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Tanaka K, Okada Y, Uemura F, Tanaka Y. Associations between time in range and insulin secretory capacity in Japanese patients with type 2 diabetes. Sci Rep 2024; 14:12910. [PMID: 38839813 PMCID: PMC11153530 DOI: 10.1038/s41598-024-63678-5] [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: 03/01/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024] Open
Abstract
Impaired insulin secretory capacity is associated with high glycemic variability in patients with type 2 diabetes (T2DM). However, there are no existing reports on the association between insulin secretory capacity and time in range (TIR). This retrospective study involved 330 T2DM admitted for diabetes education who underwent intermittently scanned continuous glucose monitoring (isCGM) and had their fasting serum C-peptide immunoreactivity (S-CPR) measured within 5 days of admission. The baseline characteristics were as follows: age, 60.2 years; glycated hemoglobin (HbA1c), 9.2%; S-CPR, 2.2 ng/mL; S-CPR index (S-CPR [ng/mL]/fasting plasma glucose [mg/dL] × 100), 1.6; and TIR, 60.3%. TIR correlated significantly with the S-CPR index, which was confirmed by multivariate analysis that included various factors such as HbA1c. Receiver operating characteristic (ROC) analysis showed that 1.88 was the optimal S-CPR index level to predict TIR ≥ 70%. In addition to HbA1c and biguanide use, the S-CPR index was a significant factor associated with TIR > 70%. S-CPR index values of ≥ 1.88 also correlated significantly with TIR > 70%. In conclusion, insulin secretory capacity is associated with TIR in Japanese T2DM, suggesting that the S-CPR index might be a potentially useful biomarker insulin secretory capacity, in association with TIR.Trial registration UMIN0000254333.
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Affiliation(s)
- Kenichi Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yosuke Okada
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Fumi Uemura
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
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Tanaka K, Okada Y, Umezu S, Hashimoto R, Tomoyose Y, Tateyama R, Hori Y, Saito M, Tokutsu A, Sonoda S, Uemura F, Kurozumi A, Tanaka Y. Comparative effects of fixed-dose mitiglinide/voglibose combination and glimepiride on vascular endothelial function and glycemic variability in patients with type 2 diabetes: A randomized controlled trial. J Diabetes Investig 2024; 15:449-458. [PMID: 38149694 PMCID: PMC10981143 DOI: 10.1111/jdi.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare the effects of mitiglinide/voglibose with those of glimepiride on glycemic variability and vascular endothelial function in patients with type 2 diabetes. MATERIALS AND METHODS It was a multicenter, open-label, randomized, crossover study. Hospitalized patients received either mitiglinide/voglibose (three times daily administration of 10 mg mitiglinide and 0.2 mg voglibose) or glimepiride (once-daily 2 mg) in random order, each for 5 days. The reactive hyperemia index (RHI) and the mean amplitude of glycemic excursions (MAGE) were measured as co-primary endpoints using reactive hyperemia peripheral arterial tonometry and continuous glucose monitoring. RESULTS The analysis included 30 patients (15 in each group). The RHI was 1.670 ± 0.369 during treatment with mitiglinide/voglibose and 1.716 ± 0.492 during treatment with glimepiride, with no significant difference between the two. MAGE was significantly lower in the mitiglinide/voglibose group (47.6 ± 18.5 mg/dL) than in the glimepiride group (100.6 ± 32.2 mg/dL). Although the mean blood glucose levels over the entire 24 h period were comparable between the two groups, the use of mitiglinide/voglibose was associated with a lower standard deviation of mean glucose, coefficient of variation, and mean postprandial glucose excursion compared with glimepiride. The time below range (<70 mg/dL) and the time above range (>180, >200, and 250 mg/dL) were lower in the mitiglinide/voglibose group, while the time in range (70-180 mg/dL) was higher. CONCLUSIONS In our short-duration randomized crossover study, although not impacting vascular endothelial function, mitiglinide/voglibose demonstrated potential benefits in reducing glycemic variability, postprandial hyperglycemia, and hypoglycemia in patients with type 2 diabetes.
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Affiliation(s)
- Kenichi Tanaka
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yosuke Okada
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
- Clinical Research CenterHospital of the University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Saeko Umezu
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Ryoma Hashimoto
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yukiko Tomoyose
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Rina Tateyama
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yuri Hori
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Momo Saito
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Akemi Tokutsu
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Satomi Sonoda
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Fumi Uemura
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Akira Kurozumi
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
- Wakamatsu Hospital of the University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
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Misra S, Wagner R, Ozkan B, Schön M, Sevilla-Gonzalez M, Prystupa K, Wang CC, Kreienkamp RJ, Cromer SJ, Rooney MR, Duan D, Thuesen ACB, Wallace AS, Leong A, Deutsch AJ, Andersen MK, Billings LK, Eckel RH, Sheu WHH, Hansen T, Stefan N, Goodarzi MO, Ray D, Selvin E, Florez JC, Meigs JB, Udler MS. Precision subclassification of type 2 diabetes: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:138. [PMID: 37798471 PMCID: PMC10556101 DOI: 10.1038/s43856-023-00360-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Heterogeneity in type 2 diabetes presentation and progression suggests that precision medicine interventions could improve clinical outcomes. We undertook a systematic review to determine whether strategies to subclassify type 2 diabetes were associated with high quality evidence, reproducible results and improved outcomes for patients. METHODS We searched PubMed and Embase for publications that used 'simple subclassification' approaches using simple categorisation of clinical characteristics, or 'complex subclassification' approaches which used machine learning or 'omics approaches in people with established type 2 diabetes. We excluded other diabetes subtypes and those predicting incident type 2 diabetes. We assessed quality, reproducibility and clinical relevance of extracted full-text articles and qualitatively synthesised a summary of subclassification approaches. RESULTS Here we show data from 51 studies that demonstrate many simple stratification approaches, but none have been replicated and many are not associated with meaningful clinical outcomes. Complex stratification was reviewed in 62 studies and produced reproducible subtypes of type 2 diabetes that are associated with outcomes. Both approaches require a higher grade of evidence but support the premise that type 2 diabetes can be subclassified into clinically meaningful subtypes. CONCLUSION Critical next steps toward clinical implementation are to test whether subtypes exist in more diverse ancestries and whether tailoring interventions to subtypes will improve outcomes.
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Affiliation(s)
- Shivani Misra
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
| | - Robert Wagner
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Bige Ozkan
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martin Schön
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Magdalena Sevilla-Gonzalez
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Katsiaryna Prystupa
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Caroline C Wang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raymond J Kreienkamp
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Sara J Cromer
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mary R Rooney
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daisy Duan
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne Cathrine Baun Thuesen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amelia S Wallace
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aaron Leong
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St 16th Floor, Boston, MA, USA
| | - Aaron J Deutsch
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mette K Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liana K Billings
- Division of Endocrinology, Diabetes and Metabolism, NorthShore University Health System, Skokie, IL, USA
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Health Research Institute, Miaoli County, Taiwan, ROC
- Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Norbert Stefan
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- University Hospital of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debashree Ray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jose C Florez
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - James B Meigs
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St 16th Floor, Boston, MA, USA
| | - Miriam S Udler
- Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
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Misra S, Wagner R, Ozkan B, Schön M, Sevilla-Gonzalez M, Prystupa K, Wang CC, Kreienkamp RJ, Cromer SJ, Rooney MR, Duan D, Thuesen ACB, Wallace AS, Leong A, Deutsch AJ, Andersen MK, Billings LK, Eckel RH, Sheu WHH, Hansen T, Stefan N, Goodarzi MO, Ray D, Selvin E, Florez JC, Meigs JB, Udler MS. Systematic review of precision subclassification of type 2 diabetes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.19.23288577. [PMID: 37131632 PMCID: PMC10153304 DOI: 10.1101/2023.04.19.23288577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Heterogeneity in type 2 diabetes presentation, progression and treatment has the potential for precision medicine interventions that can enhance care and outcomes for affected individuals. We undertook a systematic review to ascertain whether strategies to subclassify type 2 diabetes are associated with improved clinical outcomes, show reproducibility and have high quality evidence. We reviewed publications that deployed 'simple subclassification' using clinical features, biomarkers, imaging or other routinely available parameters or 'complex subclassification' approaches that used machine learning and/or genomic data. We found that simple stratification approaches, for example, stratification based on age, body mass index or lipid profiles, had been widely used, but no strategy had been replicated and many lacked association with meaningful outcomes. Complex stratification using clustering of simple clinical data with and without genetic data did show reproducible subtypes of diabetes that had been associated with outcomes such as cardiovascular disease and/or mortality. Both approaches require a higher grade of evidence but support the premise that type 2 diabetes can be subclassified into meaningful groups. More studies are needed to test these subclassifications in more diverse ancestries and prove that they are amenable to interventions.
