh K, Saito K, Yamazaki D, Tsuyuzaki T, Chen W, Kobari Y, Nakata A, Babe H, Shimano H. C-Terminal Binding Protein 2 Emerges as a Critical Player Linking Metabolic Imbalance to the Pathogenesis of Obesity. J Atheroscler Thromb 2024; 31:109-116. [PMID: 37793810 PMCID: PMC10857841 DOI: 10.5551/jat.rv22014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023] Open
Abstract
Metabolism is one of the vital functions of cells and living organisms, and the systems to sense and respond to the metabolic alterations play pivotal roles in a plethora of biological processes, including cell proliferative activities, immune cell functions, aging processes, and neuronal functions. Recently, we have reported that a transcriptional cofactor, C-terminal binding protein 2 (CtBP2), serves as a critical metabolite sensor in this context. CtBP2 has a structural pocket called Rossmann fold to accommodate metabolites, and it has been reported to be activated upon binding to NADH/NAD+. Owing to its preferential binding affinity for NADH compared with NAD+, increased glycolysis activates CtBP2 by regenerating NADH from NAD+. Furthermore, we recently reported that fatty acyl-CoAs, metabolites accumulated under the condition of lipid overload, as represented by obesity, can inactivate CtBP2. These observations suggest that CtBP2 monitors not only redox state but also energy substrate preference in the maintenance of metabolic homeostasis. In line with these metabolite-sensing capabilities, CtBP2 is activated in healthy subjects to protect against metabolic disturbances, whereas inactivation of CtBP2 in obesity contributes to the pathogeneses of obesity.This metabolic system orchestrated by CtBP2 can provide a novel framework for understanding how cells maintain their homeostasis through coordination of metabolism, and CtBP2 incapacitation can be a critical point of the obesogenic cascade.
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Affiliation(s)
- Motohiro Sekiya
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenta Kainoh
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenji Saito
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Daichi Yamazaki
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomomi Tsuyuzaki
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Wanpei Chen
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuto Kobari
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ayumi Nakata
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Haruka Babe
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
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Eldor R, Francis BH, Fleming A, Neutel J, Homer K, Kidron M, Rosenstock J. Oral insulin (ORMD-0801) in type 2 diabetes mellitus: A dose-finding 12-week randomized placebo-controlled study. Diabetes Obes Metab 2023; 25:943-952. [PMID: 36281496 DOI: 10.1111/dom.14901] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
AIMS To assess the safety and efficacy of multiple daily doses of oral insulin (ORMD-0801) in subjects with type 2 diabetes (T2DM) over 12 weeks. MATERIALS AND METHODS Participants with T2DM on metformin or combination oral therapy with glycated haemoglobin (HbA1c) levels ≥ 7.5% (58 mmol/mol) were randomized to receive ORMD-0801 8 mg or 16 mg once (QD) or twice (BID) daily, or 32 mg QD, BID or three times daily (TID) over a 12-week period. RESULTS A total of 373 subjects were randomized to active treatment or placebo (~60% male, age ~ 56 years, HbA1c 9%-9.8%; 75-84 mmol/mol). Placebo-adjusted HbA1c changes from baseline to Week 12 were observed with ORMD-0801 8 mg BID (-7.15 ± 3.57 mmol/mol [-0.65% ± 0.33%]; P = 0.046). However, a significant site interaction was observed in two sites. After excluding these, HbA1c reduction was observed with 8 mg QD (-0.81 ± 0.37%; -8.89 ± 4.01 mmol/mol; P = 0.028, n = 15), 8 mg BID (-0.82 ± 0.37%; -8.95 ± 4.08 mmol/mol; P = 0.029, n = 17), 32 mg QD (-0.54 ± 0.26%; -5.89 ± 2.78 mmol/mol;P = 0.036, n = 69) and 32 mg BID (-0.53 ± 0.26%; -5.80 ± 2.83 mmol/mol; P = 0.042, n = 68). No effect was observed with 16 mg QD (0.25 ± 0.37%; 2.76 ± 3.99 mmol/mol; P = 0.48, n = 18), 16 mg BID (-0.36 ± 0.40%; -3.97 ± P = 0.36, n = 15) or 32 mg TID (-0.45 ± 0.27%, -4.89 ± 2.90 mmol/mol; P = 0.093, n = 69). Continuous glucose monitor and serum glucose measurements showed similar trends but were not significant. ORMD-0801 was safe, well tolerated and not associated with weight gain or hypoglycaemia. CONCLUSIONS Oral insulin (ORMD-0801) induced greater reductions in HbA1c when compared to placebo, and was safe and well tolerated in individuals with uncontrolled T2DM. The efficacy and safety findings support continued development of the 8-mg dose at bedtime, which is currently being evaluated in two Phase 3 trials.
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Affiliation(s)
- Roy Eldor
- Diabetes Unit, Institute for Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel & Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | | | - Joel Neutel
- Orange County Research Center, Tustin, California, USA
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Langerman C, Forbes A, Robert G. The experiences of insulin use among older people with Type 2 diabetes mellitus: A thematic synthesis. Prim Care Diabetes 2022; 16:614-626. [PMID: 36089508 DOI: 10.1016/j.pcd.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus is common in older people. Managing diabetes in older people can be challenging due to comorbidities and age-related disabilities, particularly in the context of insulin therapy. The purpose of this review is to explore older people's experiences of insulin use and to consider how these experiences might inform healthcare delivery. REVIEW METHODS A systematic review with thematic synthesis was conducted and reported in accordance with the PRISMA and ENTREQ statements. MEDLINE, Embase, PsycInfo, CINAHL and Web of Science were searched from 1985 to September 2019 with subsequent updates in December 2019 and June 2022. Included studies were quality appraised, findings tabulated, and results used to inform an integrated thematic synthesis. RESULTS Fourteen studies that reported insulin experiences with 274 patients aged 60 years and over were included; nine of the studies were qualitative and five used questionnaires surveys. Seven themes emerged that were grouped into treatment-related factors (physical impact of insulin, physical capacity to administer insulin, insulin self-management behaviours) and person-centred factors (emotional factors, social factors, daily living, and personal knowledge/beliefs). Three analytical themes to guide clinical practice were derived from the data: addressing physical capacity and ability, supporting social and emotional issues and improving interactions with healthcare professionals. CONCLUSION The review indicates issues surrounding the technical aspects of insulin administration, side effects of treatment and reactions to insulin administration are common amongst older people. However, research evidence is limited, and there is an urgent need for empirical, participatory research with older insulin dependent adults with type 2 diabetes. IMPLICATIONS FOR PRACTICE Healthcare professionals need to ensure that older type 2 diabetes people on insulin are actively involved in their own care, to allow their insulin regimens to be personalised and aligned with their goals and expectations. Tailored educational interventions to reduce treatment hazards and promote physical and psychological wellbeing are also needed for this population.
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Affiliation(s)
- Chaya Langerman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
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Bensignor MO, Wolf JM, Rudser KD, Kelly AS, Arslanian S. Glucagon-like peptide-1 receptor agonist prescribing patterns in adolescents with type 2 diabetes. Diabetes Obes Metab 2022; 24:1380-1384. [PMID: 35491535 PMCID: PMC9177669 DOI: 10.1111/dom.14681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Megan O. Bensignor
- Center for Pediatric Obesity Medicine, Department of PediatricsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jack M. Wolf
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Kyle D. Rudser
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of PediatricsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology and MetabolismUPMC Children's Hospital, University of PittsburghPittsburghPennsylvaniaUSA
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Huang D, Cui C, Zheng Q, Li Y, Liu Y, Hu Y, Wang Y, Liu R, Liu L. Quantitative Analysis of Myocardial Work by Non-invasive Left Ventricular Pressure-Strain Loop in Patients With Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:733339. [PMID: 34660736 PMCID: PMC8517392 DOI: 10.3389/fcvm.2021.733339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a common risk factor for cardiovascular diseases. The aims of this study were to evaluate the changes in the left ventricular myocardial work in T2DM patients using the left ventricular pressure-strain loop (PSL) technique, and to explore the risk factors for the left ventricular myocardial work impairment. Methods: Fifty patients with T2DM and 50 normal controls (NCs) were included in the study. In addition to conventional echocardiography and two-dimensional speckle tracking echocardiography, the left ventricular myocardial work parameters were measured using PSL technology. Results: The absolute value for global longitudinal strain (GLS), global work index (GWI) and, global constructive work (GCW) were significantly decreased in the T2DM group (P < 0.05), while the left ventricular ejection fraction (LVEF) was not significantly different between the T2DM and NC groups. Multivariable linear regression analysis showed that hemoglobin A1c (HbA1c) was independently related to GWI (β = −0.452, P < 0.05), while HbA1c and the diabetes duration were independently related to GCW (β = −0.393, P < 0.05 and β = −0.298, P < 0.05, respectively). Conclusions: Changes in the left ventricular myocardial systolic function in T2DM patients were identified using PSL technology. HbA1c was shown to be an independent risk factor affecting GWI, while HbA1c and diabetes duration were demonstrated to be independent risk factors affecting GCW.
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Affiliation(s)
- Danqing Huang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Cunying Cui
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zheng
- School of Computer and Control Engineering, Yantai University, Yantai, China
| | - Yanan Li
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruijie Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Affiliation(s)
- Jelena Kolic
- Life Sciences Institute, Diabetes Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - James D Johnson
- Life Sciences Institute, Diabetes Research Group, University of British Columbia, Vancouver, British Columbia, Canada.
