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Aziz F, Sternad C, Sourij C, Knoll L, Kojzar H, Schranz A, Bürger A, Sourij H, Aberer F. Glycated haemoglobin, HOMA2-B, C-peptide to glucose ratio and type 2 diabetes clusters as predictors for therapy failure in individuals with type 2 diabetes without insulin therapy: A registry analysis. Diabetes Obes Metab 2024; 26:1082-1089. [PMID: 38151754 DOI: 10.1111/dom.15409] [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: 10/24/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
AIM Some people with type 2 diabetes mellitus (T2D) and declining β-cell function do require insulin over time. Various laboratory parameters, indices of glucose metabolism or phenotypes of T2D (clusters) have been suggested, which might predict future therapy failure (TF), indicating the need for insulin therapy initiation. This analysis evaluated glycated haemoglobin (HbA1c), homeostatic model assessment (HOMA)2-B, C-peptide to glucose ratio (CGR) and diabetes clusters as predictive parameters for the occurrence of glycaemic TF in individuals diagnosed with T2D without previous insulin therapy. MATERIALS AND METHODS In total, 159 individuals with T2D [41% female, median age 50 (IQR: 53-69) years, diabetes duration 9 (5-15) years], without insulin therapy were prospectively evaluated for the occurrence of a composite primary endpoint, including HbA1c increasing or remaining >8.0% (64 mmol/mol) 3 months after baseline on non-insulin glucose-lowering agents, insulin initiation or hospital admissions because of acute hyperglycaemic events. Diabetes clusters were formed according to previously described characteristics. Only severe autoimmune diabetes clusters were excluded because of a small amount of glutamate decarboxylase antibody-positive participants. The other clusters were distributed as mild age-related diabetes 33%; severe insulin-deficient diabetes 31%; mild obesity-related diabetes 20%; and severe insulin-resistant diabetes 15%. RESULTS During a median observation of 57 months, higher tertiles of HbA1c at baseline, HOMA2-B, as well as a lower CGR were significantly predictive for the occurrence of the primary endpoint. The probability of meeting the primary endpoint was the highest for mild obesity-related diabetes [hazard ratio 3.28 (95% confidence interval 1.75-6.2)], followed by severe insulin-deficient diabetes [hazard ratio 2.03 (95% confidence interval 1.1-3.7)], mild age-related diabetes and the lowest for severe insulin-resistant diabetes. The best performance to predict TF with an area under the curve (AUC) of 0.77 was HbA1c at baseline, followed by HOMA2-B (AUC 0.69) and CGR (AUC 0.64). CONCLUSION HbA1c, indices of insulin secretion capacity (HOMA2-B and CGR) and T2D clusters might be applicable tools to guide practitioners in the decision of whether insulin is required in people already diagnosed with T2D. These findings need to be validated in prospective studies.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Lisa Knoll
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Anna Schranz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Alexandra Bürger
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Zhang L, Wu X, Li X, Chang X, Ding X, Wang Q, Jiang T, Wang G, Liu J. Longitudinal changes in serum adropin levels and liver fat content during liraglutide treatment in newly diagnosed patients with type 2 diabetes mellitus and metabolic dysfunction-associated fatty liver disease. Acta Diabetol 2023; 60:971-979. [PMID: 37079136 DOI: 10.1007/s00592-023-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
AIMS To explore the effect of liraglutide treatment on serum adropin and its relationship to the liver fat content in newly diagnosed patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated fatty liver disease (MAFLD). METHODS Serum adropin level and liver fat content were assessed in patients with T2DM and MAFLD (n = 22), along with healthy controls (n = 22). Afterward, the patients received liraglutide treatment for 12 weeks. Serum adropin levels were examined by a competitive enzyme-linked immunosorbent assay. Liver fat content was quantified via magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF). RESULTS We found that patients with newly diagnosed T2DM and MAFLD had lower serum adropin levels [2.79 ± 0.47 vs. 3.27 ± 0.79 ng/mL, P < 0.05] and higher liver fat content [19.12 ± 9.46 vs. 4.67 ± 0.61%, P < 0.001], compared to healthy controls. Following 12-week liraglutide treatment, serum adropin levels increased from 2.83(2.44, 3.24) to 3.65(3.20, 3.85) ng/mL (P < 0.001), and liver fat content decreased from 18.04(11.08, 27.65) to 7.74(6.42, 13.49) % (P < 0.001) in patients with T2DM and MAFLD. Furthermore, increases in serum adropin were strongly associated with decreases in liver fat content (β = - 5.933, P < 0.001), liver enzyme and glucolipid metabolism parameters. CONCLUSION The increase in serum adropin level following liraglutide treatment was strongly correlated with the reduction in liver fat content and glucolipid metabolism. Hence, adropin might be a potential marker for the beneficial effects of liraglutide on treating T2DM and MAFLD.