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Li W, Ping F, Xu L, Zhang H, Dong Y, Yu K, Li Y. The Effect of LM25 and LM50 on Hypoglycemia in Chinese T2DM Patients: Post Hoc Analysis of a Randomized Crossover Trial. Diabetes Ther 2020; 11:643-654. [PMID: 31981211 PMCID: PMC7048899 DOI: 10.1007/s13300-020-00766-5] [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: 11/23/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To investigate the safety of insulin lispro Mix 25 and 50 (LM25 and LM50) in hypoglycemia in patients with type 2 diabetes mellitus (T2DM). METHODS This was a post hoc analysis of a phase IV, randomized, crossover clinical trial in Chinese patients with T2DM switching from premixed human insulin 70/30 (PHI70/30) to LM25 or LM50. Eighty-one subjects received a two-stage crossover protocol of either LM25 or LM50 twice daily for 16 weeks. Habitual diet was taken, and self-monitoring of blood glucose (SMBG) was performed throughout the study period. High-carbohydrate diet (HCD), high-fat diet (HFD) and habitual diet patterns were taken, and 72 h continuous glucose monitoring (CGM) was performed at the last 3 days of each treatment stage. RESULTS The frequencies of nocturnal hypoglycemia in LM50 were lower than those in LM25 under a Chinese habitual diet pattern. The related factors of hypoglycemia in patients with T2DM treated with a LM25 or LM50 regimen were the weight-based daily mean insulin dose and the type of combined oral hypoglycemic agents. Under both HCD and habitual diet patterns, the optimal cut point values of bedtime glucose predicting nocturnal hypoglycemia in LM50 were lower than those in LM25. CONCLUSIONS The risk of nocturnal hypoglycemia in the LM50 regimen was lower than that in the LM25 regimen under the HCD pattern, and the safety range of bedtime glucose for the LM50 regimen was wider than that of the LM25 regimen in Chinese T2DM patients. Premixed insulin analogs combined with acarbose were more helpful to reduce the incidence of hypoglycemia. TRIAL REGISTRATION http://www.chictr.org.cn #ChiCTR-TTRCC-12002516.
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Affiliation(s)
- Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaxiu Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Lee SH. Hidden Risks behind Normal Fasting Glucose: Is It Significant? Diabetes Metab J 2018; 42:196-197. [PMID: 29938402 PMCID: PMC6015962 DOI: 10.4093/dmj.2018.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seung Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Takahashi K, Nakamura H, Sato H, Matsuda H, Takada K, Tsuji T. Four Plasma Glucose and Insulin Responses to a 75 g OGTT in Healthy Young Japanese Women. J Diabetes Res 2018; 2018:5742497. [PMID: 29629377 PMCID: PMC5831567 DOI: 10.1155/2018/5742497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/12/2017] [Accepted: 10/24/2017] [Indexed: 12/18/2022] Open
Abstract
The incidence of diabetes has been gradually increasing, not only in middle-aged individuals but also in young individuals. However, insulin and glucose patterns have not been investigated in apparently healthy young individuals, as they are typically grouped as controls. In this study, we investigated and classified glucose and insulin patterns in healthy young women. Sixty-two nonobese women without metabolic disease were recruited. The subjects underwent a 75 g oral glucose tolerance test (OGTT), physical measurements, and a biochemical examination. Two subjects displayed impaired glucose tolerance. The 62 subjects were categorized into four patterns by plasma glucose and insulin peak time during OGTT: normal type (n = 39), insulin-late type (n = 11), insulin- and glucose-late type (n = 7), and insulin-very late type (n = 5). OGTT glucose and insulin levels at all time points, insulinogenic index, HOMA-IR, and glucose area under the curve (AUC) significantly differed among the four groups. However, insulin AUC did not significantly differ. We did not detect significant differences in body condition or biochemical measurements. Our study demonstrated that some healthy young individuals might have delayed insulin secretion by OGTT. Early detection of altered glucose metabolism might be helpful to improve lifestyle choices and prevent progression to diabetes.
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Affiliation(s)
- Kei Takahashi
- Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, 365, Maeda, Inazawa-Cho, Inazawa City, Aichi, Japan
| | - Hidetaka Nakamura
- Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, 365, Maeda, Inazawa-Cho, Inazawa City, Aichi, Japan
| | - Hiroshi Sato
- Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, 365, Maeda, Inazawa-Cho, Inazawa City, Aichi, Japan
| | - Hideto Matsuda
- Department of Food and Nutrition, College of Nagoya Bunri University, 2-1, Sasazuka-Cho, Nishi-Ku, Nagoya, Aichi, Japan
| | - Kazuo Takada
- Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, 365, Maeda, Inazawa-Cho, Inazawa City, Aichi, Japan
| | - Tomiko Tsuji
- Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, 365, Maeda, Inazawa-Cho, Inazawa City, Aichi, Japan
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Watada H, Su Q, Li PF, Iwamoto N, Qian L, Yang WY. Comparison of insulin lispro mix 25 with insulin lispro mix 50 as an insulin starter in Asian patients with type 2 diabetes: a phase 4, open-label, randomized trial (CLASSIFY study). Diabetes Metab Res Rev 2017; 33. [PMID: 27155890 DOI: 10.1002/dmrr.2816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/14/2016] [Accepted: 05/01/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lispro Mix 25% insulin lispro/75% insulin lispro protamine (LM25) and Lispro Mix 50% insulin lispro/50% insulin lispro protamine (LM50) were compared as starter insulins in East Asian patients with type 2 diabetes. METHODS Phase 4, open-label, randomized trial conducted in China, Japan, Korea, and Turkey. Subjects received twice-daily LM25 (n = 207) or LM50 (n = 196) for 26 weeks. The primary outcome was the HbA1c change from baseline. RESULTS The least squares mean changes from baseline in HbA1c are -1.52% and -1.69% for LM25 and LM50, respectively, and the least squares mean difference [95% CI] is 0.17% [-0.01, 0.35]. More subjects in the LM50 group than in the LM25 group achieved HbA1c targets of <7.0% (59.7% versus 45.9%, respectively; p = 0.007). LM50 was more effective than LM25 in reducing postprandial glucose after the morning (mean difference in change from baseline, 0.56 mmol/L; p = 0.038) and evening (1.11 mmol/L; p < 0.001) meals. The reduction in fasting blood glucose was significantly greater (p = 0.046) in the LM25 group (LS mean [95% CI] change from baseline: -2.37 mmol/L [-2.68, -2.06]) than in the LM50 group (-1.99 mmol/L [-2.30, -1.68]). LM50 was more effective than LM25 in reducing HbA1c in subjects with baseline HbA1c , postprandial glucose, or carbohydrate intake levels greater than the median levels. Hypoglycemia rates and weight gain were similar between groups. CONCLUSIONS LM25 and LM50 were noninferior to each other in improving glycemic control in Asian patients with type 2 diabetes. In addition, LM50 was more efficacious than LM25 with respect to the percentage of subjects reaching target HbA1c levels. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Fei Li