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10
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Riddle MC. The current schemes of insulin therapy: Pro and contra. Diabetes Res Clin Pract 2021; 175:108817. [PMID: 33865916 DOI: 10.1016/j.diabres.2021.108817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
Insulin regimens have been evolving for a century. The schemes used for type 1 (T1D) and type 2 (T2D) diabetes differ due to differences in pathophysiology but share important features. Insulin is required for both types of diabetes when other means of controlling glucose are insufficient. For T1D this requires multiple daily injections or continuous subcutaneous infusion assisted by CGM, whereas in early T2D basal insulin together with oral agents or GLP-1RA is usually effective. In both cases current schemes typically maintain HbA1c levels between 7 and 8%, a range that limits but does not eliminate the long-term complications of diabetes, but do not restore glycemic control to a fully protective level. Inability to control postprandial hyperglycemia without problematic weight gain and hypoglycemia is a leading obstacle in both T1D and long-duration T2D. A greater share of prandial dosing decisions will have to be provided by smart electronic systems. Further changes in the structure or formulation of insulin are of uncertain potential, but schemes including delivery of amylin, GLP-1, and glucagon show promise. More reliable access to insulins, delivery devices, and capable medical advisors will be needed to optimize replacement of this essential hormone.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Oregon Health & Science University L-345, 3181 SW Sam Jackson Park Road, Portland, OR, United States.
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11
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Storck LJ, Meffert PJ, Rausch J, Gärtner S, Aghdassi AA, Kühn JP, Kraft M, Pietzner M, Lerch MM, Steveling A. Efficiency of a 15-Week Weight-Loss Program, Including a Low-Calorie Formula Diet, on Glycemic Control in Patients with Type 2 Diabetes Mellitus and Overweight or Obesity. Obes Facts 2021; 14:1-11. [PMID: 33601371 PMCID: PMC7983589 DOI: 10.1159/000511453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patients who are overweight or obese have an increased risk of developing type 2 diabetes mellitus (T2DM). Weight loss can have a positive effect on glycemic control. OBJECTIVE We aimed to investigate glycemic control in patients with T2DM and overweight or obesity during a structured weight-loss program. METHODS This was a prospective, interventional study. We recruited 36 patients (14 men and 22 women) with a median age of 58.5 years and median body mass index (BMI) of 34.1, to a 15-week structured weight-loss program with a low-calorie (800 kcal) formula diet for 6 weeks. The primary end point, HbA1c level, and secondary end points, anthropometric data, medication, and safety, were assessed weekly. Laboratory values and quality of life were assessed at baseline and after 15 weeks. RESULTS HbA1c decreased from 7.3% at baseline to 6.5% at 15 weeks (p < 0.001), median body weight by 11.9 kg (p < 0.001), median BMI by 4.3 (p < 0.001) and median waist circumference by 11.0 cm (p < 0.001). Two participants discontinued insulin therapy, 4 could reduce their dosage of oral antidiabetic agents, and 6 completely discontinued their antidiabetic medication. Insulin dose decreased from 0.63 (0.38-0.89) to 0.39 (0.15-0.70) units/kg body weight (p < 0.001). No patient experienced hypoglycemic episodes or hospital emergency visits. Triglycerides and total cholesterol decreased as well as surrogate markers of liver function. However, the levels of high-density and low-density lipoprotein cholesterol (HDL-C and LDL-C) as well as uric acid remain unchanged. Regarding quality of life, the median physical health score increased from 44.5 (39.7-51.4) at baseline to 48.0 (43.1-55.3; p = 0.007), and the median mental health score decreased from 42.1 (36.1-46.7) to 37.4 (30.3-43.7; p = 0.004). CONCLUSIONS A structured weight-loss program is effective in the short term in reducing HbA1c, weight, and antidiabetic medication in patients with T2DM who are overweight or obese. Levels of HDL-C and LDL-C were not affected by short-term weight loss. The decline in mental health and the long-term effects of improved glycemic control require further trials.
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Affiliation(s)
- Lena J Storck
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Peter J Meffert
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
- Corvus, Statistical Consulting, Altkalen, Germany
| | - Janine Rausch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- Institute of Radiology, Carl-Gustav Carus University Dresden, Dresden, Germany
| | - Matthias Kraft
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- Medizinische Klinik I, Vinzentius-Krankenhaus Landau, Landau, Germany
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany,
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
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12
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Chatterjee S, Bhushan Sharma C, Lavie CJ, Adhikari A, Deedwania P, O'keefe JH. Oral insulin: an update. MINERVA ENDOCRINOL 2020; 45:49-60. [DOI: 10.23736/s0391-1977.19.03055-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Gutierres VO, Assis RP, Arcaro CA, Oliveira JO, Lima TFO, Beretta ALRZ, Costa PI, Baviera AM, Brunetti IL. Curcumin improves the effect of a reduced insulin dose on glycemic control and oxidative stress in streptozotocin-diabetic rats. Phytother Res 2019; 33:976-988. [PMID: 30656757 DOI: 10.1002/ptr.6291] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 12/14/2022]
Abstract
Insulin with natural antioxidants is emerging as a combination treatment for diabetes mellitus that attempts to exert effective glycemic control without adverse effects. The present study aimed to investigate the additive effects on metabolic disturbances, oxidative damage, and antioxidant defenses in streptozotocin-diabetic rats treated with curcumin and a reduced insulin dose. The best results were obtained in the treatment of diabetic rats with 4-U/day insulin; however, the glycemia levels in these rats were lower than those in normal rats, indicating a risk of hypoglycemia. Isolated treatments using curcumin or insulin in a reduced dose (1 U/day) decreased glycemia, dyslipidemia, and biomarkers of liver and kidney damage and increased the activity of hepatic antioxidants (superoxide dismutase and glutathione peroxidase), however, only to a lesser extent than 4-U/day insulin, without improvements in catalase activity or plasma lipid peroxidation. Decreases in glycemia, dyslipidemia, and tissue damage markers were more evident in the curcumin + 1-U/day insulin treatment than those seen in isolated treatments. The activity of hepatic antioxidants, including catalase, was further increased, and biomarkers of oxidative damage were decreased. Curcumin with a reduced insulin dose appears to be a promising strategy for combating the complications associated with diabetes and oxidative stress.
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Affiliation(s)
- Vânia Ortega Gutierres
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil.,Graduate Program in Biomedical Sciences Hermínio Ometto University Center, UNIARARAS, 7 Av. Dr. Maximiliano Baruto, 500, CEP 13607-339, Araras, SP
| | - Renata Pires Assis
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Carlos Alberto Arcaro
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Juliana Oriel Oliveira
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Tayra Ferreira Oliveira Lima
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Ana Laura Remédio Zeni Beretta
- Graduate Program in Biomedical Sciences Hermínio Ometto University Center, UNIARARAS, 7 Av. Dr. Maximiliano Baruto, 500, CEP 13607-339, Araras, SP
| | - Paulo Inácio Costa
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Amanda Martins Baviera
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Iguatemy Lourenço Brunetti
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
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14
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Saslow LR, Summers C, Aikens JE, Unwin DJ. Outcomes of a Digitally Delivered Low-Carbohydrate Type 2 Diabetes Self-Management Program: 1-Year Results of a Single-Arm Longitudinal Study. JMIR Diabetes 2018; 3:e12. [PMID: 30291081 PMCID: PMC6238840 DOI: 10.2196/diabetes.9333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/22/2018] [Accepted: 03/25/2018] [Indexed: 02/01/2023] Open
Abstract
Background Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, stroke, and dementia, and its annual global costs are more than US $800 billion. Although typically considered a progressive, nonreversible disease, some researchers and clinicians now argue that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. Objective Our objective was to evaluate the 1-year outcomes of the digitally delivered Low-Carb Program, a nutritionally focused, 10-session educational intervention for glycemic control and weight loss for adults with type 2 diabetes. The program reinforces carbohydrate restriction using behavioral techniques including goal setting, peer support, and behavioral self-monitoring. Methods The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. From adults with type 2 diabetes who had joined the program and had a complete baseline dataset, we randomly selected participants to be followed for 1 year (N=1000; mean age 56.1, SD 15.7 years; 59.30% (593/1000) women; mean glycated hemoglobin A1c (HbA1c) 7.8%, SD 2.1%; mean body weight 89.6 kg, SD 23.1 kg; taking mean 1.2, SD 1.01 diabetes medications). Results Of the 1000 study participants, 708 (70.80%) individuals reported outcomes at 12 months, 672 (67.20%) completed at least 40% of the lessons, and 528 (52.80%) completed all lessons of the program. Of the 743 participants with a starting HbA1c at or above the type 2 diabetes threshold of 6.5%, 195 (26.2%) reduced their HbA1c to below the threshold while taking no glucose-lowering medications or just metformin. Of the participants who were taking at least one hypoglycemic medication at baseline, 40.4% (289/714) reduced one or more of these medications. Almost half (46.40%, 464/1000) of all participants lost at least 5% of their body weight. Overall, glycemic control and weight loss improved, especially for participants who completed all 10 modules of the program. For example, participants with elevated baseline HbA1c (≥7.5%) who engaged with all 10 weekly modules reduced their HbA1c from 9.2% to 7.1% (P<.001) and lost an average of 6.9% of their body weight (P<.001). Conclusions Especially for participants who fully engage, an online program that teaches a carbohydrate-reduced diet to adults with type 2 diabetes can be effective for glycemic control, weight loss, and reducing hypoglycemic medications.
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Affiliation(s)
- Laura R Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States
| | - David J Unwin
- Principal in General Practice, The Norwood Surgery, Southport, United Kingdom
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15
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Bumbu A, Moutairou A, Matar O, Fumeron F, Velho G, Riveline JP, Gautier JF, Marre M, Roussel R, Potier L. Non-severe hypoglycaemia is associated with weight gain in patients with type 1 diabetes: Results from the Diabetes Control and Complication Trial. Diabetes Obes Metab 2018; 20:1289-1292. [PMID: 29272063 DOI: 10.1111/dom.13197] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/07/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
It is unclear whether the frequent non-severe episodes of hypoglycaemia observed during intensive glucose control in individuals with type 1 diabetes (T1D) are associated with subsequent weight gain. We analysed the association between non-severe hypoglycaemia and weight gain in 1441 Diabetes Control and Complication Trial (DCCT) participants. Non-severe hypoglycaemia was assessed by hypo-score (ie, number of blood glucose values <70 mg/dL divided by the total number of measurements during the DCCT quarterly visits). Significant associations were observed between the hypo-score and annual and total weight gain. The annual weight gain by hypo-score tertiles was 0.8 ± 1.2 (T1), 1.3 ± 1.5 (T2) and 1.4 ± 1.3 kg/y (T3), P < .001 for T2 and T3 vs T1, and for T3 vs T2. The odds ratio for a weight gain of 1.8 kg/y was 2.14 (95% CI, 1.56-2.93) for T2, and 2.53 (95%CI, 1.85-3.45) for T3 vs T1. These differences in weight gain and in risk of weight gain remained significant after adjustment for sex, age, duration of diabetes, HbA1c at baseline and treatment arms. In conclusion, our analysis shows a significant association between non-severe hypoglycaemia and weight gain in individuals with T1D from the DCCT.
