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Kraaijenhof J, Muskiet MHA, Tonneijck L, Ouwens DM, Kramer MHH, van Raalte DH, Smits MM. Effects of dipeptidyl peptidase-4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: A secondary analysis of an 8-week, randomized, controlled, double-blind trial. Diabetes Obes Metab 2020; 22:1847-1856. [PMID: 32476255 PMCID: PMC7540521 DOI: 10.1111/dom.14107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To determine the glucose-independent effect of the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin versus the sulphonylurea glimepiride on systemic haemodynamics in the fasting and postprandial state in patients with type 2 diabetes (T2D). MATERIALS AND METHODS In this prespecified secondary analysis of a phase IV, double-blind trial, 46 metformin-treated, overweight patients with T2D were included and randomly assigned (1:1) to once-daily linagliptin (5 mg) or glimepiride (1 mg) for 8 weeks. In a sub-study involving 26 patients, systemic haemodynamics were also assessed following a standardized liquid meal (Nutridrink Yoghurt style). Systemic haemodynamics (oscillometric device and finger photoplethysmography), arterial stiffness (applanation tonometry) and cardiac sympathovagal balance (heart rate variability [HRV]) were measured in the fasting state and repetitively following the meal. Ewing tests were performed in the fasting state. RESULTS From baseline to week 8, linagliptin compared with glimepiride did not affect systemic haemodynamics, arterial stiffness or HRV in the fasting state. Linagliptin increased parasympathetic nervous activity, as measured by the Valsalva manoeuvre (P = .021) and deep breathing test (P = .027) compared with glimepiride. Postprandially, systolic blood pressure (SBP) dropped an average of 7.6 ± 1.6 mmHg. Linagliptin reduced this decrease to 0.7 ± 2.3 mmHg, which was significant to glimepiride (P = .010). CONCLUSIONS When compared with glimepiride, linagliptin does not affect fasting blood pressure. However, linagliptin blunted the postprandial drop in SBP, which could benefit patients with postprandial hypotension.
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Affiliation(s)
- Jordan Kraaijenhof
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Marcel H. A. Muskiet
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Lennart Tonneijck
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - D. Margriet Ouwens
- German Diabetes Center (DDZ), Leibniz Center for Diabetes ResearchHeinrich Heine University, Medical FacultyDüsseldorfGermany
- German Center for Diabetes Research (DZD)Muenchen‐NeuherbergGermany
- Department of EndocrinlogyGhent University HospitalGhentBelgium
| | - Mark H. H. Kramer
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Daniël H. van Raalte
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Mark M. Smits
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
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Martin BL, Thompson LC, Kim Y, Williams W, Snow SJ, Schladweiler MC, Phillips P, King C, Richards J, Haykal-Coates N, Higuchi M, Ian Gilmour M, Kodavanti UP, Hazari MS, Farraj AK. Acute peat smoke inhalation sensitizes rats to the postprandial cardiometabolic effects of a high fat oral load. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 643:378-391. [PMID: 29940449 PMCID: PMC7003129 DOI: 10.1016/j.scitotenv.2018.06.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 05/11/2023]
Abstract
Wildland fire emissions cause adverse cardiopulmonary outcomes, yet controlled exposure studies to characterize health impacts of specific biomass sources have been complicated by the often latent effects of air pollution. The aim of this study was to determine if postprandial responses after a high fat challenge, long used clinically to predict cardiovascular risk, would unmask latent cardiometabolic responses in rats exposed to peat smoke, a key wildland fire air pollution source. Male Wistar Kyoto rats were exposed once (1 h) to filtered air (FA), or low (0.36 mg/m3 particulate matter) or high concentrations (3.30 mg/m3) of peat smoke, generated by burning peat from an Irish bog. Rats were then fasted overnight, and then administered an oral gavage of a HF suspension (60 kcal% from fat), mimicking a HF meal, 24 h post-exposure. In one cohort, cardiac and superior mesenteric artery function were assessed using high frequency ultrasound 2 h post gavage. In a second cohort, circulating lipids and hormones, pulmonary and systemic inflammatory markers, and circulating monocyte phenotype using flow cytometry were assessed before or 2 or 6 h after gavage. HF gavage alone elicited increases in circulating lipids characteristic of postprandial responses to a HF meal. Few effects were evident after peat exposure in un-gavaged rats. By contrast, exposure to low or high peat caused several changes relative to FA-exposed rats 2 and 6 h post HF gavage including increased heart isovolumic relaxation time, decreased serum glucose and insulin, increased CD11 b/c-expressing blood monocytes, increased serum total cholesterol, alpha-1 acid glycoprotein, and alpha-2 macroglobulin (p = 0.063), decreased serum corticosterone, and increased lung gamma-glutamyl transferase. In summary, these findings demonstrate that a HF challenge reveals effects of air pollution that may otherwise be imperceptible, particularly at low exposure levels, and suggest exposure may sensitize the body to mild inflammatory triggers.