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Noriyuki Iwamoto
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Lei Qian
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Wen Ying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
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Ikezaki H, Ai M, Schaefer EJ, Otokozawa S, Asztalos BF, Nakajima K, Zhou Y, Liu CT, Jacques PF, Cupples LA, Furusyo N. Ethnic Differences in Glucose Homeostasis Markers between the Kyushu-Okinawa Population Study and the Framingham Offspring Study. Sci Rep 2016; 6:36725. [PMID: 27830830 PMCID: PMC5103215 DOI: 10.1038/srep36725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/20/2016] [Indexed: 11/21/2022] Open
Abstract
We compared markers of glucose homeostasis and their association with diabetes and impaired fasting glucose (IFG) in Fukuoka, Japanese subjects (n = 1108) and age-, gender- and menopausal status-matched participants in the Framingham Offspring Study (n = 1096). The markers examined included fasting glucose, insulin, adiponectin, and glycated albumin, as well as body mass index (BMI), use of medications, and history of diabetes. The results showed that IFG prevalence in Japanese men (15.9%) and women (7.4%) were 50% less than those observed in Framingham men (34.5%) and women (21.4%) (P < 0.001). However, the diabetes prevalence in Japanese men at 13.3% was twice as high (P < 0.01) as the rate in Framingham men at 6.5%, while these rates were similar in women. Median insulin levels in Japanese men (4.6 μIU/mL) and women (4.3 μIU/mL) were about 50% lower (P < 0.001) than those in Framingham men (10.8 μIU/mL) and women (9.9 μIU/mL), as were insulin resistance values (P < 0.001). These population differences were also observed after subjects were stratified by glucose levels. In conclusion, our data indicate that there is significantly less IFG, lower insulin levels, and insulin resistance, but higher diabetes prevalence in Fukuoka men than in Framingham men, indicating that insulin deficiency may be an important cause of diabetes in Japan.
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Affiliation(s)
- Hiroaki Ikezaki
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA.,Nutritional Epidemiology Program, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA.,Department of General Internal Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510 Japan
| | - Ernst J Schaefer
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA
| | - Seiko Otokozawa
- Department of Public Health, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo 060-8556 Japan
| | - Bela F Asztalos
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA
| | - Katsuyuki Nakajima
- Department of Clinical Laboratory Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue CT3, Boston, MA 02118 USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue CT3, Boston, MA 02118 USA
| | - Paul F Jacques
- Nutritional Epidemiology Program, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue CT3, Boston, MA 02118 USA
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
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10
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Watanabe D, Yatabe M, Ichihara A. Evaluation of insulin sensitivity and secretion in primary aldosteronism. Clin Exp Hypertens 2016; 38:613-617. [PMID: 27669369 DOI: 10.1080/10641963.2016.1182176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In primary aldosteronism (PA), insulin response to glucose is not fully understood. Insulin action was elucidated using indices in 32 PA and 21 essential hypertension (EH) patients. These patients were evaluated using homeostasis model assessment (HOMA) indices, quantitative insulin sensitivity check index (QUICKI), and insulinogenic index (IGI), which were expressed for insulin sensitivity/secretion and the early phase of insulin secretion. Insulin sensitivity and early phase of insulin secretion were decreased in PA, and there was a negative correlation between serum potassium concentration and insulin sensitivity indices. These findings suggest that glucose intolerance in PA may be caused by hypokalemia-induced insulin resistance and hypokalemia-independent impairment of early-phase insulin secretion.
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Affiliation(s)
- Daisuke Watanabe
- a Department of Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
| | - Midori Yatabe
- a Department of Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
| | - Atsuhiro Ichihara
- a Department of Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
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11
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Hayashino Y, Izumi K, Okamura S, Nishimura R, Origasa H, Tajima N. Duration of diabetes and types of diabetes therapy in Japanese patients with type 2 diabetes: The Japan Diabetes Complication and its Prevention prospective study 3 (JDCP study 3). J Diabetes Investig 2016; 8:243-249. [PMID: 27390272 PMCID: PMC5334313 DOI: 10.1111/jdi.12550] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 01/17/2023] Open
Abstract
Aims/Introduction To analyze the association between the duration of diabetes and selection of diabetes therapy in a large database of Japanese patients with type 2 diabetes. Materials and Methods We used the data of 5,844 patients with type 2 diabetes to evaluate the association between the duration of diabetes and types of diabetes therapy. The logistic regression model was used to analyze the association between duration of diabetes and selection of diabetes therapy, and restricted cubic spline curves were used to represent the schematic association. Results Overall, clinical characteristics of the patients were women, 39.9%; mean age, 61.4 years; median duration of diabetes, 9 years; mean glycated hemoglobin, 7.4% (57.0 mmol/mol); and mean body mass index, 24.5 kg/m2. Compared with the first quartile of diabetes duration, the multivariable‐adjusted odds of any antidiabetic therapy (oral hypoglycemic agents or insulin) for the second, third and fourth quartiles were 2.17 (95% confidence interval [CI] 1.68–2.80; 3.39, 95% CI 2.53–4.54; 4.99, 95% CI 3.64–6.84), respectively (P for trend <0.001), and these associations were attenuated after adjusting possible confounders. Furthermore, those of insulin therapy were 1.48 (95% CI 1.20–1.84; 2.16, 95% CI 1.77–2.64; 4.94, 95% CI 4.04–6.04), respectively (P for trend <0.001). Schematic representation of restricted cubic spline curves analysis showed that a longer duration of diabetes was linearly associated with the odds of insulin therapy. Conclusions Obtained data showed that a longer duration of diabetes required complex diabetes drug regimens to be introduced to patients with type 2 diabetes.