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Affiliation(s)
- Anisoara Bumbu
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, AP-HP, Paris, France
| | - Abdul Moutairou
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Odette Matar
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, AP-HP, Paris, France
| | - Frédéric Fumeron
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Gilberto Velho
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Jean-Pierre Riveline
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetes and Endocrinology, DHU FIRE, Lariboisière Hospital, Paris, France
| | - Jean-François Gautier
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetes and Endocrinology, DHU FIRE, Lariboisière Hospital, Paris, France
| | - Michel Marre
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, AP-HP, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Ronan Roussel
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, AP-HP, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Louis Potier
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, AP-HP, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
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16
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Raben AT, Marshe VS, Chintoh A, Gorbovskaya I, Müller DJ, Hahn MK. The Complex Relationship between Antipsychotic-Induced Weight Gain and Therapeutic Benefits: A Systematic Review and Implications for Treatment. Front Neurosci 2018; 11:741. [PMID: 29403343 PMCID: PMC5786866 DOI: 10.3389/fnins.2017.00741] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Antipsychotic-induced weight gain (AIWG) and other adverse metabolic effects represent serious side effects faced by many patients with psychosis that can lead to numerous comorbidities and which reduce the lifespan. While the pathophysiology of AIWG remains poorly understood, numerous studies have reported a positive association between AIWG and the therapeutic benefit of antipsychotic medications. Objectives: To review the literature to (1) determine if AIWG is consistently associated with therapeutic benefit and (2) investigate which variables may mediate such an association. Data Sources: MEDLINE, Google Scholar, Cochrane Database and PsycINFO databases were searched for articles containing all the following exploded MESH terms: schizophrenia [AND] antipsychotic agents/neuroleptics [AND] (weight gain [OR] lipids [OR] insulin [OR] leptin) [AND] treatment outcome. Results were limited to full-text, English journal articles. Results: Our literature search uncovered 31 independent studies which investigated an AIWG-therapeutic benefit association with a total of 6063 enrolled individuals diagnosed with schizophrenia or another serious mental illness receiving antipsychotic medications. Twenty-two studies found a positive association while, 10 studies found no association and one study reported a negative association. Study variables including medication compliance, sex, ethnicity, or prior antipsychotic exposure did not appear to consistently affect the AIWG-therapeutic benefit relationship. In contrast, there was some evidence that controlling for baseline BMI/psychopathology, duration of treatment and specific agent studied [i.e., olanzapine (OLZ) or clozapine (CLZ)] strengthened the relationship between AIWG and therapeutic benefit. Limitations: There were limitations of the reviewed studies in that many had small sample sizes, and/or were retrospective. The heterogeneity of the studies also made comparisons difficult and publication bias was not controlled for. Conclusions: An AIWG-therapeutic benefit association may exist and is most likely to be observed in OLZ and CLZ-treated patients. The clinical meaningfulness of this association remains unclear and weight gain and other metabolic comorbidities should be identified and treated to the same targets as the general population. Further research should continue to explore the links between therapeutic benefit and metabolic health with emphasis on both pre-clinical work and well-designed prospective clinical trials examining metabolic parameters associated, but also occurring independently to AIWG.
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Affiliation(s)
- Alex T Raben
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victoria S Marshe
- Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Araba Chintoh
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ilona Gorbovskaya
- Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret K Hahn
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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17
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Brown A, Guess N, Dornhorst A, Taheri S, Frost G. Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done? Diabetes Obes Metab 2017; 19:1655-1668. [PMID: 28509408 DOI: 10.1111/dom.13009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
Abstract
Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin-associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch-up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co-morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.
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Affiliation(s)
- Adrian Brown
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
| | - Nicola Guess
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Anne Dornhorst
- Department of Metabolic Medicine, Imperial College London, London, UK
| | - Shahrad Taheri
- Department of Metabolic Medicine, Imperial College London, London, UK
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine, New York, New York
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine, Doha, Qatar
| | - Gary Frost
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
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18
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Abstract
Insulin remains indispensable to the treatment of diabetes, but its availability in injectable form only has hampered its timely and broader use. The development of an oral insulin remains an ultimate goal to both enhance ease of use, and to provide therapeutic advantages rooted in its direct delivery to the portal vein and liver. By mimicking the physiological path taken by pancreatic insulin, oral insulin is expected to have a distinct effect on the hepatic aspect of carbohydrate metabolism, hepatic insulin resistance, and, at the same time, avoid hyperinsulinemia and minimize the risk of hypoglycemia. With oral insulin approaching late stages of development, the goal of this review is to examine oral insulin in a physiological context and report on recent progress in its development.
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Affiliation(s)
- Ehud Arbit
- Oramed Pharmaceuticals, Inc. Jerusalem, Israel
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19
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Cichosz SL, Lundby-Christensen L, Johansen MD, Tarnow L, Almdal TP, Hejlesen OK. Prediction of excessive weight gain in insulin treated patients with type 2 diabetes. J Diabetes 2017; 9:325-331. [PMID: 27130075 DOI: 10.1111/1753-0407.12418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/20/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Weight gain is an ongoing challenge when initiating insulin therapy in patients with type 2 diabetes mellitus (T2DM). However, if prediction of insulin-associated weight gain was possible on an individual level, targeted initiatives could be implemented to reduce weight gain. The aim of the present study was to identify predictors of weight gain in insulin-treated patients with T2DM. METHODS In all, 412 individuals with T2DM were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analog treatment regimens (biphasic, aspart, detemir). Participants with excessive weight gain were defined as the group with weight gain in the 4th quartile (>6.2 kg).We developed a pattern classification method to predict individuals prone to excessive weight gain. RESULTS Over the 18-month treatment period, median weight gain among all 412 patients was 2.4 kg (95% prediction interval [PI] -5.6, 12.4 kg), whereas median weight gain for those in the upper 4th quartile (n = 103) was 8.9 kg (95% PI 6.3, 15.2 kg). No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a receiver operating characteristic area under the curve of 0.80. CONCLUSIONS We have developed a prediction model that could help identify a substantial proportion of individuals with T2DM prone to large weight gain during insulin therapy.
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Affiliation(s)
- Simon Lebech Cichosz
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Louise Lundby-Christensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology PE, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mette D Johansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lise Tarnow
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Nordsjaellands Hospital, Hilleroed, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
- Department of Endocrinology PE, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Ole K Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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20
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Zhang T, Zhang H, Li Y, Li S, Fernandez C, Bazzano L, He J, Xue F, Chen W. Long-term Impact of Temporal Sequence from Childhood Obesity to Hyperinsulinemia on Adult Metabolic Syndrome and Diabetes: The Bogalusa Heart Study. Sci Rep 2017; 7:43422. [PMID: 28230104 PMCID: PMC5322533 DOI: 10.1038/srep43422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/24/2017] [Indexed: 01/21/2023] Open
Abstract
This study aims to delineate the temporal relations between body mass index (BMI) and insulin in childhood and their impact on adult metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM).The longitudinal cohort consisted of 609 whites and 339 blacks who had BMI and fasting insulin measured twice in childhood (mean age = 10.5 years at baseline and 15.9 years at follow-up). Incident MetS and T2DM were identified in adulthood (mean age = 30.5 years). Cross-lagged panel and mediation analysis models were used. After adjusting for age, race, gender, and follow-up years, the cross-lagged path coefficient of BMI → insulin (β = 0.326, p < 0.001) was significantly greater than that of insulin → BMI (β = −0.023, p = 0.207) in childhood, with p < 0.001 for the difference in βs. The path coefficient for BMI → insulin was significantly greater in MetS than in non-MetS groups (0.510 vs 0.190, p < 0.001), and greater in hyperglycemia than in normoglycemia groups (0.503 vs 0.285, p = 0.026). The mediation effect of childhood insulin on the BMI-MetS and BMI-hyperglycemia associations was estimated at 19.2% (p < 0.001) and 18.3% (p < 0.001), respectively. These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this one-directional relation plays a significant role in the development of MetS and T2DM in adult life.
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Affiliation(s)
- Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Huijie Zhang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.,Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China
| | - Ying Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.,Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Shengxu Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Camilo Fernandez
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Lydia Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Zhang Q, Zhao X, Chen M, Fang Z, Chen Y, Wang Y. Weight gain and changes in plasma adiponectin and leptin concentrations after 12-month insulin intensive therapy for Chinese male patients with newly diagnosed type 2 diabetes. Obes Res Clin Pract 2016; 10:553-563. [DOI: 10.1016/j.orcp.2015.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 08/17/2015] [Accepted: 09/08/2015] [Indexed: 12/15/2022]
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22
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Zhang T, Zhang H, Li Y, Sun D, Li S, Fernandez C, Qi L, Harville E, Bazzano L, He J, Xue F, Chen W. Temporal Relationship Between Childhood Body Mass Index and Insulin and Its Impact on Adult Hypertension: The Bogalusa Heart Study. Hypertension 2016; 68:818-23. [PMID: 27432860 PMCID: PMC4982798 DOI: 10.1161/hypertensionaha.116.07991] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 12/22/2022]
Abstract
Although obesity and insulin resistance are closely correlated, their temporal sequences in early life and influence on adult hypertension are largely unknown. This study aims to delineate the temporal relationship patterns between body mass index (BMI) and insulin in childhood and their impact on adult hypertension. The longitudinal cohort consisted of 990 adults (630 whites and 360 blacks) who had BMI and fasting insulin measured twice 5.4 years apart in childhood (mean age, 10.5 years at baseline and 15.9 years at follow-up) and blood pressure measured 14.7 years later in adulthood (mean age, 30.5 years). Cross-lagged panel and mediation analysis models were used to examine the temporal relationship between childhood BMI and insulin and its impact on adult hypertension. After adjusting for age, race, sex, and follow-up years, the cross-lagged path coefficient (β=0.33; P<0.001) from baseline BMI to follow-up insulin was significantly greater than the path coefficient (β=-0.02; P>0.05) from baseline insulin to follow-up BMI in childhood with P<0.001 for the difference in βs. Blacks and whites showed similar patterns of the temporal relationship. The path coefficient (β=0.59; P<0.001) from BMI to insulin in the hypertensive group was significantly greater than that (β=0.24; P<0.001) in normotensive group, with P<0.001 for the difference in βs between these 2 groups. The mediation effect of childhood insulin on the childhood BMI-adult hypertension association was estimated at 21.1% (P<0.001). These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this 1-directional relation plays a role in the development of hypertension.