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Affiliation(s)
- Brandi L Martin
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830, United States
| | - Leslie C Thompson
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Yongho Kim
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Wanda Williams
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Samantha J Snow
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Mette C Schladweiler
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Pamela Phillips
- Toxicity Assessment Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, RTP, NC, United States
| | - Charly King
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Judy Richards
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Najwa Haykal-Coates
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Mark Higuchi
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - M Ian Gilmour
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Urmila P Kodavanti
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Mehdi S Hazari
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States
| | - Aimen K Farraj
- Environmental Public Health Division, US EPA, 109 TW Alexander Drive, Research Triangle Park, NC, United States.
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Tonneijck L, Muskiet MHA, Twisk JW, Kramer MHH, Danser AHJ, Joles JA, Smits MM, van Raalte DH. Lixisenatide Versus Insulin Glulisine on Fasting and Postbreakfast Systemic Hemodynamics in Type 2 Diabetes Mellitus Patients. Hypertension 2018; 72:314-322. [PMID: 29915021 DOI: 10.1161/hypertensionaha.117.10740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/08/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022]
Abstract
The prolonged treatment effects of a short-acting GLP-1RA (glucagon-like peptide-1 receptor agonist), such as lixisenatide, on fasting and postprandial systemic hemodynamics in type 2 diabetes mellitus patients are unknown. In this secondary analysis, we included 34 overweight insulin glargine-treated type 2 diabetes mellitus patients (mean±SD age, 62±7 years; HbA1c, 8.0±0.9%; systolic blood pressure [BP], 133.9±16.1 mm Hg; diastolic BP, 75.4±8.39 mm Hg) that were randomized to once-daily lixisenatide 20 μg or once-daily titrated insulin glulisine for 8 weeks. Systemic hemodynamics (oscillometric device and finger photoplethysmography), arterial stiffness (applanation tonometry), and cardiac sympathovagal balance (heart rate variability) were measured in the fasting state and repetitively (up to minute 175) after a standardized mixed breakfast. Acetaminophen was given orally to estimate gastric emptying rate. Lixisenatide did not affect fasting systemic hemodynamics compared with insulin glulisine from baseline to week 8. Postbreakfast overall, lixisenatide compared with insulin glulisine tended to increase systolic BP by 5.2±2.9 mm Hg (P=0.087) and increased diastolic BP by 5.4±1.4 mm Hg (P<0.001), with respective maximal differences of +10.2±3.7 mm Hg (P=0.007) and +7.2±1.5 mm Hg (P<0.001). Lixisenatide increased systemic vascular resistance (P<0.001) and arterial stiffness (P=0.007). No between-group differences in overall postbreakfast heart rate, cardiac output, or cardiac sympathovagal balance, and circulating catecholamines, angiotensin II, or aldosterone were observed. Both treatments lowered HbA1c similarly, whereas lixisenatide achieved greater reductions in postbreakfast plasma glucose excursions. Lixisenatide slowed gastric emptying rate, which statistically explained changes in postbreakfast BP. Lixisenatide compared with once-daily titrated insulin glulisine for 8 weeks does not affect fasting but increases postbreakfast BP in insulin glargine-treated type 2 diabetes mellitus patients. This effect could, at least in part, be explained by reduced passage rate of nutrients and water and activation of the gastrovascular reflex.
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Affiliation(s)
- Lennart Tonneijck
- From the Department of Internal Medicine, Diabetes Center (L.T., M.H.A.M., M.H.H.K., M.M.S., D.H.v.R.)
| | - Marcel H A Muskiet
- From the Department of Internal Medicine, Diabetes Center (L.T., M.H.A.M., M.H.H.K., M.M.S., D.H.v.R.)
| | - Jos W Twisk
- Department of Epidemiology and Biostatistics (J.W.T.)
| | - Mark H H Kramer
- From the Department of Internal Medicine, Diabetes Center (L.T., M.H.A.M., M.H.H.K., M.M.S., D.H.v.R.)
| | - A H Jan Danser
- VU University Medical Center, Amsterdam, The Netherlands; Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands (A.H.J.D.)
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands (J.A.J.)
| | - Mark M Smits
- From the Department of Internal Medicine, Diabetes Center (L.T., M.H.A.M., M.H.H.K., M.M.S., D.H.v.R.)
| | - Daniël H van Raalte
- From the Department of Internal Medicine, Diabetes Center (L.T., M.H.A.M., M.H.H.K., M.M.S., D.H.v.R.)