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Affiliation(s)
- Yasuaki Hayashino
- The Japan Diabetes Society, Tokyo, Japan.,Tenri Hospital, Nara, Japan
| | - Kazuo Izumi
- The Japan Diabetes Society, Tokyo, Japan.,The National Center for Global Health and Medicine, Tokyo, Japan
| | - Shintaro Okamura
- The Japan Diabetes Society, Tokyo, Japan.,Tenri Hospital, Nara, Japan
| | - Rimei Nishimura
- The Japan Diabetes Society, Tokyo, Japan.,Division of Diabetes, Metabolism & Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Origasa
- The Japan Diabetes Society, Tokyo, Japan.,Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Naoko Tajima
- The Japan Diabetes Society, Tokyo, Japan.,Jikei University School of Medicine, Tokyo, Japan
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12
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Elucidation of genetic factors in diabetes based on studies of animal models. Diabetol Int 2015. [DOI: 10.1007/s13340-015-0228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Zheng S, Zhou H, Han T, Li Y, Zhang Y, Liu W, Hu Y. Clinical characteristics and beta cell function in Chinese patients with newly diagnosed type 2 diabetes mellitus with different levels of serum triglyceride. BMC Endocr Disord 2015; 15:21. [PMID: 25924608 PMCID: PMC4423127 DOI: 10.1186/s12902-015-0018-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/20/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To explore clinical characteristics and beta cell function in Chinese patients with newly diagnosed drug naive type 2 diabetes mellitus (T2DM) with different levels of serum triglyceride (TG). METHODS Patients with newly diagnosed T2DM (n = 624) were enrolled and divided into different groups according to levels of serum TG. All patients underwent oral glucose tolerance tests and insulin releasing tests. Demographic data, lipid profiles, glucose levels, and insulin profiles were compared between different groups. Basic insulin secretion function index (homeostasis model assessment for beta cell function index, HOMA-β), modified beta cell function index (MBCI), glucose disposition indices (DI), and early insulin secretion function index (insulinogenic index, IGI) were used to evaluate the beta cell function. RESULTS Patients of newly diagnosed T2DM with hypertriglyceridemia were younger, fatter and had worse lipid profiles, glucose profiles, and high insulin levels than those with normal TG. There is no difference in early phase insulin secretion among groups of newly diagnosed T2DM patients with different TG levels. The basal beta cell function (HOMA-β and MBCI) initially increased along rising TG levels and then decreased as the TG levels rose further. The insulin sensitivity was relatively high in patients with a low level of TG and low with a high level of TG. CONCLUSIONS Hypertriglyceridemia influences clinical characteristics and β cell function of Chinese patients with newly diagnosed T2DM. A better management of dyslipidemia may, to some extent, reduce the effect of lipotoxicity, thereby improving glucose homeostasis in patients with newly diagnosed T2DM.
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Affiliation(s)
- Shuang Zheng
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
| | - Huan Zhou
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
| | - Tingting Han
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
| | - Yangxue Li
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
| | - Yao Zhang
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
| | - Wei Liu
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
| | - Yaomin Hu
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, NO.160, Pujian Road, Shanghai, 200127, China.
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14
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Abstract
This article highlights the difficulties in creating a definitive classification of diabetes mellitus in the absence of a complete understanding of the pathogenesis of the major forms. This brief review shows the evolving nature of the classification of diabetes mellitus. No classification scheme is ideal, and all have some overlap and inconsistencies. The only diabetes in which it is possible to accurately diagnose by DNA sequencing, monogenic diabetes, remains undiagnosed in more than 90% of the individuals who have diabetes caused by one of the known gene mutations. The point of classification, or taxonomy, of disease, should be to give insight into both pathogenesis and treatment. It remains a source of frustration that all schemes of diabetes mellitus continue to fall short of this goal.
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Affiliation(s)
- Celeste C Thomas
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637, USA.
| | - Louis H Philipson
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637, USA; Department of Pediatrics, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, 900 East 57th Street, Chicago, IL 60637, USA
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15
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Yokoi N, Beppu M, Yoshida E, Hoshikawa R, Hidaka S, Matsubara T, Shinohara M, Irino Y, Hatano N, Seino S. Identification of putative biomarkers for prediabetes by metabolome analysis of rat models of type 2 diabetes. Metabolomics 2015; 11:1277-1286. [PMID: 26366137 PMCID: PMC4559098 DOI: 10.1007/s11306-015-0784-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/05/2015] [Indexed: 10/26/2022]
Abstract
Biomarkers for the development of type 2 diabetes (T2D) are useful for prediction and intervention of the disease at earlier stages. In this study, we performed a longitudinal study of changes in metabolites using an animal model of T2D, the spontaneously diabetic Torii (SDT) rat. Fasting plasma samples of SDT and control Sprague-Dawley (SD) rats were collected from 6 to 24 weeks of age, and subjected to gas chromatography-mass spectrometry-based metabolome analysis. Fifty-nine hydrophilic metabolites were detected in plasma samples, including amino acids, carbohydrates, sugars and organic acids. At 12 weeks of age, just before the onset of diabetes in SDT rats, the amounts of nine of these metabolites (asparagine, glutamine, glycerol, kynurenine, mannose, n-alpha-acetyllysine, taurine, threonine, and tryptophan) in SDT rats were significantly different from those in SD rats. In particular, metabolites in the tryptophan metabolism pathway (tryptophan and kynurenine) were decreased in SDT rats at 12 weeks of age and later. The lower tryptophan and kynurenine levels in the prediabetic state and later were further confirmed by a replication study on SDT rats and by a longitudinal study on another animal model of T2D, the Otsuka Long-Evans Tokushima Fatty rat. Our data indicate that tryptophan and its metabolites are potential biomarkers for prediabetes and that tryptophan metabolism may be a potential target of intervention for treatment of the disease.
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Affiliation(s)
- Norihide Yokoi
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Masayuki Beppu
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
- Division of Cellular and Molecular Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, Kobe, 650-0017 Japan
| | - Eri Yoshida
- Division of Cellular and Molecular Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, Kobe, 650-0017 Japan
| | - Ritsuko Hoshikawa
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Shihomi Hidaka
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Toshiya Matsubara
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
- Life Science Research Center, Technology Research Laboratory, Shimadzu Corporation, Kyoto, 619-0237 Japan
| | - Masami Shinohara
- Tokyo Animal and Diet Department, CLEA Japan, Inc., Meguro-ku, Tokyo, 153-8533 Japan
| | - Yasuhiro Irino
- The Integrated Center for Mass Spectrometry, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017 Japan
- Division of Evidenced-based Laboratory Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017 Japan
| | - Naoya Hatano
- The Integrated Center for Mass Spectrometry, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017 Japan
| | - Susumu Seino
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
- Division of Cellular and Molecular Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, Kobe, 650-0017 Japan
- The Integrated Center for Mass Spectrometry, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017 Japan
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16
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Mitsui R, Fukushima M, Taniguchi A, Nakai Y, Aoyama S, Takahashi Y, Tsuji H, Yabe D, Yasuda K, Kurose T, Kawakita T, Seino Y, Inagaki N. Insulin secretory capacity and insulin sensitivity in impaired fasting glucose in Japanese. J Diabetes Investig 2014; 3:377-83. [PMID: 24843593 PMCID: PMC4019258 DOI: 10.1111/j.2040-1124.2012.00201.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims/Introduction: Impaired fasting glucose (IFG) increases the risk of developing diabetes mellitus (DM). This study was carried out to characterize Japanese patients who have fasting glucose levels (FPG) between 100 and 109 mg/dL (IFG100–109). Materials and Methods: A total of 1383 Japanese participants were examined by oral glucose tolerance test. We compared insulin secretory capacity (insulinogenic index) and insulin sensitivity (ISI composite) of IFG100–109/normal glucose tolerance (NGT; 100 ≤ FPG < 110 mg/dL and 2‐h postchallenge glucose level (2‐hPG) < 140 mg/dL) with NGT (100 mg/dL < FPG and 2‐hPG < 140 mg/dL) and IFG110–125/NGT (110 ≤ FPG < 126 mg/dL and 2‐hPG < 140 mg/dL). In addition, IFG100–109 patients were analyzed in three subgroups according to glucose intolerance by 2‐hPG. Results: Of the three categories of IFG100–109, IFG100–109/DM had the lowest insulinogenic index despite an ISI composite showing only a small decline from IFG100–109/NGT through IFG100–109/IGT (100 ≤ FPG < 110 mg/dL and 140 ≤ 2‐hPG < 200 mg/dL) to IFG100–109/DM (100 ≤ FPG < 110 mg/dL and 200 mg/dL < 2‐hPG). By multiple regression analysis, the insulinogenic index showed a significant relationship with 2‐h PG levels. Both insulinogenic index and ISI composite were decreased significantly from NGT through IFG100–109/NGT to IFG110–125/NGT. Conclusions: Although impaired early‐phase insulin secretion plays the more important role in the elevation of postchallenge glucose in IFG100–109 patients, both impaired early‐phase insulin secretion and decreased insulin sensitivity are involved in the deterioration of FPG in Japanese. In addition, insulin secretory defect and decreased insulin sensitivity already have begun in patients with IFG100–109.(J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00201.x, 2012)