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Affiliation(s)
- Tao Zhang
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Huijie Zhang
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Ying Li
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Dianjianyi Sun
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Shengxu Li
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Camilo Fernandez
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Lu Qi
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Emily Harville
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Lydia Bazzano
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Jiang He
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Fuzhong Xue
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
| | - Wei Chen
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
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Farshchi A, Aghili R, Oskuee M, Rashed M, Noshad S, Kebriaeezadeh A, Kia M, Esteghamati A. Biphasic insulin Aspart 30 vs. NPH plus regular human insulin in type 2 diabetes patients; a cost-effectiveness study. BMC Endocr Disord 2016; 16:35. [PMID: 27278922 PMCID: PMC4899904 DOI: 10.1186/s12902-016-0116-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/31/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the efficacy, safety, costs, and cost-effectiveness of biphasic insulin aspart 30 (BIAsp 30) with NPH plus regular human insulin (NPH/Reg) in patients with type 2 diabetes mellitus (T2DM). METHODS It was a Single-center, parallel-group, randomized, clinical trial (Trial Registration: NCT01889095). One hundred and seventy four T2DM patients with poorly controlled diabetes (HbA1c ≥ 8 % (63.9 mmol/mol)) were randomly assigned to trial arms (BIAsp 30 and NPH/Reg) and were followed up for 48 weeks. BIAsp 30 was started at an initial dose of 0.2-0.6 IU/Kg in two divided doses and was titrated according to the glycemic status of the patient. Similarly, NPH/Reg insulin was initiated at a dose of 0.2-0.6 IU/Kg with a 2:1 ratio and was subsequently titrated. Level of glycemic control, hypoglycemic events, direct and indirect costs, quality adjusted life year (QALY) and incremental cost-effectiveness ratio have been assessed. RESULTS HbA1c, Fasting plasma glucose (FPG), and two-hour post-prandial glucose (PPG) were improved in both groups during the study (P < 0.05 for all analyses). Lower frequencies of minor, major, and nocturnal hypoglycemic episodes were observed with BIAsp 30 (P < 0.05). Additionally, BIAsp 30 was associated with less weight gain and also higher QALYs (P < 0.05). Total medical and non-medical costs were significantly lower with BIAsp 30 as compared with NPH/Reg (930.55 ± 81.43 USD vs. 1101.24 ± 165.49 USD, P = 0.004). Moreover, BIAsp 30 showed lower ICER as a dominant alternative. CONCLUSIONS Despite being more expensive, BIAsp 30 offers the same glycemic control as to NPH/Reg dose-dependently and also appears to cause fewer hypoglycemic events and to be more cost-effective in Iranian patients with type 2 diabetes.
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Affiliation(s)
- Amir Farshchi
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Rokhsareh Aghili
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Oskuee
- Pharmaceutical Sciences branch, Islamic Azad University, Tehran, Iran
| | - Marjan Rashed
- Pharmaceutical Sciences branch, Islamic Azad University, Tehran, Iran
| | - Sina Noshad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kia
- Department of Internal Medicine, Dr. Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
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Atkin S, Javed Z, Fulcher G. Insulin degludec and insulin aspart: novel insulins for the management of diabetes mellitus. Ther Adv Chronic Dis 2015; 6:375-88. [PMID: 26568812 PMCID: PMC4622316 DOI: 10.1177/2040622315608646] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with type 2 diabetes mellitus require insulin as disease progresses to attain or maintain glycaemic targets. Basal insulin is commonly prescribed initially, alone or with one or more rapid-acting prandial insulin doses, to limit mealtime glucose excursions (a basal-bolus regimen). Both patients and physicians must balance the advantages of improved glycaemic control with the risk of hypoglycaemia and increasing regimen complexity. The rapid-acting insulin analogues (insulin aspart, insulin lispro and insulin glulisine) all have similar pharmacokinetic and pharmacodynamic characteristics and clinical efficacy/safety profiles. However, there are important differences in the pharmacokinetic and pharmacodynamic profiles of basal insulins (insulin glargine, insulin detemir and insulin degludec). Insulin degludec is an ultra-long-acting insulin analogue with a flat and stable glucose-lowering profile, a duration of action exceeding 30 h and less inter-patient variation in glucose-lowering effect than insulin glargine. In particular, the chemical properties of insulin degludec have allowed the development of a soluble co-formulation with prandial insulin aspart (insulin degludec/insulin aspart) that provides basal insulin coverage for at least 24 h with additional mealtime insulin for one or two meals depending on dose frequency. Pharmacokinetic and pharmacodynamic studies have shown that the distinct, long basal glucose-lowering action of insulin degludec and the prandial glucose-lowering effect of insulin aspart are maintained in the co-formulation. Evidence from pivotal phase III clinical trials indicates that insulin degludec/insulin aspart translate into sustained glycaemic control with less hypoglycaemia and the potential for a simpler insulin regimen with fewer daily injections.
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Affiliation(s)
- Stephen Atkin
- Weill Cornell Medical College Qatar, Education City, PO Box 24144, Doha, Qatar
| | - Zeeshan Javed
- The Michael White Centre for Diabetes and Endocrinology, Hull Royal Infirmary, Hull, UK
| | - Gregory Fulcher
- Department of Endocrinology, University of Sydney, Royal North Shore Hospital, Sydney, Australia
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25
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Frikke-Schmidt H, Pedersen TÅ, Fledelius C, Olsen GS, Bouman SD, Fitch M, Hellerstein M. Treatment of diabetic rats with insulin or a synthetic insulin receptor agonist peptide leads to divergent metabolic responses. Diabetes 2015; 64:1057-66. [PMID: 25315006 DOI: 10.2337/db14-0914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In addition to lowering of blood glucose, treatment with insulin also induces lipid synthesis and storage. Patients with type 2 diabetes often suffer from lipid-related comorbidities including dyslipidemia, obesity, and fatty liver disease. We examined here in two separate studies changes in lipid dynamics in Zucker diabetic fatty (ZDF) rats, in response to 7 days of treatment with either insulin or the insulin receptor agonist peptide S597. In concert with blood glucose normalization, the treated rats displayed large increases in hepatic de novo lipid synthesis and deposition of newly synthesized lipids in adipose tissue depots, accompanied by weight gain and expansion of adipose depots. In both treatment groups, heavy water labeling revealed that after 2 h (study A), de novo lipogenesis was responsible for 80% of newly stored hepatic triglyceride (TG)-palmitate, and after 5 days (study B), ∼60% of newly deposited TG-palmitate in adipose tissues originated from this pathway. Interestingly, in both studies, treatment with the insulin mimetic peptide resulted in significantly lower blood TG levels, plasma TG production rates, and hepatic de novo synthesized fatty acid in plasma TG compared with insulin. There were no differences in plasma TG turnover (clearance rate) in response to either treatment, consistent with differential actions on the liver. These results show that in ZDF rats, treatment with a synthetic insulin-receptor-activating peptide or with insulin to lower blood glucose is accompanied by different effects on hepatic lipid anabolism and blood TG profiles.
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Affiliation(s)
- Henriette Frikke-Schmidt
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA Department of Insulin Biology, Novo Nordisk, Maaloev, Denmark
| | | | | | - Grith S Olsen
- Department of Insulin Biology, Novo Nordisk, Maaloev, Denmark
| | - Stephan D Bouman
- Department of Insulin Pharmacology, Novo Nordisk, Maaloev, Denmark
| | - Mark Fitch
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA KineMed, Inc., Emeryville, CA
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Gulati V, Gulati P, Harding IH, Palombo EA. Exploring the anti-diabetic potential of Australian Aboriginal and Indian Ayurvedic plant extracts using cell-based assays. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:8. [PMID: 25652009 PMCID: PMC4328078 DOI: 10.1186/s12906-015-0524-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 01/15/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Plant-derived compounds have been used clinically to treat type 2 diabetes for many years as they also exert additional beneficial effects on various other disorders. The aim of the present study was to investigate the possible mechanism of anti-diabetic activity of twelve (seven Australian Aboriginal and five Indian Ayurvedic) plant extracts. METHODS The ethanolic plant extracts were investigated for glucose uptake and adipogenesis in murine 3T3-L1 adipocytes. Cytotoxicity studies were also carried out against two cancerous cell lines, HeLa and A549, to investigate the potential anti-cancer activities of the extracts. RESULTS Of the seven Australian Aboriginal plant extracts tested, only Acacia kempeana and Santalum spicatum stimulated glucose uptake in adipocytes. Among the five Indian Ayurvedic plant extracts, only Curculigo orchioides enhanced glucose uptake. With respect to adipogenesis, the Australian plants Acacia tetragonophylla, Beyeria leshnaultii and Euphorbia drumondii and the Indian plants Pterocarpus marsupium, Andrographis paniculata and Curculigo orchioides reduced lipid accumulation in differentiated adipocytes. Extracts of Acacia kempeana and Acacia tetragonophylla showed potent and specific activity against HeLa cells. CONCLUSIONS The findings suggest that the plant extracts exert their anti-diabetic properties by different mechanisms, including the stimulation of glucose uptake in adipocytes, inhibition of adipogenesis or both. Apart from their anti-diabetic activities, some of the extracts have potential for the development of chemotherapeutic agents for the treatment of cervical cancer.