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Bucca BC, Maahs DM, Snell-Bergeon JK, Hokanson J, Rinella S, Bishop F, Boufard A, Homann J, Cheung CY, Wong TY. Dynamic changes in retinal vessel diameter during acute hyperglycemia in type 1 diabetes. J Diabetes Complications 2018; 32:234-239. [PMID: 29174301 DOI: 10.1016/j.jdiacomp.2017.10.001] [Citation(s) in RCA: 4] [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: 01/26/2017] [Revised: 09/20/2017] [Accepted: 10/04/2017] [Indexed: 11/21/2022]
Abstract
AIMS To investigate changes in retinal vessel diameter during acute hyperglycemia in patients with type 1 diabetes. METHODS We conducted a study on 11 subjects with type 1 diabetes. Euglycemia was maintained for 3h followed by induction of hyperglycemia and simultaneous bolus of rapid acting insulin. Two fundus photos were captured during euglycemia and five fundus photos, blood glucose and blood pressure were taken every 30min for 2.5h post-prandial. Central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) were measured over the study visit and examined using generalized linear mixed models. RESULTS In a multivariate mixed model, mean CRAE and CRVE were reduced at 90min post-prandial in both zones B and C. In repeated measures analysis, arterioles exhibited a significant association with change in vessel caliber per change in blood glucose. Inconsistent effects of blood pressure on vessel diameter were also measured. CONCLUSIONS We document a change in retinal vessel diameter during acute hyperglycemia in persons with type 1 diabetes. Larger controlled studies are required to further investigate this phenomenon and to more accurately assess if hyperglycemia has direct effects on retinal vessel diameter.
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Affiliation(s)
- Brian C Bucca
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Medicine, Division of Nephrology, University of Colorado Denver, Aurora, CO 80045, United States; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States; Division of Pediatric Endocrinology, Stanford University, Stanford, CA 94305, United States
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Sean Rinella
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Franziska Bishop
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Alexis Boufard
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Joanna Homann
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Carol Y Cheung
- Singapore Eye Research Institute, The Acedemia, 20 College Road, Discovery Tower Level 6, Singapore 169856; Duke-NUS Graduate Medical School, 8 College Road, 169857, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, The Acedemia, 20 College Road, Discovery Tower Level 6, Singapore 169856; Duke-NUS Graduate Medical School, 8 College Road, 169857, Singapore
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Smits MM, Tonneijck L, Muskiet MHA, Hoekstra T, Kramer MHH, Diamant M, van Raalte DH. The effects of GLP-1 based therapies on postprandial haemodynamics: Two randomised, placebo-controlled trials in overweight type 2 diabetes patients. Diabetes Res Clin Pract 2017; 124:1-10. [PMID: 28086201 DOI: 10.1016/j.diabres.2016.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/03/2016] [Accepted: 12/08/2016] [Indexed: 01/23/2023]
Abstract
AIMS To assess the effects of glucagon-like peptide (GLP)-1 receptor agonists and dipeptidyl peptidase (DPP)-4 inhibitors on postprandial haemodynamics. METHODS 57 patients with type 2 diabetes (mean±SD age 62.8±6.9years; BMI 31.8±4.1kg/m2; HbA1c 7.3±0.6%) were included in an acute (exenatide- or placebo-infusion) and 12-week (liraglutide, sitagliptin or placebo) randomised, placebo-controlled, double-blind trial. Systemic haemodynamics (oscillometric technique and finger photoplethysmography), vascular stiffness (tonometry), and sympathetic nervous system (SNS)-activity (heart rate variability) were determined in the fasting state and following a standardised mixed meal. RESULTS In both studies, postprandial blood pressure (BP) decreased during placebo-intervention. Compared with placebo, acute exenatide-infusion increased postprandial diastolic BP (6.7 [95%-confidence interval 3.6-9.9]mmHg, p<0.001) and vascular resistance (683.6 [438.5-928.8]dyn*s/cm5/1.73m2, p<0.001), while cardiac index decreased (0.6 [0.40.8]L/min/1.73m2; p<0.001). Systolic BP, augmentation index and SNS-activity were unaffected. Twelve-week liraglutide-treatment did not affect postprandial haemodynamics, while sitagliptin decreased diastolic BP (3.5 [0.0-6.9] mmHg; p=0.050), vascular resistance (309.9 [66.6-553.1]dyn*s/cm5/1.73m2; p=0.013) and cardiac index (0.3 [0.0-0.6]L/min/1.73m2; p=0.040), compared with placebo. Neither liraglutide nor sitagliptin affected SNS-activity or augmentation index. All treatments significantly lowered postprandial glucose levels. CONCLUSIONS Acute exenatide-infusion prevented the meal-induced decline in diastolic BP, although prolonged liraglutide intervention did not affect postprandial haemodynamics. The meal-induced drop in BP was augmented during sitagliptin-treatment.
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Affiliation(s)
- Mark M Smits
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands.
| | - Lennart Tonneijck
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Marcel H A Muskiet
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Mark H H Kramer
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Michaela Diamant
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Daniël H van Raalte
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
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