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Affiliation(s)
- Rie Mitsui
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University ; Center for Preventive Medicine, St. Luke's International Hospital, Tokyo
| | - Mitsuo Fukushima
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University ; Division of Clinical Nutrition and Internal Medicine
| | - Ataru Taniguchi
- Department of Internal Medicine, Kyoto Preventive Medical Center
| | | | - Sae Aoyama
- Division of Clinical Nutrition and Internal Medicine
| | - Yoshitaka Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Okayama
| | - Hideaki Tsuji
- Faculty of Health and Welfare Science, Okayama Prefectural University, Okayama
| | - Daisuke Yabe
- Division of Diabetes and Clinical Nutrition, Kansai-Denryoku Hospital
| | - Koichiro Yasuda
- Department of Diabetes and Endocrinology, Saiseikai Noe Hospital, Osaka, Japan
| | - Takeshi Kurose
- Division of Diabetes and Clinical Nutrition, Kansai-Denryoku Hospital
| | - Toshiko Kawakita
- Center for Preventive Medicine, St. Luke's International Hospital, Tokyo
| | - Yutaka Seino
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University ; Division of Diabetes and Clinical Nutrition, Kansai-Denryoku Hospital
| | - Nobuya Inagaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University
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17
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Harada N, Hamasaki A, Yamane S, Muraoka A, Joo E, Fujita K, Inagaki N. Plasma gastric inhibitory polypeptide and glucagon-like peptide-1 levels after glucose loading are associated with different factors in Japanese subjects. J Diabetes Investig 2014; 2:193-9. [PMID: 24843483 PMCID: PMC4014918 DOI: 10.1111/j.2040-1124.2010.00078.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aims/Introduction: Gastric inhibitory polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1) are major incretins that potentiate insulin secretion from pancreatic β‐cells. The factors responsible for incretin secretion have been reported in Caucasian subjects, but have not been thoroughly evaluated in Japanese subjects. We evaluated the factors associated with incretin secretion during oral glucose tolerance test (OGTT) in Japanese subjects with normal glucose tolerance (NGT). Materials and Methods: We measured plasma GIP and GLP‐1 levels during OGTT in 17 Japanese NGT subjects and evaluated the factors associated with GIP and GLP‐1 secretion using simple and multiple regression analyses. Results: GIP secretion (AUC‐GIP) was positively associated with body mass index (P < 0.05), and area under the curve (AUC) of C‐peptide (P < 0.05) and glucagon (P < 0.01), whereas GLP‐1 secretion (AUC‐GLP‐1) was negatively associated with AUC of plasma glucose (P < 0.05). The insulinogenic index was most strongly associated with GIP secretion (P < 0.05); homeostasis model assessment β‐cell was the most the strongly associated factor in GLP‐1 secretion (P < 0.05) among the four indices of insulin secretion and insulin sensitivity. Conclusions: Several distinct factors might be associated with GIP and GLP‐1 secretion during OGTT in Japanese subjects. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00078.x, 2011)
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Affiliation(s)
- Norio Harada
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Hamasaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunsuke Yamane
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Muraoka
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Erina Joo
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuyo Fujita
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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18
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Narita T, Goto T, Suganuma Y, Hosoba M, Morii T, Sato T, Fujita H, Miura T, Shimotomai T, Yamada Y, Kakei M. Efficacy and safety of patient-directed titration of once-daily pre-dinner premixed biphasic insulin aspart 70/30 injection in Japanese type 2 diabetic patients with oral antidiabetic drug failure: STEP-AKITA study. J Diabetes Investig 2014; 2:63-70. [PMID: 24843463 PMCID: PMC4008017 DOI: 10.1111/j.2040-1124.2010.00062.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aims/Introduction: To clarify clinical characteristics related to optimal glycemic control achieved after adding once‐daily pre‐dinner biphasic insulin aspart 70/30 (BIAsp 30) in Japanese type 2 diabetic (T2D) patients with oral antidiabetic drug (OAD) failure. Materials and Methods: Under this regimen, we evaluated changes in HbA1c levels and daily self‐monitoring blood glucose (BG) profiles, as well as the incidences of hypoglycemia and retinopathy progression. The patients adjusted BIAsp 30 dosages themselves every 3–4 days according to a pre‐determined algorithm to achieve fasting BG levels of 101–120 mg/dL. HbA1c levels were expressed as Japan Diabetes Society values. Results: Of 29 enrolled patients, 22 (HbA1c levels, 8.5 ± 1.5% [mean ± SD]) and 20 patients completed the 16‐ and 24‐week follow‐up, respectively. At 16 weeks 68.2 and 45.5%, and at 24 weeks 80.0 and 35% of patients had achieved HbA1c levels of <7.0 and <6.5%, respectively. The patients who had achieved optimal glycemic control, including daytime postprandial BG profiles after treatment, had lower post‐breakfast BG excursions at baseline, shorter diabetes durations and younger age. No severe hypoglycemic episodes were recorded. Progression of retinopathy was observed in 3 of the 29 enrolled patients. Conclusions: Lower post‐breakfast BG excursions, shorter diabetes duration and younger age in Japanese T2D patients with OAD failure might warrant optimal glycemic control with safety after adding once‐daily pre‐dinner BIAsp 30 initiating regimen. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00062.x, 2010)
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Affiliation(s)
- Takuma Narita
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo
| | | | - Yumi Suganuma
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo ; Akita Red Cross Hospital, Saruta, Kamikitate
| | - Mihoko Hosoba
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo ; Akita City Hospital, Kawamoto
| | - Tsukasa Morii
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo
| | - Takehiro Sato
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo
| | - Hiroki Fujita
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo
| | - Takeshi Miura
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo ; Akita City Hospital, Kawamoto
| | - Takashi Shimotomai
- Yokote Municipal Hospital, Yokote ; Akita Kumiai General Hospital, Ijima, Akita
| | - Yuichiro Yamada
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo
| | - Masafumi Kakei
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Hondo ; Department of Medicine, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
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19
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Aoyama-Sasabe S, Xin X, Taniguchi A, Nakai Y, Mitsui R, Tsuji H, Yabe D, Yasuda K, Kurose T, Inagaki N, Seino Y, Fukushima M. Relationship and factors responsible for regulating fasting and post-challenge plasma glucose levels in the early stage development of type 2 diabetes mellitus. J Diabetes Investig 2014; 5:663-70. [PMID: 25422766 PMCID: PMC4234229 DOI: 10.1111/jdi.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/11/2013] [Accepted: 01/05/2014] [Indexed: 01/10/2023] Open
Abstract
AIMS/INTRODUCTION Elevation of 2-h plasma glucose (2-h PG) levels keeps step with fasting plasma glucose (FPG) levels elevation, but some individuals show dominant elevation of 2-h PG and others FPG. We analyzed dependent and independent relationships between 2-h PG and FPG, and investigated the factors regulating 2-h PG and FPG. MATERIALS AND METHODS In 1,657 Japanese participants who underwent a 75-g oral glucose tolerance test at the initial examination for a medical check-up, we carried out simple linear regression analysis between 2-h PG and FPG levels on the three patterns of independent variables. We divided the participants into two subgroups: the 2-h PG-side group and the FPG-side from the regression line, and examined the relationships between 2-h PG-FPG and factors responsible for elevation of plasma glucose levels. RESULTS There was a significant positive correlation between 2-h PG and FPG levels. The regression line of both 2-h PG and FPG as independent variables was in accordance with the regression line of 2-h PG as an independent variable and FPG as a dependent variable. In 2-h PG-side group, age was the independent factor affecting 2-h PG in addition to insulinogenic index and insulin sensitivity index (ISI composite). In the FPG-side group, triglyceride was the independent factor affecting FPG in addition to insulinogenic index and ISI composite. CONCLUSIONS Two-hour PG was an independent predictor of FPG. In addition to the importance of decreased insulin secretion and insulin sensitivity, age was the strong factor to elevate 2-h PG levels in the 2-h PG-side group and triglyceride was the strong factor to elevate FPG levels in the FPG-side group in the early stage of development of type 2 diabetes.