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Affiliation(s)
- Vandana Gulati
- Department of Chemistry and Biotechnology, Faculty of Science, Engineering and Technology, Swinburne University of Technology, John Street, PO Box 218, Hawthorn, 3122, Victoria, Australia.
| | - Pankaj Gulati
- Department of Chemistry and Biotechnology, Faculty of Science, Engineering and Technology, Swinburne University of Technology, John Street, PO Box 218, Hawthorn, 3122, Victoria, Australia.
| | - Ian H Harding
- Department of Chemistry and Biotechnology, Faculty of Science, Engineering and Technology, Swinburne University of Technology, John Street, PO Box 218, Hawthorn, 3122, Victoria, Australia.
| | - Enzo A Palombo
- Department of Chemistry and Biotechnology, Faculty of Science, Engineering and Technology, Swinburne University of Technology, John Street, PO Box 218, Hawthorn, 3122, Victoria, Australia.
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27
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Domeki N, Matsumura M, Monden T, Nakatani Y, Aso Y. A Randomized Trial of Step-up Treatment with Premixed Insulin Lispro-50/50 vs. Aspart-70/30 in Patients with Type 2 Diabetes Mellitus. Diabetes Ther 2014; 5:403-13. [PMID: 25159168 PMCID: PMC4269650 DOI: 10.1007/s13300-014-0078-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION When insulin treatment is started in patients with type 2 diabetes mellitus (T2DM), there are many regimens that control serum glucose levels to a normal range. Basal-bolus insulin therapy is one of the most effective treatments for improving glycemic control to prevent the progression of diabetic microvascular complications. This study was conducted to determine whether step-up insulin treatment with premixed insulin aspart-30/70 (BIAsp 30) or lispro-50/50 (Mix50) in Japanese patients with type 2 diabetes mellitus could achieve better glycemic control. METHODS In this open label study, 72 insulin-naïve patients with poorly controlled T2DM (HbA1c ≥8.4%), who had been taking oral antidiabetic drugs for at least 12 months, were randomized to receive BIAsp 30 or Mix50 therapy. Patients started treatment of a pre-dinner injection of each type of insulin (Step 1). At 16 ± 2 weeks, a pre-breakfast injection of each type of insulin was added if HbA1c exceeded 7.4% (step 2). If patients had still not achieved HbA1c <7.4% after an additional 16 ± 2 weeks, a pre-lunch insulin injection was added (step 3). Hypoglycemic episodes were also recorded. RESULTS The cumulative percentages of subjects who achieved HbA1c <7.4% were 36.1% (13/36) for both Mix50 and BIAsp 30 in step 1, 62.9% (23/36) for BIAsp 30 and 52.8% (19/36) for Mix50 in step 2, and 66.7% (24/36) in BIAsp 30 and 72.2% (26/36) in Mix50 in step 3. The achievement rates of HbA1c <7.4% were not statistically different between the two groups. A total of ten hypoglycemic episodes occurred in this study. However, there were no severe hypoglycemic episodes. All cases recovered by taking glucose and drinking juice. CONCLUSION Mix50 step-up treatment has a clinical effect in achieving good glycemic control equal to that of BIAsp 30 treatment.
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Affiliation(s)
- Nozomi Domeki
- Department of Endocrinology and Metabolism, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293 Japan
| | - Mihoko Matsumura
- Department of Endocrinology and Metabolism, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293 Japan
| | - Tsuyoshi Monden
- Department of Endocrinology and Metabolism, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293 Japan
| | - Yuki Nakatani
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan
| | - Yoshimasa Aso
- Department of Endocrinology and Metabolism, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293 Japan
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28
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Jansen HJ, Vervoort GMM, de Haan AFJ, Netten PM, de Grauw WJ, Tack CJ. Diabetes-related distress, insulin dose, and age contribute to insulin-associated weight gain in patients with type 2 diabetes: results of a prospective study. Diabetes Care 2014; 37:2710-7. [PMID: 25011948 DOI: 10.2337/dc13-1205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The determinants of insulin-associated weight gain in type 2 diabetes mellitus (T2DM) are partly unknown. Therefore, we conducted a prospective study to identify predictors of insulin-associated weight gain. RESEARCH DESIGN AND METHODS In patients with T2DM, we assessed physical activity by accelerometry and measured diabetes-related distress by questionnaires before and 6 and 12 months after starting insulin therapy. Glycemic control (HbA1c) and insulin dose were monitored. RESULTS After 12 months of insulin therapy, mean body weight had increased by 3.0 ± 2.5 kg (P < 0.001). The drop in HbA1c was correlated with insulin-associated weight gain. With the use of a multiple linear regression model, a cluster of variables was identified that significantly related to weight gain. Diabetes-related distress, initial insulin dose, and the increase of insulin dose during the course of the study as well as age appeared to be important predictors of weight gain after initiation of insulin therapy. Physical activity (measured as MET) decreased from 1.40 ± 0.04 at baseline to 1.32 ± 0.04 MET (P < 0.05) but was not significantly related to weight changes. CONCLUSIONS Diabetes-related distress, initial and titration of insulin dose, and age all significantly predict insulin-associated weight gain. After the initiation of insulin therapy, physical activity decreased significantly, but this did not determine weight gain over the first 12 months. Our study findings may have clinical implications.
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Affiliation(s)
- Henry J Jansen
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Gerald M M Vervoort
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Anton F J de Haan
- Biostatistics Group, Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - Paetrick M Netten
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Wim J de Grauw
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands Family Practice Berghem, Berghem, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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29
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Kim JK, Yoo C, Cha YH, Kim YH. Thermo-reversible injectable gel based on enzymatically-chopped low molecular weight methylcellulose for exenatide and FGF 21 delivery to treat types 1 and 2 diabetes. J Control Release 2014; 194:316-22. [PMID: 25245775 DOI: 10.1016/j.jconrel.2014.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/04/2014] [Accepted: 09/11/2014] [Indexed: 02/01/2023]
Abstract
Diabetes is the fastest growing metabolic disease that fails to utilize glucose properly due to insulin deficiency or insulin resistance. Although several limited studies demonstrated non-invasive means of protein delivery, major hurdles for commercial success such as short half-life, enzymatic degradation and low bioavailability still remain to overcome. Methylcellulose (MC), a hydrophobically-modified cellulose derivative, forms temperature reversible gel in aqueous solution. However, as the gelling temperature of MC is higher than body temperature, it should be lowered to below body temperature for practical clinical application. In order to decrease gelling temperature and increase bio-compatibility and bio-elimination of MC, the molecular weight of MC was decreased using enzymatic degradation method and confirmed by gel permeation chromatography. Bio-elimination of low molecular weight (LMw) MC was confirmed with non-invasive live image and ex vivo experiment. The exenatide and FGF 21 were physically loaded 100% into LMwMC-based thermo-reversible gel and slowly released from gel with no initial bursts. Exenatide-loaded LMwMC gel showed reduction of blood glucose level for a week in type 1 diabetic animal model. FGF 21-loaded LMwMC gel reduced glucose level to normal condition and maintained over 10 days in type 2 diabetic animal model. LMwMC-based thermo-reversible and injectable hydrogel provides a strong potential to be efficient protein drug delivery system for the treatment of type 1 and type 2 diabetes.
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Affiliation(s)
- Jang Kyoung Kim
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea
| | - Changhun Yoo
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea
| | - Yong-Hoon Cha
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea
| | - Yong-Hee Kim
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea; Institute for Bioengineering and Biopharmaceutical Research, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea.
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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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Mita T, Katakami N, Shiraiwa T, Yoshii H, Onuma T, Kuribayashi N, Osonoi T, Kaneto H, Kosugi K, Umayahara Y, Yamamoto T, Matsumoto K, Yokoyama H, Tsugawa M, Gosho M, Shimomura I, Watada H. Rationale, design, and baseline characteristics of a clinical trial for prevention of atherosclerosis in patients with insulin-treated type 2 diabetes mellitus using DPP-4 inhibitor: the Sitagliptin Preventive study of Intima-media thickness Evaluation (SPIKE). Diabetol Metab Syndr 2014; 6:35. [PMID: 24607023 PMCID: PMC3973974 DOI: 10.1186/1758-5996-6-35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/26/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, is currently used to achieve glycemic targets in patients with type 2 diabetes mellitus (T2DM). The addition of DPP-4 inhibitors to ongoing insulin therapy is expected to reduce insulin dosage, leading to a reduction in the frequency of hypoglycaemia and/or weight gain. Recent studies have demonstrated potential anti-atherosclerotic effects for DPP-4 inhibitors. The aim of the present ongoing study is to assess the effects of sitagliptin on the progression of atherosclerosis in patients with insulin-treated T2DM using carotid intima-media thickness (IMT), an established marker of cardiovascular disease. METHODS AND DESIGN The Sitagliptin Preventive study of Intima media thickness Evaluation (SPIKE) is a prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group, comparative study. Between February 2012 and September 2012, 282 participants who failed to achieve glycemic control despite insulin therapy were recruited at 12 clinics and randomly allocated to the sitagliptin group (n = 142) or the control group (n = 140). Primary outcomes are changes in maximum and mean IMT of the common carotid artery after 24-month treatment period measured by carotid arterial echography. Secondary outcomes include changes in glycemic control, parameters related to beta-cell function and diabetic nephropathy, occurrence of cardiovascular events and adverse events such as hypoglycaemia, and biochemical markers of vascular function. DISCUSSION The present study is designed to assess the effects of sitagliptin on the progression of carotid IMT. Results will be available in the near future, and the findings are expected to provide new strategy to prevent atherosclerosis in patients with insulin-treated T2DM. CLINICAL TRIAL REGISTRATION UMIN000007396.
