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Mondkar S, Khandagale S, Shah N, Khadilkar A, Oza C, Bhor S, Gondhalekar K, Wagle A, Kajale N, Khadilkar V. Effect of metformin adjunct therapy on cardiometabolic parameters in Indian adolescents with type 1 diabetes: a randomized controlled trial. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1353279. [PMID: 38706949 PMCID: PMC11067706 DOI: 10.3389/fcdhc.2024.1353279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/05/2024] [Indexed: 05/07/2024]
Abstract
Introduction Insulin resistance is being increasingly reported in type-1 Diabetes (T1D) and is known to accelerate microvascular complications. The Asian Indian population has a higher risk of double diabetes development compared to Caucasians. Hence, we studied the effect of adding Metformin to standard insulin therapy on glycemic control, insulin sensitivity (IS), cardiometabolic parameters and body composition in Indian adolescents with T1D. Methods A Randomized controlled trial was conducted spanning 9 months (Registration number:CTRI/2019/11/022126). Inclusion: Age 10-19 years, T1D duration>1year, HbA1c>8% Exclusion: Uncontrolled vascular complications/comorbidities, Metformin intolerance, concomitant drugs affecting insulin sensitivity. Participants were randomized to Metformin/Placebo (n=41 each) groups and age, sex, duration-matched. Assessments were performed at baseline, 3 and 9 months. Results 82 participants aged 14.7 ± 3years (40 females) were enrolled, with a mean diabetes duration of 5.2 ± 2.3 years. Over 9 months, HbA1c decreased significantly by 0.8 (95% confidence interval: -1.2 to -0.3) from 9.8 ± 1.8% to 9.1 ± 1.7% on Metformin but remained largely unchanged (difference of 0.2, 95% confidence interval: -0.7 to 0.2) i.e. 9.9 ± 1.6% and 9.7 ± 2.2% on placebo. HbA1c improvement correlated negatively with baseline IS (EGDR:r= -0.3;SEARCH:r = -0.24, p<0.05) implying better HbA1c-lowering in those with decreased initial IS. CGM-based glycemic variability (standard deviation) reduced by 6.3 mg/dL (95% confidence interval: -12.9 to 0.2) from 100.2 ± 19.1 mg/dL to 93.7 ± 19.9 mg/dL in those on Metformin (p=0.05) but not placebo (94.0 ± 20.5; 90.0 ± 22.6 mg/dL). Insulin sensitivity: CACTIexa & SEARCH scores demonstrated no change with Metformin but significant worsening on placebo. Significant increase in LDL-C(42%), total cholesterol(133.6 to 151.1 mg/dL), triglyceride (60.0 to 88.0 mg/dL) and carotid intima-media thickness was noted on placebo but not Metformin. Weight, BMI, fat Z-scores increased significantly on placebo but not Metformin. Adverse events (AE) were minor; AE, compliance and safety parameters were similar between the two groups. Conclusion Metformin as an adjunct to insulin in Asian Indian adolescents with T1D demonstrated beneficial effect on glycemic control, glycemic variability, IS, lipid profile, vascular function, weight and body fat, with a good safety profile when administered for 9 months.