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Affiliation(s)
- Sae Aoyama-Sasabe
- Division of Clinical Nutrition and Internal Medicine, Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University Okayama, Japan
| | - Xin Xin
- Department of Systems Engineering, Faculty of Computer Science and Systems Engineering, Okayama Prefectural University Okayama, Japan
| | - Ataru Taniguchi
- Division of Diabetes and Endocrinology, Kyoto Preventive Medical Center Kyoto, Japan
| | | | - Rie Mitsui
- Center for Preventive Medicine, St. Luke's International Hospital Tokyo, Japan
| | - Hideaki Tsuji
- Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University Okayama, Japan
| | - Daisuke Yabe
- Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital Osaka, Japan
| | - Koichiro Yasuda
- Department of Diabetes and Endocrinology, Saiseikai Noe Hospital Osaka, Japan
| | - Takeshi Kurose
- Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital Osaka, Japan
| | - Nobuya Inagaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University Kyoto, Japan
| | - Yutaka Seino
- Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital Osaka, Japan
| | - Mitsuo Fukushima
- Division of Clinical Nutrition and Internal Medicine, Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University Okayama, Japan
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Kothare PA, Linnebjerg H, Isaka Y, Uenaka K, Yamamura A, Yeo KP, de la Peña A, Teng CH, Mace K, Fineman M, Shigeta H, Sakata Y, Irie S. Pharmacokinetics, Pharmacodynamics, Tolerability, and Safety of Exenatide in Japanese Patients With Type 2 Diabetes Mellitus. J Clin Pharmacol 2013; 48:1389-99. [DOI: 10.1177/0091270008323750] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wu X, Chen H, Wang Y, Li H. The relationship between coronary risk factors and elevated 1-h postload plasma glucose levels in patients with established coronary heart disease. Clin Endocrinol (Oxf) 2013; 78:67-72. [PMID: 22324971 DOI: 10.1111/j.1365-2265.2012.04362.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/05/2012] [Accepted: 01/24/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Recent studies have shown that an elevated 1-h postload plasma glucose (1hPG) is able to identify subjects with normal glucose tolerance (NGT) at high risk for future type 2 diabetes and atherosclerotic cardiovascular disease. However, clinical studies about the characteristics of coronary heart disease (CHD) patients with elevated 1hPG are lacking. The aim of this study was to analyse the 1hPG level in CHD patients with NGT. METHODS A total of 204 CHD patients with NGT were recruited. Subjects underwent an oral glucose tolerance test, echocardiography and coronary angiography. Demographic data were recorded and blood samples obtained. According to the 1hPG cut-off point of 8.6 mm, patients were divided into two groups: 1hPG ≥ 8.6 mm (n = 65) and 1hPG < 8.6 mm (n = 139). RESULTS Compared with the 1hPG < 8.6 mm group, subjects with 1hPG ≥ 8.6 mm had a worse metabolic profile, exhibiting significantly higher body mass index, systolic blood pressure, triglyceride level and lower HDL-cholesterol level. Plasma high-sensitivity CRP (hsCRP) levels were higher in the 1hPG ≥ 8.6 mm group than in the 1hPG < 8.6 mm group. Coronary angiography revealed that single-vessel changes were more frequent in the 1hPG < 8.6 mm group, but there were no significant differences in the Gensini score. CONCLUSIONS Patients with CHD with 1hPG ≥ 8.6 mm have a worse metabolic profile, higher levels of hsCRP and multi-vessel coronary atherosclerosis. These findings suggest that, in patients with CHD, elevated 1hPG increases coronary risk factors and may be a marker for early-stage glucose intolerance.
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Affiliation(s)
- Xing Wu
- Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Shin JA, Lee JH, Kim HS, Choi YH, Cho JH, Yoon KH. Prevention of diabetes: a strategic approach for individual patients. Diabetes Metab Res Rev 2012; 28 Suppl 2:79-84. [PMID: 23280871 DOI: 10.1002/dmrr.2357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The 'diabetes epidemic' is an important health and socioeconomic problem worldwide. Type 2 diabetes is a chronic disease with gradual deterioration in glucose metabolism which causes multiple systemic complications. Therefore, early intervention in the prediabetic stage is a valuable approach to reduce diabetes development and related complications. Many clinical trials have suggested that lifestyle intervention, including moderate-intensity exercise and diet control, and pharmacologic intervention using metformin, α-glucosidase inhibitors, thiazolidinediones, anti-obesity drugs and incretin mimics, are effective in preventing diabetes development. However, an individualized approach with careful consideration of the patient's risk status and health economics is needed to perform a successful intervention programmes. In this review, we will summarize the known evidence on treatment- and cost-effectiveness of drug and lifestyle treatment. Additionally, we will propose a strategic approach algorithm that is applicable to clinical practice.
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Affiliation(s)
- Jeong-Ah Shin
- Department of Endocrinology & Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
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Katsuno T, Watanabe N, Nagai E, Okazaki K, Yokoyama A, Hamaguchi T, Miyagawa J, Namba M. Comparison of efficacy of concomitant administration of mitiglinide with voglibose and double dose of mitiglinide in patients with type 2 diabetes mellitus. J Diabetes Investig 2011; 2:204-9. [PMID: 24843485 PMCID: PMC4014920 DOI: 10.1111/j.2040-1124.2010.00082.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Aims/Introduction: When monotherapy with an oral hypoglycemic agent (OHA) is not sufficiently effective for blood glucose control, combination therapy with OHA having different mechanisms of action might be indicated. MATERIALS AND METHODS In the present study, we compared the efficacy of two options in type 2 diabetes mellitus patients whose blood glucose had not been well controlled with mitiglinide (30 mg/day) alone. A total of 20 patients were included in the study and divided into two groups: group A, in which mitiglinide was given concomitantly with the α-glucosidase inhibitor voglibose (0.6 mg/day); and group B, in which a double dose of mitiglinide was given (60 mg/day). Twelve weeks after changing the medication, HbA1c, glycoalbumin and 1,5-anhydroglucitol (1,5-AG) were measured. In addition, at weeks 0 and 12, a meal tolerance test was carried out, and plasma glucose, insulin, glucagon, active glucagon-like peptide-1 (GLP-1) and total glucose-dependent insulinotropic polypeptide levels were measured. RESULTS The plasma level of 1,5-AG improved in both groups at week 12. In group A, the plasma insulin level significantly decreased and the plasma active GLP-1 level significantly increased during the meal tolerance test at week 12; thus, bodyweight significantly decreased only in group A. CONCLUSIONS Our findings suggested that concomitant administration of mitiglinide with voglibose could achieve better glycemic control, particularly in the postprandial period, without bodyweight gain and might have beneficial effects in type 2 diabetic patients at risk of macrovascular complications. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.0082.x, 2011).