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Affiliation(s)
- Tomoya Mita
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
- Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Toshihiko Shiraiwa
- Shiraiwa Medical clinic, 4-10-24 Houzenji, Kashiwara, Osaka 582-0005, Japan
| | - Hidenori Yoshii
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | - Tomio Onuma
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | | | - Takeshi Osonoi
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, Ibaraki 311-0113, Japan
| | - Hideaki Kaneto
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Keisuke Kosugi
- Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka 543-0035, Japan
| | - Yutaka Umayahara
- Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
| | - Tsunehiko Yamamoto
- Kansai Rosai Hospital, 3-1-69 Inabasou, Amagasaki-shi, Hyogo 660-8511, Japan
| | - Kazunari Matsumoto
- Diabetes Center, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo, Nagasaki 857-1195, Japan
| | - Hiroki Yokoyama
- Jiyugaoka Medical Clinic, Internal Medicine, West 6, South 6-4-3, Obihiro 080-0016, Hokkaido, Japan
| | - Mamiko Tsugawa
- Ikeda Municipal Hospital, 3-1-18, Jonan, Ikeda, Osaka 563-8510, Japan
| | - Masahiko Gosho
- Unit of Biostatistics, Advanced Medical Research Center, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
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Clinical efficacy of a medically supervised outpatient high-protein, low-calorie diet program is equivalent in prediabetic, diabetic and normoglycemic obese patients. Nutr Diabetes 2014; 4:e105. [PMID: 24513578 PMCID: PMC3940825 DOI: 10.1038/nutd.2014.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/03/2013] [Accepted: 12/20/2013] [Indexed: 01/10/2023] Open
Abstract
Objective: Type 2 diabetes mellitus (T2DM) affects approximately 10% of Americans, while 79 million Americans are estimated to have glucose intolerance or prediabetes (pre-DM). The present study was designed to determine whether obese patients with pre-DM or T2DM would lose weight as effectively as obese normoglycemic patients, in a medically supervised high-protein, low-calorie-weight management program. Method: Patients enrolled in a self-paid, university-based, outpatient weight loss program using prescribed very-low-calorie diet (VLCD) (500–800 cal per day) or LCD diet (800–1200 cal per day), recommended exercise and group behavioral counseling were studied retrospectively. Patients entering the program for the first time and attending weekly clinic visits for more than 4 weeks were included in the analysis. Results: A total of 2093 obese patients, of whom 583 patients with pre-DM (fasting glucose ⩾100 and <126 mg dl−1), 367 patients with T2DM and 1143 normoglycemic patients entered the program from 1991 to 2010, who met all the inclusion criteria were included in the analysis. The body weight at baseline was 104.0±20.0 kg for DM, 101.4±18.4 for pre-DM and 99.0±18.8 kg for non-DM. Weight loss and percent of weight loss within 12 months were analyzed using a linear mixed-effects model. There was no significant difference in weight loss between DM vs non-DM (P=0.4597) and pre-DM vs non-DM (P=0.6006) in 12 months. The length of enrollment in the program was positively correlated to weight loss rates in all patients (P<0.001). Conclusion: This study demonstrates that obese, pre-DM and DM patients all lost weight as effectively with VLCD or LCD over 12 months. Given the impact of weight loss on the progression of comorbid conditions, these data support the hypothesis that medically supervised diets, including VLCD and LCD, should be more widely used in the prevention and treatment of obese patients with pre-DM or T2DM.
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Richard J, Lingvay I. Is insulin treatment a first-line defense against Type 2 diabetes? Expert Rev Cardiovasc Ther 2014; 8:483-5. [DOI: 10.1586/erc.10.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37 Suppl 1:S120-43. [PMID: 24357208 DOI: 10.2337/dc14-s120] [Citation(s) in RCA: 421] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013; 36:3821-42. [PMID: 24107659 PMCID: PMC3816916 DOI: 10.2337/dc13-2042] [Citation(s) in RCA: 356] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is no standard meal plan or eating pattern that works universally for all people with diabetes. In order to be effective, nutrition therapy should be individualized for each patient/client based on his or her individual health goals; personal and cultural preferences; health literacy and numeracy; access to healthful choices; and readiness, willingness, and ability to change. Nutrition interventions should emphasize a variety of minimally processed nutrient dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term.
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Frikke-Schmidt H, Pedersen TÅ, Fledelius C, Olsen GS, Hellerstein M. Adipose weight gain during chronic insulin treatment of mice results from changes in lipid storage without affecting de novo synthesis of palmitate. PLoS One 2013; 8:e76060. [PMID: 24069458 PMCID: PMC3775753 DOI: 10.1371/journal.pone.0076060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
Insulin treatment is associated with increased adipose mass in both humans and mice. However, the underlying dynamic basis of insulin induced lipid accumulation in adipose tissue remains elusive. To assess this, young female C57BL6/J mice were fed a low fat diet for 3 weeks, treated subsequently with 7 days of constant subcutaneous insulin infusion by osmotic minipumps and compared to mice with only buffer infused. To track changes in lipid deposition during insulin treatment, metabolic labeling was conducted with heavy water for the final 4 days. Blood glucose was significantly lowered within one hour after implantation of insulin loaded mini pumps and remained lower throughout the study. Insulin treated animals gained significantly more weight during treatment and the mean weight of the subcutaneous adipose depots was significantly higher with the highest dose of insulin. Surprisingly, de novo palmitate synthesis within the subcutaneous and the gonadal depots was not affected significantly by insulin treatment. In contrast insulin treatment caused accumulation of triglycerides in both depots due to either deposition of newly synthesised triglycerides (subcutaneous depot) or inhibition of lipolysis (gonadal depot).
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Affiliation(s)
- Henriette Frikke-Schmidt
- Department of Nutritional Sciences and Toxicology, University of California Berkeley, Berkeley, California, United States of America
- Department of Insulin Biology, Novo Nordisk A/S, Maaloev, Denmark
| | | | | | | | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California Berkeley, Berkeley, California, United States of America
- KineMed, Inc., Emeryville, California, United States of America
- * E-mail:
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Tambascia MA, Nery M, Gross JL, Ermetice MN, de Oliveira CP. Evidence-based clinical use of insulin premixtures. Diabetol Metab Syndr 2013; 5:50. [PMID: 24011173 PMCID: PMC4016222 DOI: 10.1186/1758-5996-5-50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/17/2013] [Indexed: 01/04/2023] Open
Abstract
Brazil is expected to have 19.6 million patients with diabetes by the year 2030. A key concept in the treatment of type 2 diabetes mellitus (T2DM) is establishing individualized glycemic goals based on each patient's clinical characteristics, which impact the choice of antihyperglycemic therapy. Targets for glycemic control, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin (A1C), are often not reached solely with antihyperglycemic therapy, and insulin therapy is often required. Basal insulin is considered an initial strategy; however, premixed insulins are convenient and are equally or more effective, especially for patients who require both basal and prandial control but desire a more simplified strategy involving fewer daily injections than a basal-bolus regimen. Most physicians are reluctant to transition patients to insulin treatment due to inappropriate assumptions and insufficient information. We conducted a nonsystematic review in PubMed and identified the most relevant and recently published articles that compared the use of premixed insulin versus basal insulin analogues used alone or in combination with rapid-acting insulin analogues before meals in patients with T2DM. These studies suggest that premixed insulin analogues are equally or more effective in reducing A1C compared to basal insulin analogues alone in spite of the small increase in the risk of nonsevere hypoglycemic events and nonclinically significant weight gain. Premixed insulin analogues can be used in insulin-naïve patients, in patients already on basal insulin therapy, and those using basal-bolus therapy who are noncompliant with blood glucose self-monitoring and titration of multiple insulin doses. We additionally provide practical aspects related to titration for the specific premixed insulin analogue formulations commercially available in Brazil.
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Affiliation(s)
- Marcos Antônio Tambascia
- Faculty of Medical Sciences, State University of Campinas, Brazil Rua Frei Manoel da Ressurreição 965, Campinas, SP, Brazil
| | - Márcia Nery
- Diabetes Unit - Endocrinology and Metabolism Service, Clinical Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Luiz Gross
- Department of Internal Medicine, Faculty of Medicine of Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Mariana Narbot Ermetice
- Diabetes Group, Eli Lilly do Brazil São Paulo, São Paulo, Brazil
- Currently at Novo Nordisk Brazil, São Paulo, Brazil
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Afsar B. The comparison of 24-hour urinary sodium, albumin, and protein excretion in chronic kidney disease patients with type 2 diabetes mellitus using insulin detemir or insulin glargine. Clin Drug Investig 2013; 33:773-8. [PMID: 23943142 DOI: 10.1007/s40261-013-0118-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Insulin detemir induces bodyweight loss or less weight gain in patients with type 2 diabetes mellitus. However, in contrast to insulin detemir, insulin glargine has no weight loss effect. Increased sodium excretion has been speculated to be one of the mechanisms of weight loss by insulin detemir. However, there are no studies in the literature comparing sodium excretion between patients using insulin detemir and those using insulin glargine. There are also no studies comparing the excretion of urinary albumin and urinary protein in chronic kidney disease (CKD) patients using insulin detemir or insulin glargine. Thus, the aim of the current study was to compare the effects of insulin detemir and insulin glargine on sodium, albumin, and protein excretion in patients with various stages of CKD and concomitant type 2 diabetes. METHODS Demographic, clinical, and laboratory data were evaluated for all patients. Hypoglycemic attacks, appetite score, 24-h urinary sodium, albumin, and protein excretion were also measured. RESULTS A total of 47 patients (23 taking insulin detemir, 24 taking insulin glargine) were included in the study. There were no differences with respect to 24-h sodium (p = 0.694), albumin (p = 0.297), or protein excretion (p = 0.202) between patient groups. Appetite and hypoglycemic attacks also did not differ between groups. Use of insulin detemir or insulin glargine was not related to sodium, albumin, and protein excretion in stepwise regression analysis. CONCLUSION There was no difference between insulin detemir and insulin glargine with respect to sodium, albumin, and protein excretion in type 2 diabetic CKD patients. Studies are needed both in CKD patients and those with normal renal function to highlight mechanisms regarding the weight loss effect unique to insulin detemir.