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Affiliation(s)
- Lin Zhang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiaojuan Wu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xinyue Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiaona Chang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiaoyu Ding
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Jia Liu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Sun T, Wang C, Huo L, Wang Y, Liu K, Wei C, Zhao H, Chen S, Ren L. Serum Cortistatin Level in Type 2 Diabetes Mellitus and Its Relationship with Nonalcoholic Fatty Liver Disease. Int J Gen Med 2023; 16:631-639. [PMID: 36851999 PMCID: PMC9960706 DOI: 10.2147/ijgm.s396315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Purpose To evaluate serum cortistatin (CST) levels in type 2 diabetes mellitus (T2DM) patients with or without non-alcoholic fatty liver disease (NAFLD) and to examine the relationship between CST and NAFLD. Methods A total of 90 T2DM patients, which included 56 NAFLD patients (referred to as DM+NAFLD group) and 34 patients without NAFLD (DM-only group), and 83 non-diabetes individuals that included 39 NAFLD patients (NAFLD-only group) and 44 without NAFLD that acted as the normal-control group (NC group). The differences in the serum CST levels between the groups were compared, and the correlations between CST and other variables were calculated by applying both correlational analysis and multiple linear regression analysis. Results The mean serum CST levels were significantly lower in the DM+NAFLD and DM groups than in the NC group (P < 0.05). In addition, the CST levels were lower in the DM group relative to that in the NAFLD group (P < 0.05). However, no statistical difference was noted in the serum CST between diabetic patients with and without NAFLD (P > 0.05). Similarly, in the non-diabetic group, the serum CST level was not significantly different between individuals with and without NAFLD (P > 0.05). Furthermore, the serum CST levels were negatively associated with the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), homeostasis model assessment-insulin resistance (HOMA-IR), and insulin cell function index (HOMA-β). Conversely, the serum CST levels were positively associated with high-density lipoprotein cholesterol (HDL-C). The data obtained through multiple linear regression implied that LDL-C and HOMA-β, but not HOMA-IR, were closely related to serum CST levels. Conclusion T2DM was related to decreased serum CST. However, serum CST was correlated with HOMA-β in T2DM patients, while HOMA-IR was not. There was no correlation between CST and NAFLD.
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Affiliation(s)
- Tiantian Sun
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Chang Wang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,North China University of Science and Technology, Tangshan, People's Republic of China
| | - Lijing Huo
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Yichao Wang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Ke Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Changmei Wei
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Hang Zhao
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Shuchun Chen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Luping Ren
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
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Wang Q, An Y, Zhang L, Zhang Y, Wang G, Liu J. Regulation of Adropin by Sitagliptin monotherapy in participants with newly diagnosed type 2 Diabetes. BMC Endocr Disord 2022; 22:306. [PMID: 36476135 PMCID: PMC9727947 DOI: 10.1186/s12902-022-01233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adropin is a potent metabolic regulator of insulin sensitivity and glycolipid metabolism. The present study investigated the effects of sitagliptin on adropin and metabolic parameters in participants with newly diagnosed type 2 diabetes (T2D). METHODS Thirty-five participants newly-diagnosed with T2D were prescribed sitagliptin 100 mg once daily for 17 weeks. Twenty-eight age-, sex-, and BMI-matched healthy subjects were included as the control group. Adropin and clinical parameters were assessed at baseline and after treatment. RESULTS At baseline, serum adropin levels were lower in T2D participants than in the healthy individuals (3.12 ± 0.73 vs. 5.90 ± 1.22 ng/ml, P < 0.01). Serum adropin levels were significantly higher in T2D patients after sitagliptin treatment (4.97 ± 1.01 vs. 3.12 ± 0.73 ng/ml, P < 0.01). The changes in serum adropin levels after sitagliptin treatment were associated with the improvements of fasting blood glucose (FBG) (β = - 0.71, P < 0.01), glycosylated hemoglobin (HbA1c) (β = - 0.44, P < 0.01) and homeostatic model assessment of β-cell function (HOMA-β) (β = 9.02, P < 0.01). CONCLUSIONS Sitagliptin treatment could significantly increase serum adropin levels in participants with newly diagnosed T2D. The increase in serum adropin levels could be associated with the amelioration of glucose metabolism, which might be involved in beneficial glucose-lowering mechanisms of sitagliptin. TRIAL REGISTRATION Clinicaltrials.gov , NCT04495881 . Retrospectively registered on 03/08/2020.
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Affiliation(s)
- Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yuanying Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Bian N, Sun X, Zhou B, Zhang L, Wang Q, An Y, Li X, Li Y, Liu J, Meng H, Wang G. Obese patients with higher TSH levels had an obvious metabolic improvement after bariatric surgery. Endocr Connect 2021; 10:1326-1336. [PMID: 34524974 PMCID: PMC8558898 DOI: 10.1530/ec-21-0360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Bariatric surgery has become the most effective treatment for morbid obesity. Increasing evidence showed that bariatric surgery can alleviate insulin resistance and influence thyroid function. This study aimed to investigate the relationship between changes in thyroid function and adipose tissue insulin resistance (adipo-IR) after bariatric surgery. METHODS A total of 287 non-diabetic participants with regular thyroid function were recruited and divided into the lean, overweight and obese groups. Among them, 50 morbidly obese patients submitted to bariatric surgery. RESULTS The obese group had a higher level of adipo-IR, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), FT3/free thyroxine (FT4) and metabolism disorders than the lean and overweight groups. BMI was correlated with TSH, FT3, FT3/FT4 and adipo-IR (r = 0.309, 0.315, 0.322 and 0.651, respectively, all P < 0.001). Adipo-IR was significantly correlated with TSH (r = 0.402, P < 0.001), FT3 (r = 0.309, P < 0.001), and FT3/FT4 (r = 0.228, P < 0.05). Bariatric surgery resulted in a sharp decline in BMI, adipo-IR, TSH, FT3 and FT3/FT4 levels, meanwhile, metabolic disorders improved. The decrease in BMI after bariatric surgery was significantly correlated with reductions in adipo-IR (r = 0.577, P < 0.001) and TSH (r = 0.401, P = 0.005). Interestingly, the fasting blood glucose, fasting insulin, adipo-IR and TSH in the higher TSH group decreased more remarkably than in the lower TSH group. CONCLUSION Obese individuals with higher TSH levels had an obvious metabolic improvement after bariatric surgery.