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Affiliation(s)
| | - Nobuaki Watanabe
- Innovative Diabetes Treatment, Department of Internal Medicine, Hyogo College of Medicine
| | | | - Kazumi Okazaki
- Innovative Diabetes Treatment, Department of Internal Medicine, Hyogo College of Medicine
| | - Ariko Yokoyama
- Innovative Diabetes Treatment, Department of Internal Medicine, Hyogo College of Medicine
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Sheu WHH, Rosman A, Mithal A, Chung N, Lim YT, Deerochanawong C, Soewondo P, Lee MK, Yoon KH, Schnell O. Addressing the burden of type 2 diabetes and cardiovascular disease through the management of postprandial hyperglycaemia: an Asian-Pacific perspective and expert recommendations. Diabetes Res Clin Pract 2011; 92:312-21. [PMID: 21605924 DOI: 10.1016/j.diabres.2011.04.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/29/2011] [Accepted: 04/25/2011] [Indexed: 11/16/2022]
Abstract
The world is facing an epidemic of cardiovascular disease (CVD) and type 2 diabetes, with populations in low- to middle-income countries, including many in the Asia Pacific (AP) region, being disproportionately affected. Emerging data identify postprandial hyperglycaemia (PPHG) as an important predictor of CVD, and several professional bodies, including the International Diabetes Federation, have issued guidelines on the management of PPHG in type 2 diabetes. Guidance on how international recommendations could be implemented in Asian populations is currently lacking. Therefore, a panel of experts from the AP region convened to consider the current status of PPHG and CVD in the region, and to develop recommendations for clinical practice. The group concluded that improved awareness of the impact of PPHG on CVD risk, among clinicians and the general public, and more widespread use of routine screening for PPHG, using oral glucose tolerance testing in those without recognised diabetes, are required. Additionally, frequent meal-based testing and effective PPHG management are essential to the management of IGT and type 2 diabetes.
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Affiliation(s)
- Wayne H-H Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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Kozawa J, Iwahashi H, Okita K, Okauchi Y, Imagawa A, Shimomura I. Insulin tolerance test predicts the effectiveness of insulin sensitizers in japanese type 2 diabetic patients. Diabetes Ther 2010; 1:121-30. [PMID: 22127749 PMCID: PMC3138481 DOI: 10.1007/s13300-010-0011-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The purpose of this study was to assess the efficacy of the insulin tolerance test (ITT) in predicting the effectiveness of insulin sensitizers in type 2 diabetic patients. METHODS We retrospectively reviewed 360 consecutive patients with type 2 diabetes admitted to Osaka University Hospital, Japan. In 163 of these hospitalized patients, insulin resistance was evaluated by the ITT after their blood glucose level was ameliorated. We then analyzed the association between their clinical characteristics and their glycemic control 6 months after discharge. RESULTS The rate constant for plasma glucose disappearance, K (ITT), was negatively correlated with body mass index (BMI), waist circumference (WC), and visceral fat area (VFA). The median value of K (ITT) was 1.56 (%/min). In the K (ITT) > 1.56 group (n=81), hemoglobin A(1c) (HbA(1c)) significantly increased in both patients treated with insulin sensitizers (n=10) and patients not treated with insulin sensitizers (n=71). In the K (ITT) ≤1.56 group (n=82), HbA(1c) significantly increased in patients not treated with insulin sensitizers (n=60); however, it was maintained well in the patients treated with insulin sensitizers (n=22). When the patients were divided and analyzed according to the median values of BMI, WC, or VFA, the glycemic control change was not different between the two groups with insulin sensitizers for each parameter. CONCLUSION Insulin sensitizers were effective in type 2 diabetic patients with high insulin resistance estimated by the ITT. The ITT could be useful to predict the effectiveness of insulin sensitizers.
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Affiliation(s)
- Junji Kozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, 2-2-B5 Yamadaoka, Suita, 565-0871, Japan,
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Qian L, Xu L, Wang X, Fu X, Gu Y, Lin F, Peng Y, Li G, Luo M. Early insulin secretion failure leads to diabetes in Chinese subjects with impaired glucose regulation. Diabetes Metab Res Rev 2009; 25:144-9. [PMID: 19116942 DOI: 10.1002/dmrr.922] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Both beta-cell dysfunction and decreased insulin sensitivity are involved in the pathogenesis of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), while their relative contribution in the progression to type 2 diabetes still remains controversial. The aim of the present study is to clarify this process in Chinese subjects by using cross-sectional method. METHODS 2,975 Chinese subjects were classified into: normal glucose tolerance (NGT), impaired glucose regulations (IGR), and diabetes mellitus (DM) based on oral glucose tolerance test (OGTT). The IGR group was sub-classified as isolated IFG, isolated IGT and combined glucose intolerance (CGI). The DM group was sub-classified as normal fasting plasma glucose and 2-hour hyperglycemia (N0D2), fasting hyperglycemia and normal 2-hour plasma glucose (D0N2), and both fasting and 2-hour hyperglycemia (D0D2). RESULTS As far as insulinogenic index (IGI) was concerned, there was no difference between IFG and IGT in either gender, however, HOMA2-B% (homeostasis model assessment for beta-cell function) of IGT was higher than that of IFG and CGI in both male and female (P < 0.05). In the diabetic sub-groups, IGI of N0D2 was higher than that of D0N2, and both deteriorated compared with those of IGT and IFG, respectively. HOMA2-B% of N0D2 was still higher than that of D0N2 and D0D2. No significant difference was detected in OGIS and HOMA2-S% (homeostasis model assessment for insulin sensitivity) between IFG and IGT, and this was the case between N0D2 and D0N2. OGIS and HOMA-IR of IGR sub-groups were not different from those of their diabetic counterparts. CONCLUSION Failure of beta-cell function might be the main reason for both IGT and IFG developing into diabetes instead of aggravated insulin resistance.
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Affiliation(s)
- Lei Qian
- Department of Endocrine and Metabolic Disease, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, Shanghai, PR China
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Gao Y, Yoon KH, Chuang LM, Mohan V, Ning G, Shah S, Jang HC, Wu TJ, Johns D, Northrup J, Brodows R. Efficacy and safety of exenatide in patients of Asian descent with type 2 diabetes inadequately controlled with metformin or metformin and a sulphonylurea. Diabetes Res Clin Pract 2009; 83:69-76. [PMID: 19019476 DOI: 10.1016/j.diabres.2008.09.037] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 09/02/2008] [Accepted: 09/23/2008] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the efficacy of exenatide in Asian patients with type 2 diabetes (T2D) inadequately controlled with oral agents. METHODS Patients taking metformin (MET) alone or with a sulphonylurea (SU) were randomly assigned to exenatide 5 microg then 10 microg twice-daily for 4 and 12 weeks, respectively, or placebo. The primary endpoint was baseline to endpoint HbA(1c) change. RESULTS 466 patients (age 54+/-9 years, weight 68.7+/-11.2 kg, BMI 26.3+/-3.3 kg/m(2), and HbA(1c) 8.3+/-1.1%; mean+/-S.D.) were enrolled in the full analysis set. Endpoint HbA(1c) reduction (mean [95% CI]) with exenatide was superior to placebo (-1.2 [-1.3, -1.1]% vs. -0.4 [-0.5, -0.2]%, p<0.001). More exenatide- than placebo-treated patients achieved HbA(1c) <or=7% (48% vs. 17%, p<0.001). At endpoint, weight reduction was greater with exenatide (-1.2 [-1.5, -0.9]kg) than placebo (-0.1 [-0.3, 0.2]kg), p<0.001. Nausea, generally mild-to-moderate, was the most common adverse event with exenatide (25% vs. 1% with placebo). The incidence of symptomatic hypoglycaemia with exenatide and placebo were 36% and 9%, respectively (p<0.001). Hypoglycaemia rates (events/patient-year) for patients taking exenatide with MET or MET and SU were 1.8 (0.9, 3.7) and 4.7 (3.5, 6.5), respectively. CONCLUSION Exenatide treatment improved glycaemic control in Asian patients with T2D and had a similar safety profile as in non-Asian patients.