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Affiliation(s)
- Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Konya Numune State Hospital, Ferhuniye Mah. Hastane Cad., 42690, Konya, Turkey,
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Fonseca V, McDuffie R, Calles J, Cohen RM, Feeney P, Feinglos M, Gerstein HC, Ismail-Beigi F, Morgan TM, Pop-Busui R, Riddle MC. Determinants of weight gain in the action to control cardiovascular risk in diabetes trial. Diabetes Care 2013; 36:2162-8. [PMID: 23412077 PMCID: PMC3714487 DOI: 10.2337/dc12-1391] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Identify determinants of weight gain in people with type 2 diabetes mellitus (T2DM) allocated to intensive versus standard glycemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS We studied determinants of weight gain over 2 years in 8,929 participants (4,425 intensive arm and 4,504 standard arm) with T2DM in the ACCORD trial. We used general linear models to examine the association between each baseline characteristic and weight change at the 2-year visit. We fit a linear regression of change in weight and A1C and used general linear models to examine the association between each medication at baseline and weight change at the 2-year visit, stratified by glycemia allocation. RESULTS There was significantly more weight gain in the intensive glycemia arm of the trial compared with the standard arm (3.0 ± 7.0 vs. 0.3 ± 6.3 kg). On multivariate analysis, younger age, male sex, Asian race, no smoking history, high A1C, baseline BMI of 25-35, high waist circumference, baseline insulin use, and baseline metformin use were independently associated with weight gain over 2 years. Reduction of A1C from baseline was consistently associated with weight gain only when baseline A1C was elevated. Medication usage accounted for <15% of the variability of weight change, with initiation of thiazolidinedione (TZD) use the most prominent factor. Intensive participants who never took insulin or a TZD had an average weight loss of 2.9 kg during the first 2 years of the trial. In contrast, intensive participants who had never previously used insulin or TZD but began this combination after enrolling in the ACCORD trial had a weight gain of 4.6-5.3 kg at 2 years. CONCLUSIONS Weight gain in ACCORD was greater with intensive than with standard treatment and generally associated with reduction of A1C from elevated baseline values. Initiation of TZD and/or insulin therapy was the most important medication-related factor associated with weight gain.
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Affiliation(s)
- Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
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Elvert R, Wille A, Wandschneider J, Werner U, Glombik H, Herling AW. Energy loss via urine and faeces--a combustive analysis in diabetic rats and the impact of antidiabetic treatment on body weight. Diabetes Obes Metab 2013; 15:324-34. [PMID: 23121319 DOI: 10.1111/dom.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/25/2012] [Accepted: 10/24/2012] [Indexed: 01/10/2023]
Abstract
AIMS Intensive glycaemic control in type 2 diabetes achieved by insulin is generally accompanied by body weight gain. This study was performed to emphasize the meaning of caloric analysis of urine and faeces for energy balance. METHODS We measured energetic loss via urine and faeces during antihyperglycaemic treatment in male obese Zucker diabetic fatty (ZDF) rats. Rats were treated for 10 days with the sodium-glucose-linked transporter-2 (SGLT2) inhibitor AVE2268, with insulin glargine, with the GLP-1 receptor agonist lixisenatide and with the combination of insulin glargine and lixisenatide. Each study was accompanied by one lean (Fa/?) and one obese (fa/fa) untreated non-diabetic and diabetic control group, respectively. Blood glucose, body weight alterations and food assimilation efficiency were monitored. RESULTS In control ZDF rats, more than 12 g/day of pure glucose was urinarily excreted. In total, the energetic loss via urine exceeded 30% from total energy uptake. Insulin glargine treatment decreased urinary energetic loss, leading to a body weight gain of approximately 3 g/day. An almost body weight-neutral antihyperglycaemic treatment could be achieved with AVE2268 and lixisenatide. While lixisenatide reduced body weight gain via reduction of energy uptake, the SGLT2 inhibitor even increased urinary glucose and thus energy excretion. Combining insulin glargine with lixisenatide attenuated the anabolic effect of insulin resulting in weight neutrality. CONCLUSIONS Our data clearly show renal contribution to the body's energy control by urinary glucose excretion (UGE) during antidiabetic treatment. The undesired retained energy could be reduced via additional UGE or via simultaneous reduction of energy uptake and/or energy retention.
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Affiliation(s)
- R Elvert
- R&D Diabetes Division, Translational Medicine, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany.
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41
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McNay EC, Teske JA, Kotz CM, Dunn-Meynell A, Levin BE, McCrimmon RJ, Sherwin RS. Long-term, intermittent, insulin-induced hypoglycemia produces marked obesity without hyperphagia or insulin resistance: a model for weight gain with intensive insulin therapy. Am J Physiol Endocrinol Metab 2013; 304:E131-8. [PMID: 23169787 PMCID: PMC3543569 DOI: 10.1152/ajpendo.00262.2012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A major side effect of insulin treatment of diabetes is weight gain, which limits patient compliance and may pose additional health risks. Although the mechanisms responsible for this weight gain are poorly understood, it has been suggested that there may be a link to the incidence of recurrent episodes of hypoglycemia. Here we present a rodent model of marked weight gain associated with weekly insulin-induced hypoglycemic episodes in the absence of diabetes. Insulin treatment caused a significant increase in both body weight and fat mass, accompanied by reduced motor activity, lowered thermogenesis in response to a cold challenge, and reduced brown fat uncoupling protein mRNA. However, there was no effect of insulin treatment on total food intake nor on hypothalamic neuropeptide Y or proopiomelanocortin mRNA expression, and insulin-treated animals did not become insulin-resistant. Our results suggest that repeated iatrogenic hypoglycemia leads to weight gain, and that such weight gain is associated with a multifaceted deficit in metabolic regulation rather than to a chronic increase in caloric intake.
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Affiliation(s)
- Ewan C McNay
- Behavioral Neuroscience, University at Albany, 1400 Washington Ave., Albany, NY 12222, USA.
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Morgan CL, Jenkins-Jones S, Evans M, Barnett AH, Poole CD, Currie CJ. Weight change in people with type 2 diabetes: secular trends and the impact of alternative antihyperglycaemic drugs. Diabetes Obes Metab 2012; 14:424-32. [PMID: 22192841 DOI: 10.1111/j.1463-1326.2011.01552.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to describe the pattern of weight change in people with type 2 diabetes (T2DM) over time and when using alternative treatment regimens. METHODS Data were from routine clinical practice in the UK. The weight trend was determined for each year from 1995 to 2010 for both prevalent and incident cases. Baseline weight was compared to absolute (mean Δ) and relative weights (% Δ) at 6, 12 and 24 months. RESULTS Mean, standardized weight in prevalent cases increased from 83.4 to 92.1 kg for males and from 73.5 to 79.9 kg for females between 1995 and 2010 (p < 0.0001). For incident cases, the respective figures were 86.7 to 93.6 kg for males and 76.0 to 80.7 kg for females (p < 0.001). Between baseline and 6, 12 and 24 months, there were significant changes in weight for the majority of the treatment regimens selected for analysis. The largest weight increase at 12 months was for the patients who were prescribed a combination therapy with insulin and a thiazolidinedione, with a median increase of 4.1 kg (95% CI -0.60 to 8.0, p < 0.001). The largest weight decrease at 12 months was for the patients who were prescribed a combination therapy of metformin and exenatide, with a median decrease of -7.0 kg (95% CI -12.0 to -2.0, p < 0.001). CONCLUSIONS There was a continual increase in body weight in people with T2DM over time, and considerable differences in the impact on weight using alternative treatment regimens. At the same time, glycaemic control remained relatively unchanged.
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Affiliation(s)
- C Ll Morgan
- Department of Epidemiology, Pharmatelligence, Cardiff, UK
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Katsiki N, Mikhailidis DP, Gotzamani-Psarrakou A, Didangelos TP, Yovos JG, Karamitsos DT. Effects of improving glycemic control with insulin on leptin, adiponectin, ghrelin and neuropeptidey levels in patients with type 2 diabetes mellitus: a pilot study. Open Cardiovasc Med J 2011; 5:136-47. [PMID: 21760856 PMCID: PMC3134985 DOI: 10.2174/1874192401105010136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 05/30/2011] [Accepted: 05/31/2011] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Insulin therapy is associated with weight gain in patients with type 2 diabetes mellitus (T2DM). Several peptides are implicated in appetite control. We evaluated the effects of insulin-induced improved glycaemic control on leptin, adiponectin, ghrelin, neuropeptide Y (NPY) levels and patient characteristics. METHOD Consecutive T2DM patients (n = 90) were divided into 2 groups: Group A: 45 insulin-naïve uncontrolled (glycosylated haemoglobin A(1c); HbA(1c )>7%) patients on oral hypoglycaemic agents (OHAs) who converted to insulin monotherapy. Group B: 45 well-controlled (HbA(1c )<7%) patients on OHAs. Both groups were monitored at baseline, 3 and 6 months. Males and females were analyzed separately because some hormone levels differ between genders. RESULTS In both genders, insulin therapy (Group A) was associated with significant (p = 0.003 to <0.001) increases in weight, body mass index and leptin levels and significant decreases in glucose, HbA(1c) and NPY levels. In male insulin-treated patients a significant increase in adiponectin levels (p = 0.008) was observed. There were significant correlations (p = 0.016 to <0.001) between leptin levels, waist circumference and body fat in all patient groups, except group B males. CONCLUSION Changes in leptin, adiponectin and NPY levels may occur after insulin-induced improved glycaemic control. These changes may be influenced by gender, weight, body fat and HbA(1c).
