1
|
Uchida T, Ueno H, Konagata A, Taniguchi N, Kogo F, Nagatomo Y, Shimizu K, Yamaguchi H, Shimoda K. Improving the Effects of Imeglimin on Endothelial Function: A Prospective, Single-Center, Observational Study. Diabetes Ther 2023; 14:569-579. [PMID: 36732433 PMCID: PMC9981829 DOI: 10.1007/s13300-023-01370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Endothelial dysfunction is a risk factor for cardiovascular disease in patients with diabetes. We hypothesized that imeglimin, a novel oral hypoglycemic agent, would improve endothelial function. METHODS In this study, imeglimin was administered to patients with type 2 diabetes and HbA1c ≥ 6.5% who were not receiving insulin therapy. A meal tolerance test (592 kcal, glucose 75.0 g, fat 28.5 g) was performed before and 3 months after administration, and endothelial function, blood glucose, insulin, glucagon, and triglycerides were evaluated. Endothelial function was assessed by flow-mediated dilation (FMD). RESULTS Twelve patients (50% male) with a median age of 55.5 years old (interquartile range [IQR] 51.3-66.0) were enrolled. Fasting FMD did not differ before or 3 months after imeglimin administration (from 6.1 [3.9-8.5] to 6.6 [3.9-9.0], p = 0.092), but 2 h postprandial FMD was significantly improved 3 months after imeglimin administration (from 2.3 [1.9-3.4] to 2.9 [2.4-4.7], p = 0.013). In terms of the glucose profile, imeglimin administration significantly improved HbA1c (from 7.2 ± 0.6% to 6.9 ± 0.6%, p = 0.007), fasting glucose (from 138 ± 19 mg/dL to 128 ± 20 mg/dL, p = 0.020), and 2 h postprandial glucose (from 251 ± 47 mg/dL to 215 ± 68 mg/dL, p = 0.035). The change in 2 h postprandial FMD between before and 3 months after imeglimin administration (Δ2 h postprandial FMD) was negatively correlated with Δ2 h postprandial glucose (r = - 0.653, p = 0.021) in a univariate correlation coefficient analysis. Both patients with and without decreased postprandial glucose 3 months after imeglimin administration had improved postprandial FMD. CONCLUSION In this small study, imeglimin administration improved 2 h postprandial FMD. Both glycemic control-dependent and -independent mechanisms might contribute to improved endothelial function. TRIAL REGISTRATION This research was registered in the University Hospital Medical Information Network (UMIN, UMIN000046311).
Collapse
Affiliation(s)
- Taisuke Uchida
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroaki Ueno
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Ayaka Konagata
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Norifumi Taniguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Fumiko Kogo
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yuma Nagatomo
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Koichiro Shimizu
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hideki Yamaguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kazuya Shimoda
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| |
Collapse
|
2
|
Fewkes JJ, Kellow NJ, Cowan SF, Williamson G, Dordevic AL. A single, high-fat meal adversely affects postprandial endothelial function: a systematic review and meta-analysis. Am J Clin Nutr 2022; 116:699-729. [PMID: 35665799 PMCID: PMC9437993 DOI: 10.1093/ajcn/nqac153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/29/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endothelial dysfunction is a predictive risk factor for the development of atherosclerosis and is assessed by flow-mediated dilation (FMD). Although it is known that NO-dependent endothelial dysfunction occurs after consuming a high-fat meal, the magnitude of the effect and the factors that affect the response are unquantified. OBJECTIVES We conducted a systematic review and meta-analysis exploring the quantitative effects of a single high-fat meal on endothelial function and determined the factors that modify the FMD response. METHODS Six databases were systematically searched for original research published up to January 2022. Eligible studies measured fasting and postprandial FMD following consumption of a high-fat meal. Meta-regression was used to analyze the effect of moderator variables. RESULTS There were 131 studies included, of which 90 were suitable for quantitative meta-analysis. A high-fat meal challenge transiently caused endothelial dysfunction, decreasing postprandial FMD at 2 hours [-1.02 percentage points (pp); 95% CI: -1.34 to -0.70 pp; P < 0.01; I2 = 93.3%], 3 hours [-1.04 pp; 95% CI: -1.48 to -0.59 pp; P < 0.001; I2 = 84.5%], and 4 hours [-1.19 pp; 95% CI: -1.53 to -0.84 pp; P < 0.01; I2 = 94.6%]. Younger, healthy-weight participants exhibited a greater postprandial reduction in the FMD percentage change than older, heavier, at-risk groups after a high-fat meal ( P < 0.05). The percentage of fat in the meals was inversely associated with the magnitude of postprandial changes in FMD at 3 hours (P < 0.01). CONCLUSIONS A single, high-fat meal adversely impacts endothelial function, with the magnitude of the impact on postprandial FMD moderated by the fasting FMD, participant age, BMI, and fat content of the meal. Recommendations are made to standardize the design of future postprandial FMD studies and optimize interpretation of results, as high-fat meals are commonly used in clinical studies as a challenge to assess endothelial function and therapeutics. This trial was registered at PROSPERO as CRD42020187244.
Collapse
Affiliation(s)
- Juanita J Fewkes
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stephanie F Cowan
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Aimee L Dordevic
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| |
Collapse
|