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Affiliation(s)
- Nannan Bian
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Sun
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Biao Zhou
- Departments of General Surgery and Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J Liu or H Meng or G Wang: or or
| | - Yu An
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Li
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J Liu or H Meng or G Wang: or or
| | - Yinhui Li
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J Liu or H Meng or G Wang: or or
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J Liu or H Meng or G Wang: or or
| | - Hua Meng
- Departments of General Surgery and Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
- Correspondence should be addressed to J Liu or H Meng or G Wang: or or
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J Liu or H Meng or G Wang: or or
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Wang Q, Ma L, Zhang Y, Zhang L, An Y, Liu J, Wang G. Effect of Sitagliptin on Serum Irisin Levels in Patients with Newly Diagnosed Type 2 Diabetes Mellitus. Diabetes Ther 2021; 12:1029-1039. [PMID: 33625721 PMCID: PMC7994490 DOI: 10.1007/s13300-021-01023-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Irisin is a unique myokine with striking effects on regulating insulin sensitivity and energy metabolism. This study aimed to investigate the changes in serum irisin in patients with newly diagnosed type 2 diabetes mellitus (T2DM) following sitagliptin treatment. METHODS Thirty-two patients with T2DM were treated with 100 mg/day sitagliptin for 16 weeks. Twenty age-, sex- and body mass index (BMI)-matched healthy subjects were enrolled as the control group. Irisin and metabolic parameters were measured at baseline and after treatment. RESULTS Patients with T2DM had lower irisin levels than the controls (10.03 ± 2.06 vs. 13.06 ± 3.10 ng/ml, P < 0.01). Sitagliptin treatment significantly increased serum irisin levels in T2DM patients compared to baseline (11.18 ± 1.91 vs. 10.03 ± 2.06 ng/ml, P < 0.01). Increased irisin levels were associated with decreased fasting blood glucose (FBG) (β = - 0.24, P < 0.05) and glycosylated hemoglobin (HbA1c) (β = - 0.15, P < 0.05). CONCLUSIONS Sitagliptin treatment significantly increased serum irisin levels in patients with T2DM, and the increase of the irisin level was associated with decreases of FBG and HbA1c levels. These results suggest that irisin might be involved in the antidiabetic mechanisms of sitagliptin. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04495881.
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Affiliation(s)
- Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lirong Ma
- Department of Endocrinology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100026, China
| | - Yuanying Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
- Department of Endocrinology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100026, China.
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Li X, Wu X, Jia Y, Fu J, Zhang L, Jiang T, Liu J, Wang G. Liraglutide Decreases Liver Fat Content and Serum Fibroblast Growth Factor 21 Levels in Newly Diagnosed Overweight Patients with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease. J Diabetes Res 2021; 2021:3715026. [PMID: 34660809 PMCID: PMC8519721 DOI: 10.1155/2021/3715026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSES In this study, we aimed to verify plasma fibroblast growth factor 21 (FGF21) elevation in newly diagnosed overweight patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) and to evaluate the effectiveness of liraglutide on reducing liver fat content and serum (FGF21) levels in those patients. METHODS A 12-week, single-center, prospective study was conducted. Twenty newly diagnosed overweight patients with T2DM and NAFLD were recruited. Twenty healthy age, sex, and body mass index (BMI) matched subjects were enrolled as the control group. Enzyme-linked immunosorbent assay was used to measure serum FGF21 levels. Liver fat content was determined using the 3.0 T whole-body MRI scanner. RESULTS Those newly diagnosed overweight patients with T2DM and NAFLD had a BMI of 27.6 ± 0.5 kg/m2. They had higher levels of FGF21 (159.6 ± 35.7 vs. 124.1 ± 42.9 pg/ml, P < 0.001) and increased liver fat content (19.3 ± 9.4 vs. 4.5 ± 0.6%, P < 0.001) compared to the controls. Liraglutide treatment for 12 weeks induced a significant 4.9 kg weight loss (95% confidence interval (CI): -6.1, -3.7, P < 0.001), which was equivalent to a relative reduction of 6.8% (95% CI: 5.3%, 8.3%, P < 0.001). FGF21 levels decreased after the 12-week liraglutide treatment (159.6 ± 35.7 vs. 124.2 ± 27.8 pg/ml, P = 0.006). There was a positive correlation between relative changes of liver fat content and relative change of FGF21 (r = 0.645, P = 0.002). FGF21 levels significantly decreased in patients who had a significant decrease in liver fat content (≥29%) (95% CI: -262.8, -55.1, P = 0.006); however, there was no significant change in the patients without a significant decrease in liver fat content (<29%) (95% CI: -60.0, 54.1, P = 0.899). CONCLUSIONS Liraglutide treatment reduced both liver fat content and FGF21 levels in newly diagnosed overweight patients with T2DM and NAFLD. FGF21 may be a potential biomarker for evaluating the effects of liraglutide treatment on hepatic fat and glucose metabolism.