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Affiliation(s)
- Shruti Mondkar
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
| | - Sukeshini Khandagale
- Symbiosis School of Biological Sciences, Symbiosis International University, Pune, India
| | - Nikhil Shah
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
| | - Anuradha Khadilkar
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Chirantap Oza
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
| | - Shital Bhor
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
| | - Ketan Gondhalekar
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
| | - Aneeta Wagle
- Department of Radiology, Jehangir Hospital, Pune, India
- Department of Radiology, KEM Hospital Research Centre, Pune, India
| | - Neha Kajale
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Vaman Khadilkar
- Department of Pediatric Endocrinology & Growth, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
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Menegucci T, Chagas EFB, de Oliveira Zanuso B, Quesada K, dos Santos Haber JF, Menegucci Zutin TL, Felipe Pimenta L, Cressoni Araújo A, Landgraf Guiguer E, Rucco P. Detregiachi C, Gabaldi Rocha M, Cincotto dos Santos Bueno P, Fornari Laurindo L, Barbalho SM. The Influence of Body Fat and Lean Mass on HbA1c and Lipid Profile in Children and Adolescents with Type 1 Diabetes Mellitus. Diseases 2023; 11:125. [PMID: 37873769 PMCID: PMC10594441 DOI: 10.3390/diseases11040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023] Open
Abstract
Glycated hemoglobin (HbA1c) is used to assess glycemic control in Type 1 diabetes (DM1) patients. Apolipoproteins play an essential role in DM1 pathophysiology and may be associated with complications and HbA1c. This cross-sectional observational study of 81 children and adolescents of both sexes diagnosed with DM1 investigated the relationship between body fat distribution and lean mass with HbA1C and apolipoprotein values, analyzing biochemical and body composition measurements. A Shapiro-Wilk test with Lilliefors correction, a non-parametric Mann-Whitney test, and others were used with a significance level of 5%. The sample had a diagnosis time of 4.32 years and high blood glucose levels (mean 178.19 mg/dL) and HbA1c (mean 8.57%). Subjects also had a moderate level of adiposity, as indicated by arm and thigh fat areas. The study also found significant differences in the distribution of patients concerning levels of apolipoproteins A and B, with a smaller proportion of patients having undesirable levels. Finally, the study found a significant difference in the distribution of patients with estimated cardiovascular risk based on the ApoB/ApoA-I ratio. Conclusively, visceral fat in children and adolescents with DM1 may increase the risk of DM1 long-term complications owing to its association with elevated HbA1C and apolipoprotein values.
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Affiliation(s)
- Thais Menegucci
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
| | - Eduardo Federighi Baisi Chagas
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
- Postgraduate Program of Health and Aging, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Marília 17519-030, São Paulo, Brazil
- Interdisciplinary Center on Diabetes (CENID), Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
| | - Barbara de Oliveira Zanuso
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
| | - Karina Quesada
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Marília 17500-000, São Paulo, Brazil
| | - Jesselina Francisco dos Santos Haber
- Interdisciplinary Center on Diabetes (CENID), Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
| | - Tereza Laís Menegucci Zutin
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
| | - Luis Felipe Pimenta
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
| | - Adriano Cressoni Araújo
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
| | - Elen Landgraf Guiguer
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Marília 17500-000, São Paulo, Brazil
| | - Claudia Rucco P. Detregiachi
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
| | - Marcia Gabaldi Rocha
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
| | | | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
- Department of Biochemistry and Pharmacology, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Marília 17519-030, São Paulo, Brazil
| | - Sandra M. Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; (T.M.)
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (L.F.L.)
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Marília 17500-000, São Paulo, Brazil
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Cheng JX, Yu K. New Discovered Adipokines Associated with the Pathogenesis of Obesity and Type 2 Diabetes. Diabetes Metab Syndr Obes 2022; 15:2381-2389. [PMID: 35966830 PMCID: PMC9371465 DOI: 10.2147/dmso.s376163] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/26/2022] [Indexed: 12/16/2022] Open
Abstract
Obesity is defined as abnormal or excessive accumulation of adipose tissue, closely associated with the increased risk of various comorbidities, especially type 2 diabetes mellitus (T2DM). Adipose tissue is a complex structure responsible for not only fat storage but also releasing adipokines which may play roles in the pathogenesis and could be developed into biomarkers for diagnosis, treatment and prognosis of obesity-related metabolic diseases. This review aims to summarize several adipokines discovered recently that have promising functions in obesity and T2DM. Among them, the levels of FSTL1, WISP1 and Asprosin in subjects with obesity or diabetes are commonly higher than in normal controls, suggesting that they may be pathogenic. Inversely, SFRP5, Metrnl, NRG4 and FAM19A5 may serve as the protective factors.
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Affiliation(s)
- Jia-Xue Cheng
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ke Yu
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Ke Yu, Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, No. 82, Xinhua South Road, Tongzhou District, Beijing, People’s Republic of China, Tel +86 13811657618, Email
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