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Affiliation(s)
- Yan Gao
- Department of Endocrinology, Peking University First Hospital, Beijing, China
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Qian L, Fu X, Xu L, Zheng S, Zhou W, Wang X, Gu Y, Lin F, Luo M. Metabolic characteristics of subjects with normal glucose tolerance and 1-h hyperglycaemia. Clin Endocrinol (Oxf) 2008; 69:575-9. [PMID: 18248638 DOI: 10.1111/j.1365-2265.2008.03209.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Nondiabetic subjects with a 1-h plasma glucose >or= 11.1 mmol/l during an oral glucose tolerance test (OGTT) drew our attention to their somewhat confusing status and relative frequency among Chinese patients. The aim of this study was to clarify the metabolic characteristics of these subjects. DESIGN AND PATIENTS A total of 2549 Chinese subjects were included in this study. Based on results of OGTT, these subjects were classified into three groups: normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes mellitus (DM). Then, according to the level of 1-h plasma glucose, the NGT and IGR groups were subclassified, respectively, as: NGT without 1-h hyperglycaemia (NGTN), NGT with hyperglycaemia at 1 h (NGT1H), IGR without 1-h hyperglycaemia (IGRN), and IGR with hyperglycaemia at 1 h (IGR1H). RESULTS After adjustments for age and gender, the insulinogenic index (IGI) of NGT1H and IGR1H was found to be lower than for those with NGTN and of IGRN, respectively (P < 0.05). No statistical differences, however, were found in oral glucose insulin sensitivity (OGIS) between either of the 1-h hyperglycaemic groups or of the corresponding NGTN or IGRN groups. Homeostasis model assessment for beta-cell function (HOMA-B) of NGT1H was lower than that of NGTN (P < 0.05), while IGRN and IGR1H showed no difference. No differences in homeostasis model assessment for insulin resistance (HOMA-IR) were found among NGTN, NGT1H, IGRN and IGR1H groups. The levels of triglycerides (TG) were not significantly different among NGT1H, IGRN and IGR1H, while TG in these groups were significantly higher than in NGTN (P < 0.05). LDL-C was significantly higher and HDL significantly lower in NGT1H than in all other groups (P < 0.05).The IGR group was also subclassified as: isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined glucose intolerance (CGI). The IGI of the NGT1H group was similar to the IGI that of combined glucose intolerance group but lower than those of IFG and IGT (P < 0.05).The OGIS of the NGT1H group was the highest among all groups (P < 0.05). HOMA-B of IGT and NGT1H were higher than that of IFG (P < 0.05). There was no difference among all groups in HOMA-IR. Plasma lipid levels were not significantly different between NGT1H and any other group. CONCLUSIONS Chinese NGT subjects with a 1-h plasma glucose >/= 11.1 mmol/l are characterized by metabolic abnormalities, which may be caused by the impairment of early insulin release rather than aggravated insulin resistance.
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Affiliation(s)
- Lei Qian
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Harada N, Fukushima M, Toyoda K, Mitsui R, Izuka T, Taniguchi A, Nakai Y, Yamada Y, Seino Y, Inagaki N. Factors responsible for elevation of 1-h postchallenge plasma glucose levels in Japanese men. Diabetes Res Clin Pract 2008; 81:284-9. [PMID: 18674839 DOI: 10.1016/j.diabres.2008.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/16/2008] [Indexed: 01/10/2023]
Abstract
The 1-h postchallenge plasma glucose (1-h PG) level is considered to be a good index of the development of glucose intolerance and type 2 diabetes as well as of diabetic complications. In some cases, in Japanese, 1-h PG is elevated despite normal fasting glucose during oral glucose tolerance test (OGTT), but the factors responsible remain unclear. In the present study, subjects with normal glucose tolerance (NGT), isolated impaired fasting glucose (IFG), and isolated impaired glucose tolerance (IGT) were divided into subgroups at 1-h PG of 10.0mM, and the four indices of insulin secretion and insulin sensitivity were compared. In all three categories, the insulinogenic index in subjects with elevated 1-h PG was remarkably lower than in those without elevated 1-h PG. In addition, the insulinogenic index was the strongest factor in elevated 1-h PG according to the multiple regression analysis. Interestingly, one third of the NGT subjects enrolled in this study had elevated 1-h PG. These subjects showed significantly elevated area under the curve of glucose (G-AUC) compared to NGT subjects without 1-h PG elevation. Thus, elevated 1-h PG in Japanese subjects indicates mildly impaired glucose tolerance due to decreased early-phase insulin secretion.
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Affiliation(s)
- Norio Harada
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Toyoda K, Fukushima M, Mitsui R, Harada N, Suzuki H, Takeda T, Taniguchi A, Nakai Y, Kawakita T, Yamada Y, Inagaki N, Seino Y. Factors responsible for age-related elevation in fasting plasma glucose: a cross-sectional study in Japanese men. Metabolism 2008; 57:299-303. [PMID: 18191064 DOI: 10.1016/j.metabol.2007.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 10/15/2007] [Indexed: 11/28/2022]
Abstract
To evaluate the factors associated with age-related increase in fasting plasma glucose (FPG) in Japanese men with normal fasting glucose, we measured FPG, fasting immunoreactive insulin, glycated hemoglobin, total cholesterol, triglyceride, and high-density lipoprotein cholesterol levels in health check examinees. Subjects with FPG less than 6.1 mmol/L together with glycated hemoglobin less than 5.6% were enrolled in the study. The homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-beta were used as the indices of insulin sensitivity and insulin secretion, respectively. Fasting plasma glucose increased significantly with age (r = 0.30, P < .0001), and HOMA-beta decreased significantly with age (r = 0.24, P < .0001). The HOMA-IR had no significant relation with age (r = 0.06, not significant), whereas body mass index and serum triglyceride were associated with HOMA-IR (r = 0.49, P < .0001 and r = 0.33, P < .0001, respectively). Thus, in Japanese male subjects with normal fasting glucose, it is suggested that the FPG increment with age is associated with decreased beta-cell function rather than with insulin resistance. Further analyses were performed by comparing 3 groups: low FPG (FPG <5.0 mmol/L), high FPG (5.0 < or = FPG < 5.6 mmol/L), and mild impairment of fasting glycemia (mild IFG) (5.6 < or = FPG < 6.1 mmol/L). The insulin levels in mild IFG and high FPG were significantly higher than in low FPG (P < .001), but those in mild IFG were similar to those in high FPG. Analysis of the 3 subgroups revealed that, whereas insulin sensitivity was impaired more in high FPG, there was little compensatory increase in insulin in mild IFG, suggesting that beta-cell function is already deteriorated when the FPG level is greater than 5.6 mmol/L.
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Affiliation(s)
- Kentaro Toyoda
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Koshiyama H, Taniguchi A, Inagaki N, Seino Y. Is the concept of 'cardiometabolic risk' more useful than 'metabolic syndrome'? Diabet Med 2007; 24:571. [PMID: 17470194 DOI: 10.1111/j.1464-5491.2007.02174.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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