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Affiliation(s)
- Xinyue Li
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Xiaojuan Wu
- Department of Endocrinology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Yumei Jia
- Department of Endocrinology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Jing Fu
- Department of Endocrinology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Tao Jiang
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao Yang Hospital, Capital Medical University, No. 8, Gong ti South Road, Chao Yang District, Beijing 100020, China
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Sun X, Zhang H, Liu J, Wang G. Serum vascular endothelial growth factor level is elevated in patients with impaired glucose tolerance and type 2 diabetes mellitus. J Int Med Res 2019; 47:5584-5592. [PMID: 31547733 PMCID: PMC6862917 DOI: 10.1177/0300060519872033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective This study was performed to investigate the serum vascular endothelial growth factor (VEGF) levels in Chinese patients with impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes mellitus (T2DM). Methods A total of 189 subjects (41 controls, 40 patients with IGT, and 108 patients with newly diagnosed T2DM) were recruited. Serum VEGF levels were determined by ELISA; other metabolic parameters were assessed by standard laboratory methods. Results There were significant differences in serum VEGF levels among the T2DM, IGT, and control groups (T2DM vs. controls: 72.00 [45.40, 98.35] pg/mL vs. 53.10 [36.30, 116.25] pg/mL; IGT vs. controls: 78.17 [55.52, 137.25] pg/mL vs. 53.10 [36.30, 116.25] pg/mL). Moreover, serum VEGF levels were positively associated with the homeostasis model assessment for insulin resistance (HOMA-IR) value. Multiple linear regression analysis indicated that the HOMA-IR value was an independent risk factor for elevated serum VEGF level. Conclusions Both IGT and T2DM patients exhibited increased serum VEGF levels, compared with controls; increased serum VEGF level was positively associated with the HOMA-IR value. Therefore, the increased serum VEGF level might partially result from increased insulin resistance in these patients.
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Affiliation(s)
| | | | | | - Guang Wang
- Guang Wang, Department of Endocrinology, Beijing Chao-Yang Hospital, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, P. R. China.
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Duan Y, Liu J, Xu Y, Yang N, Yang W, Wang G. Factors That Influence Pancreatic Beta Cell Function and Insulin Resistance in Newly Diagnosed Type 2 Diabetes Patients: A Sub-Analysis of the MARCH Trial. Diabetes Ther 2018; 9:743-752. [PMID: 29524187 PMCID: PMC6104271 DOI: 10.1007/s13300-018-0393-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The Metformin and Acarbose in Chinese as the initial Hypoglycemic treatment (MARCH) trial has demonstrated a similar efficacy in HbA1c reduction between acarbose and metformin treatments in newly diagnosed type 2 diabetes mellitus (T2DM) patients. The current sub-analysis of the MARCH trail aims to evaluate the baseline characteristics that may influence the improvement of pancreatic β-cell function and insulin resistance after acarbose therapy in Chinese patients with newly diagnosed T2DM. METHODS Of the 784 patients who entered the MARCH trail, 391 were assigned to the acarbose therapy group; 304 of these completed 48 weeks of follow-up of acarbose therapy. At 48 weeks, on the basis of the tertiles of change in homeostasis model assessment-beta cell function (∆HOMA-β) and homeostasis model assessment-insulin resistance (∆HOMA-IR), the subjects were divided into lowly, mediumly, and highly improved groups. RESULTS In the highly improved HOMA-β group, patients had higher systolic blood pressure (SBP), 2-h postprandial blood glucose (PBG), hemoglobin A1c (HbA1c), and lower high-density lipoprotein cholesterol (HDL-c), fasting serum insulin (FINS) concentration, and HOMA-IR in comparison to the lowly improved group (p < 0.05). A positive correlation was observed between HbA1c, SBP, and highly improved ∆HOMA-β (p < 0.05), while an inverse correlation was evident between HDL-c and highly improved ∆HOMA-β (p < 0.05). The highly improved HOMA-IR group had a significantly higher body mass index (BMI), fasting blood glucose (FBG), FINS concentration, and HOMA-β in comparison to the lowly improved group (p < 0.05). A positive correlation was observed between FBG, waist circumference, and highly improved HOMA-IR (p < 0.05). CONCLUSION Newly diagnosed T2DM Chinese patients with lower baseline HDL-c and higher HbA1c and SBP values are more likely to achieve improvement in beta cell function whereas baseline fasting blood glucose and waist circumference were the significant factors associated with improvement in insulin resistance with acarbose therapy. TRIAL REGISTRATION The clinical trial registry number was ChiCTR-TRC-08000231.
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Affiliation(s)
- Yan Duan
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Ning Yang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
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Wang Z, Xu D, Huang L, Zhang T, Wang J, Chen Q, Kong L, Zhou X. Effects of saxagliptin on glucose homeostasis and body composition of obese patients with newly diagnosed pre-diabetes. Diabetes Res Clin Pract 2017; 130:77-85. [PMID: 28575729 DOI: 10.1016/j.diabres.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/21/2017] [Accepted: 05/08/2017] [Indexed: 01/19/2023]
Abstract
AIMS To assess the effect of saxagliptin monotherapy on blood glucose and islet β-cell function in obese patients with newly diagnosed pre-diabetes and abnormal fat metabolism. METHODS A 24-week, randomized controlled trial was conducted involving 25 obese subjects with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) (mean age 45years) to receive lifestyle intervention only (control group) or combined with saxagliptin 2.5mg or 5mg daily (S2.5 or S5 group), metformin 1500mg daily (Met group). Anthropometrics, body fat and biochemical parameters were measured before and after 4, 12 and 24weeks intervention. RESULTS S5 group and Met group showed a significant decrease in fasting plasma glucose (FPG) and HbA1c compared with the control group (all P<0.05) after 24-week intervention. However, the decrease in 2h postprandial plasma glucose levels (2hPPG) in S5 group were greater compared with control group (P<0.01). Insulin resistance (HOMA-IR) was reduced in S5 group, Met group and control group (P<0.05), and the β-cell function (HOMA-β) was improved in all groups (P<0.05). However, the changes in obesity-related indicators including waist circumference, hip circumference, weight, BMI, body fat, percentage of body fat and waist-to-hip fat ratio were greate in Met group (all P<0.05) compared with other groups (P>0.05). CONCLUSIONS Saxagliptin monotherapy may prevent or delay the progression of IGT or IFG to type 2 diabetes mellitus in obese patients with newly diagnosed pre-diabetes. ClinicalTrials.gov: NCT01960205.