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Affiliation(s)
- Niki Katsiki
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Boye KS, Matza LS, Walter KN, Van Brunt K, Palsgrove AC, Tynan A. Utilities and disutilities for attributes of injectable treatments for type 2 diabetes. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:219-30. [PMID: 20224930 DOI: 10.1007/s10198-010-0224-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 02/09/2010] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Although cost-utility models are frequently used to estimate treatment outcomes for type 2 diabetes, utilities are not available for key attributes of injectable treatments. The purpose of this study was to identify the utility or disutility of three injection-related attributes (dose frequency, dose flexibility, injection site reaction) that may influence patient preference. METHODS Patients with type 2 diabetes in Scotland completed standard gamble (SG) interviews to assess the utility of hypothetical health states and their own current health state. The EQ-5D, PGWB, IWQOL-Lite, and QIDS were also administered. Construct validity and differences among health states were examined. RESULTS A total of 151 patients completed interviews. Of the three injection-related attributes, dose frequency was the only attribute with a statistically significant impact on utility (in a multiple regression model, p = 0.01). Weekly injections were associated with an average added utility of 0.023 in comparison to everyday injections. Flexible dosing and injection site reactions resulted in somewhat smaller utility shifts that were in the expected directions (+0.006 and -0.011, respectively). SG utility of current health (mean = 0.897) demonstrated construct validity through statistically significant correlations with patient-reported outcome measures. DISCUSSION The three injection attributes were associated with small utility shifts in the expected directions. Dose frequency appears to be the most important of the three attributes from the patients' perspective. The vignette-based SG approach was feasible and useful for assessing added utility or disutility of injection-related attributes associated with treatments for type 2 diabetes.
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Shah PK, Mudaliar S, Chang AR, Aroda V, Andre M, Burke P, Henry RR. Effects of intensive insulin therapy alone and in combination with pioglitazone on body weight, composition, distribution and liver fat content in patients with type 2 diabetes. Diabetes Obes Metab 2011; 13:505-10. [PMID: 21272186 PMCID: PMC3580155 DOI: 10.1111/j.1463-1326.2011.01370.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the effects of intensive insulin therapy alone and with added pioglitazone on body weight, fat distribution, lean body mass (LBM) and liver fat in type 2 diabetic patients. METHODS Twenty-five insulin-treated, obese patients with type 2 diabetes were randomized to addition of pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12-16 weeks. Dual-energy X-ray absorptiometry/abdominal computed tomography scans were performed before/after treatment. LBM, visceral/subcutaneous adipose tissue (VAT/SAT) and liver/spleen (L/S) attenuation ratios were measured pre-/posttreatment (a ratio <1 represents fatty liver). RESULTS Intensive insulin alone and insulin + pioglitazone significantly improved glycaemic control (7.8 ± 0.3 to 7.2 ± 0.3% and 7.6 ± 0.3 to 7.1 ± 0.4%, respectively). Body weight gain was greater with insulin + pioglitazone (4.9 ± 4.5 kg) versus insulin therapy alone (1.7 ± 0.7 kg). SAT increased significantly with pioglitazone + insulin therapy (393.9 ± 48.5 to 443.2 ± 56.7 cm(2) , p < 0.01) compared to a non-significant increase with insulin therapy alone (412.9 ± 42.5 to 420.8 ± 43.8 cm(2) ). VAT decreased non-significantly in both groups (240.3 ± 41.7 to 223.8 ± 38.1 cm(2) with insulin + pioglitazone and 266.6 ± 27.4 to 250.5 ± 22.2 cm(2) with insulin therapy). LBM increased significantly by 1.92 ± 0.74 kg with insulin + pioglitazone treatment. The L/S attenuation ratio in the placebo + insulin group decreased from 1.08 ± 0.1 to 1.04 ± 0.1 (p = ns) and increased from 1.00 ± 0.1 to 1.08 ± 0.05 (p = 0.06) in the pioglitazone + insulin group. CONCLUSIONS Intensification of insulin therapy in type 2 diabetic patients causes modest weight gain and no change in body fat distribution, LBM or liver fat. In contrast, the addition of pioglitazone, at equivalent glycaemia, increases weight gain, fat mass and SAT; increases LBM and tends to decrease liver fat. These changes in fat distribution may contribute to the beneficial effects of pioglitazone, despite greater weight gain.
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Affiliation(s)
- P K Shah
- VA San Diego Healthcare System, San Diego, CA, USA
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Jansen HJ, Hendriks JC, de Galan BE, Penders G, Tack CJ, Vervoort G. Contribution of change in glycosylated haemoglobin to insulin-associated weight gain: results of a longitudinal study in type 2 diabetic patients. Endocrine 2011; 39:190-7. [PMID: 21069577 DOI: 10.1007/s12020-010-9423-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
To investigate the contribution of glycosylated haemoglobin change (HbA1c) on body weight in patients with type 2 diabetes after start of insulin therapy. We analysed 122 individual weight-profiles in relation to the change in HbA1c per se in these patients up to 36 months after the start of insulin therapy. Data were analysed separately for the first 9 months after commencement of insulin therapy and for the period thereafter. Within the first 9 months of insulin therapy mean body weight increased by 0.52 kg per month. HbA1c decreased from 9.9 ± 1.8 to 7.9 ± 1.3%. Only 12% of the initial weight gain could be attributed to the change in HbA1c. Furthermore, the mean monthly increase in body weight gain was reduced by 0.006 kg for every 1 kg higher body weight at baseline. From 9 to 36 months after start of insulin therapy, body weight increased by 0.1 kg/month, which was independent of change in HbA1c. Improvement of glycaemic control per se contributes little to initial weight gain after start of insulin therapy in patients with T2DM. After 9 months of insulin treatment, weight gain is unrelated to change in glycosylated haemoglobin. Other factors have to be responsible for weight gain after start of insulin therapy.
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Affiliation(s)
- H J Jansen
- Department of General Internal Medicine 463, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Provilus A, Abdallah M, McFarlane SI. Weight gain associated with antidiabetic medications. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/thy.11.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Katsiki N, Mikhailidis DP, Gotzamani-Psarrakou A, Yovos JG, Karamitsos D. Effect of various treatments on leptin, adiponectin, ghrelin and neuropeptide Y in patients with type 2 diabetes mellitus. Expert Opin Ther Targets 2011; 15:401-20. [DOI: 10.1517/14728222.2011.553609] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Jung JY, Han KA, Kwon HR, Ahn HJ, Lee JH, Park KS, Min KW. The usefulness of an accelerometer for monitoring total energy expenditure and its clinical application for predicting body weight changes in type 2 diabetic korean women. KOREAN DIABETES JOURNAL 2010; 34:374-83. [PMID: 21246011 PMCID: PMC3021114 DOI: 10.4093/kdj.2010.34.6.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the usefulness of an accelerometer in predicting body weight (BW) change during a lifestyle intervention and to find out whether exercise or overall physical activity is associated with change in insulin sensitivity and body composition. METHODS A total of 49 overweight (body mass index [BMI] ≥ 23 kg/m(2)) women with diabetes were enrolled and performed lifestyle intervention while monitoring BW, total energy expenditure (TEE) and physical activity energy expenditure (PAEE) using an accelerometer, and energy intake (EI) using a three-day dietary record at baseline and every 2 weeks for 12 weeks. We assessed body composition using bioimpedance analysis and compared the actual BW change to the predicted BW change, which was calculated from the energy deficit (ED) between EI and TEE (ED = EI-TEE). RESULTS Mean age was 57.2 years, duration of diabetes was 8.0 years, and BMI was 27.8 kg/m(2). There was no significant difference between EI and TEE at baseline. For 12 weeks, the ED was 474.0 kcal·day(-1), which was significantly correlated with BW change (-3.1 kg) (r = 0.725, P < 0.001). However, the actual BW change was 50% lower than the predicted BW change. Both TEE and PAEE correlated with change in K(ITT) (r = 0.334, P = 0.019; r = 0.358, P = 0.012, respectively), BMI (r = -0.395, P = 0.005; r = -0.347, P = 0.015, respectively), and fat mass (r = -0.383, P = 0.007; r = -0.395, P = 0.005, respectively), but only TEE correlated with fat free mass change (r = -0.314, P = 0.030). CONCLUSION The accelerometer appears to be a useful tool for measuring TEE under free-living conditions for both short- and long-term periods.
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Affiliation(s)
- Ji Yeon Jung
- Diabetes Center, Eulji University Hospital, Seoul, Korea
| | - Kyung Ah Han
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Hwi Ryun Kwon
- Diabetes Center, Eulji University Hospital, Seoul, Korea
| | - Hee Jung Ahn
- Diabetes Center, Eulji University Hospital, Seoul, Korea
| | - Jae Hyuk Lee
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Kang Seo Park
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung Wan Min
- Diabetes Center, Eulji University Hospital, Seoul, Korea
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
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Temizel M, Mert M, Bozbey C, Arman Y, Cevizci E, Altintaş N, Cetin Ölek A. Evaluation of the weight-increasing effects of biphasic analog and regular NPH insulin mixtures in patients with Type 2 diabetes mellitus. J Diabetes 2010; 2:250-5. [PMID: 20923498 DOI: 10.1111/j.1753-0407.2010.00080.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Weight gain is a significant problem in diabetic patients in terms of worsening glycemic control, increasing diabetic and cardiovascular morbidity and mortality, and contributing to social and psychological problems. In the present study, we evaluated the effects of a biphasic analog and regular NPH insulin mixtures on weight gain in patients with Type 2 diabetes mellitus (T2DM) over 1 year. METHODS Group I consisted of 71 patients (29 men and 42 women) being treated with analog mixtures (insulin lispro 75/25 mix and biphasic insulin aspart 70/30 mix) twice daily; Group II consisted of 69 patients (23 men and 46 women) being treated with a regular insulin mixture (70/30) twice daily. Starting weight, body mass index, HbA1c, and hypoglycemic episodes were evaluated after 6 and 12 months. RESULTS Weight gain in Group I at 6 and 12 months was 1.41 ± 2.70 and 2.08 ± 3.74 kg, respectively. In Group II, weight gain at 6 and 12 months was 1.5 ± 3.0 and 2.29 ± 3.85 kg, respectively. Intragroup comparisons indicated that, for both groups, weight gain at 6 and 12 months differed significantly from the starting weight. However, no significant differences in weight gain were found between the two groups (P > 0.05). CONCLUSIONS The weight-increasing effects of an analog mixture of insulin and the NPH regular mixture of insulin appear to be similar. This should be taken into account when determining the type of insulin to use in treating T2DM patients.
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Affiliation(s)
- Mustafa Temizel
- Department of Internal Medicine, Okmeydanı Training and Research Hospital, Istanbul, Turkey
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