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Affiliation(s)
- Zixuan Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China
| | - Dengcheng Xu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China; Department of Endocrinology, The People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Lanhui Huang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China
| | - Tiantian Zhang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China; Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing, China
| | - Junqiao Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China
| | - Qing Chen
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China
| | - Lei Kong
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China
| | - Xinli Zhou
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 324 Jing 5 Road, Jinan, Shandong, China.
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Liu J, Hu Y, Xu Y, Jia Y, Miao L, Wang G. Comparison of Exenatide and Metformin Monotherapy in Overweight/Obese Patients with Newly Diagnosed Type 2 Diabetes. Int J Endocrinol 2017; 2017:9401606. [PMID: 29358950 PMCID: PMC5735665 DOI: 10.1155/2017/9401606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/19/2017] [Accepted: 09/07/2017] [Indexed: 01/12/2023] Open
Abstract
AIMS The present study assessed the therapeutic effect of exenatide and metformin as the initial therapy on overweight/obese patients with newly diagnosed type 2 diabetes (T2D). METHODS The prospective, nonrandomized, interventional study enrolled a total of 230 overweight or obese patients with newly diagnosed T2D who were administrated exenatide or metformin hydrochloride for 12 weeks. RESULTS 224/230 patients, including 106 in the exenatide group and 118 in the metformin group, completed the 12-week treatment. Both exenatide and metformin significantly decreased the HbA1c levels in overweight/obese patients with newly diagnosed T2D (all P < 0.05). The reduction in HbA1c and the proportion of patients with HbA1c < 7.0% (53 mmol/mol) were higher in the exenatide group than in the metformin group (all P < 0.05). The exenatide treatment caused a greater decline in the body weight and BMI as compared to the metformin treatment (all P < 0.01). The exenatide treatment (β = 0.41, P < 0.01) and baseline HbA1c level (β = -0.84, P < 0.01) were independent influencing factors for the decrease in HbA1c level. CONCLUSIONS For an initial therapy in overweight/obese patients with newly diagnosed T2D, exenatide causes a better glycemic control than metformin. This trial is registered with NCT03297879.
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Affiliation(s)
- Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, China
| | - Yanjin Hu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, China
| | - Yumei Jia
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, China
| | - Li Miao
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, China
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Liu J, Wang Y, Hu Y, Leng S, Wang G. Comparison of β-cell dysfunction and insulin resistance correlating obesity with type 2 diabetes: A cross-sectional study. J Diabetes Complications 2016; 30:898-902. [PMID: 27012460 DOI: 10.1016/j.jdiacomp.2016.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/13/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
AIM To assess the contribution of β-cell dysfunction and insulin resistance to type 2 diabetes (T2D) in obese and non-obese Chinese people. METHODS In this cross-sectional study, we recruited 1384 newly diagnosed T2D patients and 1712 healthy controls. Insulin resistance was estimated by homeostasis model assessment of insulin resistance (HOMA-IR). β-cell function was estimated by homeostasis model assessment of β-cell function (HOMA-β) and 60min insulinogenic index (IGI60). We compared the insulin resistance and β-cell function of obese and non-obese Chinese patients with and without T2D. RESULTS 50.18% of control participants and 62.28% of T2D patients were obese (BMI≥25kg/m(2)). HOMA-IR, HOMA-β and IGI60 were significantly higher in obese than non-obese, irrespective of T2D. Non-obese T2D patients had significantly greater HOMA-IR, and lower HOMA-β and IGI60 than non-obese control participants. The obese T2D group had lower HOMA-β and IGI60 than the obese control group. There was no significant difference in HOMA-IR between the obese T2D and obese control groups. Multivariate logistic regression analysis revealed that HOMA-IR was associated with T2D only in non-obese group, and HOMA-β and IGI60 were associated with T2D in both non-obese and obese groups. CONCLUSIONS HOMA-β and IGI60 were associated with T2D in obese and non-obese patients, but HOMA-IR was associated with T2D in non-obese Chinese.
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Affiliation(s)
- Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Physical Examination Center, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yanjin Hu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Song Leng
- Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
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Wang G, Liu J, Yang N, Hu Y, Zhang H, Miao L, Yao Z, Xu Y. Levothyroxine treatment restored the decreased circulating fibroblast growth factor 21 levels in patients with hypothyroidism. Eur J Intern Med 2016; 31:94-8. [PMID: 27085392 DOI: 10.1016/j.ejim.2016.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/03/2016] [Accepted: 03/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Fibroblast growth factor 21 (FGF21) is an important endogenous regulator of energy metabolism. Thyroid hormone has been shown to regulate hepatic FGF21 expression in rodents. The goal of this study was to evaluate the plasma FGF21 levels in participants with normal thyroid function, subclinical hypothyroidism, or overt hypothyroidism and to investigate the change of plasma FGF21 levels in patients with overt hypothyroidism after levothyroxine treatment. METHODS A total of 473 drug-naive participants were recruited, including 250 healthy control subjects, 116 patients with subclinical hypothyroidism, and 107 patients with overt hypothyroidism. Thirty-eight patients with overt hypothyroidism were assigned to receive levothyroxine treatment. RESULTS The overt hypothyroidism group had decreased FGF21 levels compared with the control and subclinical hypothyroidism groups (P<0.01). Levothyroxine treatment markedly attenuated the increased circulating levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high-sensitivity C-reactive protein (hsCRP), and homeostasis model assessment index of insulin resistance (HOMA-IR) in patients with overt hypothyroidism. A significant increase in plasma FGF21 levels was observed after levothyroxine treatment (P<0.01). The change in FGF21 levels was correlated with the increase of FT3 and FT4 after levothyroxine treatment (FT3: r=0.44; FT4: r=0.53; all P<0.05). CONCLUSIONS Levothyroxine treatment ameliorated metabolic disorders and restored the decreased circulating FGF21 levels in patients with overt hypothyroidism. The increase in FGF21 levels after levothyroxine treatment might be partly associated with the amelioration of metabolic disorders in patients with hypothyroidism.
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Affiliation(s)
- Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China.
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
| | - Ning Yang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
| | - Yanjin Hu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
| | - Heng Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
| | - Li Miao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
| | - Zhi Yao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing 100020, China
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Zhang J, Wang N, Xing X, Yang Z, Wang X, Yang W. Factors that influence the efficacy of acarbose and metformin as initial therapy in Chinese patients with newly diagnosed type 2 diabetes: a subanalysis of the MARCH trial. Curr Med Res Opin 2016; 32:713-9. [PMID: 26714411 DOI: 10.1185/03007995.2015.1136819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To conduct a subanalysis of the randomized MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycemic treatment) trial to investigate whether specific characteristics are associated with the efficacy of either acarbose or metformin as initial therapy. RESEARCH DESIGN AND METHODS A total of 657 type 2 diabetes patients who were randomly assigned to 48 weeks of therapy with either acarbose or metformin in the MARCH trial were divided into two groups based upon their hemoglobin A1c (HbA1c) levels at the end of follow-up: HbA1c <7% (<53 mmol/mol) and ≥7% (≥53 mmol/mol). Univariate, multivariate, and stepwise linear regression analyses were applied to identify the factors associated with treatment efficacy. MAIN OUTCOME MEASURES Because this was a subanalysis, no measurement was performed. RESULTS Univariate analysis showed that the efficacy of acarbose and metformin was influenced by HbA1c, fasting blood glucose (FBG), and 2 hour postprandial venous blood glucose (2hPPG) levels, as well as by changes in body mass index (BMI) (p ≤ 0.006). Multivariate analysis and stepwise linear regression analyses indicated that lower baseline 2hPPG values and greater changes in BMI were factors that positively influenced efficacy in both treatment groups (p ≤ 0.05). Stepwise regression model analysis also revealed that a lower baseline homeostasis model assessment-estimated insulin resistance (HOMA-IR) and higher serum insulin area under the curve (AUC) were factors positively influencing HbA1c normalization in all patients (p ≤ 0.032). CONCLUSIONS Newly diagnosed type 2 diabetes patients with lower baseline 2hPPG and HOMA-IR values are more likely to achieve glucose control with acarbose or metformin treatment. Furthermore, the change in BMI after acarbose or metformin treatment is also a factor influencing HbA1c normalization. A prospective study with a larger sample size is necessary to confirm our results as well as measure β cell function and examine the influence of the patients' dietary habits.
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Affiliation(s)
- Jinping Zhang
- a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China
| | - Na Wang
- a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China
| | - Xiaoyan Xing
- a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China
| | - Zhaojun Yang
- a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China
| | - Xin Wang
- a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China
| | - Wenying Yang
- a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China
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Wang G, Liu J, Yang N, Gao X, Fan H, Xu Y, Yang W. MARCH2: comparative assessment of therapeutic effects of acarbose and metformin in newly diagnosed type 2 diabetes patients. PLoS One 2014; 9:e105698. [PMID: 25148570 PMCID: PMC4141807 DOI: 10.1371/journal.pone.0105698] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/23/2014] [Indexed: 12/20/2022] Open
Abstract
Background The data of MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment) trial demonstrated that acarbose and metformin have similar efficacy as initial therapy for hemoglobin A1c (HbA1c) reduction in Chinese patients with newly diagnosed type 2 diabetes. We investigated whether the therapeutic efficacy was diversified under different body mass index (BMI) status. Methods All 784 subjects were divided into normal-weight group (BMI<24 kg/m2), overweight group (BMI 24–28 kg/m2) and obese group (BMI≥28 kg/m2). Patients were assigned to 48 weeks of therapy with acarbose or metformin, respectively. The clinical trial registry number was ChiCTR-TRC-08000231. Results The reduction of HbA1c levels and the proportion of patients with HbA1c of 6.5% or less were similar in the three groups after acarbose and metformin treatment. In overweight group, fasting blood glucose (FBG) after metformin treatment showed greater decline compared to acarbose group at 48 weeks [−1.73 (−1.99 to −1.46) vs. −1.37 (−1.61 to −1.12), P<0.05), however the decrease of 2 h post-challenge blood glucose (PBG) after acarbose treatment at 48 weeks was bigger compared to metformin group [−3.34 (−3.83 to−2.84) vs. −2.35 (−2.85 to −1.85), P<0.01 ]. Both acarbose and metformin treatment resulted in a significant decrease in waist circumference, hip circumference, weight and BMI in the three groups (all P<0.05). Conclusion Acarbose and metformin decreased HbA1c levels similarly regardless of BMI status of Chinese type 2 diabetic patients. Acarbose and metformin resulted in a significant and modest improvement of anthropometric parametres in different BMI status. Thus, acarbose treatment may contribute a similar effect on plasma glucose control compared to metformin, even in obesity patients. Trial Registration ChiCTR.org ChiCTR-TRC-08000231
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Affiliation(s)
- Guang Wang
- Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, P. R. China
| | - Jia Liu
- Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, P. R. China
| | - Ning Yang
- Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, P. R. China
| | - Xia Gao
- Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, P. R. China
| | - Hui Fan
- Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, P. R. China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, P. R. China
- * E-mail: (YX); (WYY)
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, P. R. China
- * E-mail: (YX); (WYY)
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Zhu Z, Jiang Z, Zhou J, Zhou D, Wang W, Zhao C, Zhen Z, Nanji AA. Involvement of insulin resistance in the protective effect of metformin against alcoholic liver injury. Alcohol Clin Exp Res 2014; 38:1510-9. [PMID: 24797033 DOI: 10.1111/acer.12418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 02/11/2014] [Accepted: 03/12/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alcoholic liver disease (ALD) continues to be a major cause of morbidity worldwide. The exact mechanisms for ALD pathogenesis are not fully understood. There is currently no known available drug for ALD. Previous studies have suggested that ethanol (EtOH)-induced hepatic insulin resistance, through the inhibition of adenosine monophosphate-activated protein kinase (AMPK) and the expression of adiponectin as well as downstream enzymes, contribute to the development of ALD. This study was to determine the effects of EtOH on AMPK activity as well as the protective effect of metformin. METHODS Forty male Wistar rats weighing 200 ± 20 g were randomized into 4 groups (n = 10) as follows: A = control group-rats received rodent chow; B = control + metformin group-rats received metformin (200 mg/kg/d intragastrically [IG]) at 21:00; C = EtOH group-rats were gavaged with alcohol of gradually increasing concentrations (30 to 60%, 5 to 9 g/kg/d) twice a day (9:00 and 16:00); D = EtOH + metformin group-rats received the same amount of EtOH as the rats in group C, and in addition received metformin (200 mg/kg/d IG) at 21:00. After 16 weeks, blood and liver samples were collected for further study. RESULTS Chronic EtOH consumption led to liver injury both histologically and biochemically accompanied by insulin resistance, reduced AMPK activity, and dysregulation of downstream enzymes. Decreased levels of circulating adiponectin and decreased expression of proliferator-activated receptor gamma coactivator-1α (PGC-1α) and peroxisome proliferator-activated receptors-α (PPAR-α) in the hepatic tissue were observed. Treatment with metformin attenuated the severity of liver injury, restored AMPK activity and normalized the expression of acetyl-CoA carboxylase and fatty acid synthase. In addition, metformin also increased the circulating adiponectin and liver adiponectin receptor 2 expression. Furthermore, PGC-1α and PPAR-α activities were also restored. CONCLUSIONS EtOH exposure induces hepatic insulin resistance. Metformin improved insulin resistance and reversed liver injury through the activation of AMPK and normalized adiponectin signaling making metformin a promising drug for the treatment of ALD.
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Affiliation(s)
- ZhanTao Zhu
- Department of Infectious disease , Third Hospital, Hebei Medical University, Shijiazhuang, China
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Smart MC, Dedoussis G, Yiannakouris N, Grisoni ML, Ken-Dror G, Yannakoulia M, Papoutsakis C, Louizou E, Mantzoros CS, Melistas L, Kontogianni MD, Cooper JA, Humphries SE, Talmud PJ. Genetic variation within IL18 is associated with insulin levels, insulin resistance and postprandial measures. Nutr Metab Cardiovasc Dis 2011; 21:476-84. [PMID: 20227263 PMCID: PMC3158674 DOI: 10.1016/j.numecd.2009.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/18/2009] [Accepted: 12/10/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS IL-18 expression is up-regulated in atherosclerotic plaques, and higher levels are seen in obese and Type 2 Diabetic individuals. More recently, a possible role for IL-18 in glucose and energy homeostasis has been suggested. METHODS AND RESULTS We investigated variation within the IL18 gene and its association with measures of obesity and the metabolic syndrome. Five IL18 tagging single nucleotide polymorphisms (rs1946519, rs2043055, rs549908, rs360729, rs3882891) were selected and genotyped in the Gene-Diet Attica Investigation on childhood obesity (GENDAI) (age range 10-14 yrs); in young European men in the second European Atherosclerosis Research offspring Study (EARSII), an offspring study (age range 18-28 yrs) and in a group of healthy women from the Greek Obese Women study (GrOW) (age range 18-74 yrs). Six common haplotypes were observed. In GrOW, Hap6 (Frequency-2.6%) was associated with higher insulin levels (p<0.0001), estimates of HOMA(-Insulin Resistance) (p<0.0001) and HOMA(-β-cell) (p<0.0001) compared to the common haplotype Hap1 (Frequency-33.2%). In EARSII, rs2043055 was associated with peak and area under the curve triglycerides (p=0.001 and p=0.002, respectively) after an oral fat tolerance test in 'cases' but not 'controls'. None of the haplotypes were associated with measures of body fatness in any of the studies. CONCLUSION Association of IL18 variation with insulin levels and estimates of insulin resistance were only observed in our adult study, suggesting that the effects of IL-18 are only associated with increasing age. Taken together with the association of IL18 variants with post-prandial measures, this provides support for IL-18 as a metabolic factor.
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Key Words
- interleukin 18
- obesity
- insulin resistance
- single nucleotide polymorphisms
- genetic variants
- haplotypes
- auc, area under the curve
- catameri, catanzaro metabolic risk
- cvd, cardiovascular disease
- ci, confidence intervals
- chd, coronary heart disease
- earsii, european atherosclerosis research case control study
- fdr, false discovery rate
- gendai, gene-diet attica investigation on childhood obesity
- grow, greek obese women
- hwe, hardy–weinberg equilibrium
- homa, homeostasis model assessment
- iipga, innate immunity pga
- ir, insulin resistance
- il-18, interleukin 18
- ld, linkage disequilibrium
- mi, myocardial infarct
- maf, minor allele frequency
- oftt, oral fat tolerance test
- ogtt, oral glucose tolerance test
- quicki, quantitative insulin sensitivity check index
- snp, single nucleotide polymorphism
- tsnps, tagging single nucleotide polymorphisms
- t2d, type 2 diabetes
- utr, untranslated region
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Affiliation(s)
- M C Smart
- Division of Cardiovascular Genetics, British Heart Foundation Laboratories, Department of Medicine, Royal Free and UCL Medical School, London, UK.
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18
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Salpeter SR, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010; 2010:CD002967. [PMID: 20393934 PMCID: PMC7138050 DOI: 10.1002/14651858.cd002967.pub4] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Metformin is an oral anti-hyperglycemic agent that has been shown to reduce total mortality compared to other anti-hyperglycemic agents, in the treatment of type 2 diabetes mellitus. Metformin, however, is thought to increase the risk of lactic acidosis, and has been considered to be contraindicated in many chronic hypoxemic conditions that may be associated with lactic acidosis, such as cardiovascular, renal, hepatic and pulmonary disease, and advancing age. OBJECTIVES To assess the incidence of fatal and nonfatal lactic acidosis, and to evaluate blood lactate levels, for those on metformin treatment compared to placebo or non-metformin therapies. SEARCH STRATEGY A comprehensive search was performed of electronic databases to identify studies of metformin treatment. The search was augmented by scanning references of identified articles, and by contacting principal investigators. SELECTION CRITERIA Prospective trials and observational cohort studies in patients with type 2 diabetes of least one month duration were included if they evaluated metformin, alone or in combination with other treatments, compared to placebo or any other glucose-lowering therapy. DATA COLLECTION AND ANALYSIS The incidence of fatal and nonfatal lactic acidosis was recorded as cases per patient-years, for metformin treatment and for non-metformin treatments. The upper limit for the true incidence of cases was calculated using Poisson statistics. In a second analysis lactate levels were measured as a net change from baseline or as mean treatment values (basal and stimulated by food or exercise) for treatment and comparison groups. The pooled results were recorded as a weighted mean difference (WMD) in mmol/L, using the fixed-effect model for continuous data. MAIN RESULTS Pooled data from 347 comparative trials and cohort studies revealed no cases of fatal or nonfatal lactic acidosis in 70,490 patient-years of metformin use or in 55,451 patients-years in the non-metformin group. Using Poisson statistics the upper limit for the true incidence of lactic acidosis per 100,000 patient-years was 4.3 cases in the metformin group and 5.4 cases in the non-metformin group. There was no difference in lactate levels, either as mean treatment levels or as a net change from baseline, for metformin compared to non-metformin therapies. AUTHORS' CONCLUSIONS There is no evidence from prospective comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis, or with increased levels of lactate, compared to other anti-hyperglycemic treatments.
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Affiliation(s)
- Shelley R Salpeter
- Stanford University, and Santa Clara Valley Medical CenterMedicine2400 Moorpark Ave, Suite 118San JoseCAUSA95128
| | - Elizabeth Greyber
- Santa Clara Valley Medical CenterMedicine2400 Moorpark Ave, Suite 118San JoseCAUSA95128
| | - Gary A Pasternak
- Santa Clara Valley Medical CenterMedicine2400 Moorpark Ave, Suite 118San JoseCAUSA95128
| | - Edwin E Salpeter
- Cornell UniversityCenter for Radiophysics and Space Research612 Space Sciences BuildingIthacaNYUSA14853
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Salpeter SR, Greyber E, Pasternak GA, Salpeter Posthumous EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010:CD002967. [PMID: 20091535 DOI: 10.1002/14651858.cd002967.pub3] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Metformin is an oral anti-hyperglycemic agent that has been shown to reduce total mortality compared to other anti-hyperglycemic agents, in the treatment of type 2 diabetes mellitus. Metformin, however, is thought to increase the risk of lactic acidosis, and has been considered to be contraindicated in many chronic hypoxemic conditions that may be associated with lactic acidosis, such as cardiovascular, renal, hepatic and pulmonary disease, and advancing age. OBJECTIVES To assess the incidence of fatal and nonfatal lactic acidosis, and to evaluate blood lactate levels, for those on metformin treatment compared to placebo or non-metformin therapies. SEARCH STRATEGY A comprehensive search was performed of electronic databases to identify studies of metformin treatment. The search was augmented by scanning references of identified articles, and by contacting principal investigators. SELECTION CRITERIA Prospective trials and observational cohort studies in patients with type 2 diabetes of least one month duration were included if they evaluated metformin, alone or in combination with other treatments, compared to placebo or any other glucose-lowering therapy. DATA COLLECTION AND ANALYSIS The incidence of fatal and nonfatal lactic acidosis was recorded as cases per patient-years, for metformin treatment and for non-metformin treatments. The upper limit for the true incidence of cases was calculated using Poisson statistics. In a second analysis lactate levels were measured as a net change from baseline or as mean treatment values (basal and stimulated by food or exercise) for treatment and comparison groups. The pooled results were recorded as a weighted mean difference (WMD) in mmol/L, using the fixed-effect model for continuous data. MAIN RESULTS Pooled data from 347 comparative trials and cohort studies revealed no cases of fatal or nonfatal lactic acidosis in 70,490 patient-years of metformin use or in 55,451 patients-years in the non-metformin group. Using Poisson statistics the upper limit for the true incidence of lactic acidosis per 100,000 patient-years was 4.3 cases in the metformin group and 5.4 cases in the non-metformin group. There was no difference in lactate levels, either as mean treatment levels or as a net change from baseline, for metformin compared to non-metformin therapies. AUTHORS' CONCLUSIONS There is no evidence from prospective comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis, or with increased levels of lactate, compared to other anti-hyperglycemic treatments.
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Affiliation(s)
- Shelley R Salpeter
- Medicine, Stanford University, and Santa Clara Valley Medical Center, 2400 Moorpark Ave, Suite 118, San Jose, CA, USA, 95128
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