Effect of Pre-Meal Metformin With or Without an Acute Exercise Bout on Postprandial Lipemic and Glycemic Responses in Metabolic Syndrome Patients: A Randomized, Open Label, Crossover Study

SGLT2 inhibitors reduce epicardial adipose tissue more than GLP-1 agonists or exercise interventions in patients with type 2 diabetes mellitus and/or obesity: A systematic review and network meta-analysis

BACKGROUND

Epicardial adipose tissue (EAT) plays a significant role in several cardiovascular diseases. As a correctable risk factor and potential therapeutic target, reducing EAT has multiple cardiovascular benefits, especially in those with abnormal glucolipid metabolism. The objective of this research was to compare the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and exercise on the thickness of EAT and indicators of glucolipid metabolism in people with type 2 diabetes mellitus (T2DM), obesity, and T2DM with obesity.

METHODS

We searched four electronic databases: PubMed, EMBASE, the Cochrane Library, and Web of Science for articles before 31 January 2024, regardless of language. We included randomized controlled trials and a small number of case-control studies in this network meta-analysis. Differences in mean changes in EAT, body mass index, and glucolipid metabolism-related metrics were assessed.

RESULTS

A comprehensive analysis was conducted on 16 trials (15 randomized controlled trials and one case-control study), comprising a total of 867 people. SGLT2 inhibitors were significantly better at reducing EAT than placebo (standard mean different [SMD] = -0.85 cm [95% confidence interval (CI) -1.39, -0.31]); a similar result was observed for exercise compared with placebo (SMD = -0.78 cm [95% CI -1.37, -0.18]). SGLT2 inhibitors were also significantly better at reducing EAT than GLP-1 agonists and conventional hypoglycaemic therapy (e.g., metformin or insulin; SMD = -0.74 cm [95% CI -1.45, -0.02] and SMD = -1.69 cm [95% CI -2.38, -0.99], respectively). SGLT2 inhibitors were significantly better than placebo at reducing body mass index (MD = -0.90 kg/m2 [95% CI -1.14, -0.66]) and glycosylated haemoglobin (MD = -0.52% [95%CI -0.86, -0.18]). A similar result was observed when comparing GLP-1 agonists and placebo (MD = -0.48% [95% CI -0.93, -0.03]). Changes in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were not statistically significant between interventions.

CONCLUSION

SGLT2 inhibitors have a distinct advantage over both placebo and other therapies at lowering EAT thickness, a result supported by direct comparisons and surface under the cumulative ranking curve analysis. Therefore, SGLT2 inhibitors should be prioritized as a treatment to reduce EAT in individuals with aberrant glucolipid levels, such as patients with T2DM and/or obesity.

Deciphering the Role of Androgen in the Dermatologic Manifestations of Polycystic Ovary Syndrome Patients: A State-of-the-Art Review

Polycystic ovary syndrome is a presvalent endocrine disorder affecting women globally, characterized by hormonal imbalance, metabolic disturbances, and reproductive dysfunction. Diagnosis relies on clinical evaluation, medical history assessment, physical examination, and laboratory tests, with the Rotterdam criteria being widely used. The pathophysiology of PCOS involves genetic predisposition, environmental factors, and lifestyle influences, with hormonal dysregulation, particularly elevated androgens, insulin resistance, and chronic inflammation, playing a pivotal role. These mechanisms not only contribute to reproductive and metabolic disturbances but also to the various cutaneous manifestations, such as acne, hirsutism, and alopecia. This review aims to analyze the role of androgens in the dermatological manifestations in patients with polycystic ovary syndrome, providing insights into underlying mechanisms and guiding the development of effective therapeutic strategies. By synthesizing available evidence, this review aims to deepen understanding of related dermatological manifestations and improve outcomes for affected individuals.

Rethinking the Terminology: A Perspective on Renaming Polycystic Ovary Syndrome for an Enhanced Pathophysiological Understanding

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects women at various stages of life, presenting a wide range of symptoms and health implications. The term "Polycystic Ovary Syndrome" can be misleading, prompting many within the medical community and advocacy groups to advocate for a name change. Critics argue that this terminology can complicate understanding and awareness of the disease among patients. The primary concern is that PCOS emphasizes the ovarian aspect, fostering the misconception that PCOS is merely a gynecological disorder. In reality, PCOS impacts multiple organ systems, particularly metabolic health. Patients frequently experience insulin resistance, weight gain, irregular menstrual cycles, and hirsutism-symptoms that extend beyond ovarian dysfunction. In light of these issues, there is increasing support for renaming PCOS to better reflect its systemic implications and minimize confusion. The current name may hinder understanding and potentially lead to inadequate disease management. Alternative names have been proposed, including "Ovarian Dysmetabolic Syndrome," which our team supports, as well as "Metabolic Reproductive Syndrome" and "Hyperandrogenic Persistent Ovulatory Dysfunction Syndrome." These alternatives aim to highlight the hormonal imbalances and metabolic disturbances associated with the condition, fostering inclusivity and reducing stigma for all affected individuals. This narrative review provides a historical overview of PCOS, tracing its recognition from early descriptions to contemporary guidelines. We discuss the evolving understanding of its pathophysiology and the rationale behind the proposed name change. By adopting a new nomenclature, we can enhance understanding among healthcare professionals, increase inclusivity for affected women, reduce the stigma and anxiety linked to the diagnosis, and offer a more accurate representation of the condition's complex pathophysiology.

Impact of the timing of metformin administration on glycaemic and glucagon-like peptide-1 responses to intraduodenal glucose infusion in type 2 diabetes: a double-blind, randomised, placebo-controlled, crossover study

AIMS/HYPOTHESIS

Metformin lowers postprandial glycaemic excursions in individuals with type 2 diabetes by modulating gastrointestinal function, including the stimulation of glucagon-like peptide-1 (GLP-1). The impact of varying the timing of metformin administration on postprandial glucose metabolism is poorly defined. We evaluated the effects of metformin, administered at different intervals before an intraduodenal glucose infusion, on the subsequent glycaemic, insulinaemic and GLP-1 responses in metformin-treated type 2 diabetes.

METHODS

Sixteen participants with type 2 diabetes that was relatively well-controlled by metformin monotherapy were studied on four separate days in a crossover design. On each day, participants were randomised to receive a bolus infusion of metformin (1000 mg in 50 ml 0.9% saline) via a nasoduodenal catheter at t = -60, -30 or 0 min (and saline at the other timepoints) or saline at all timepoints (control), followed by an intraduodenal glucose infusion of 12.56 kJ/min (3 kcal/min) at t = 0-60 min. The treatments were blinded to both participants and investigators involved in the study procedures. Plasma glucose, insulin and total GLP-1 levels were measured every 30 min between t = -60 min and t = 120 min.

RESULTS

There was a treatment-by-time interaction for metformin in reducing plasma glucose levels and increasing plasma GLP-1 and insulin levels (p<0.05 for each). The reduction in plasma glucose levels was greater when metformin was administered at t = -60 or -30 min vs t = 0 min (p<0.05 for each), and the increases in plasma GLP-1 levels were evident only when metformin was administered at t = -60 or -30 min (p<0.05 for each). Although metformin did not influence insulin sensitivity, it enhanced glucose-induced insulin secretion (p<0.05), and the increases in plasma insulin levels were comparable on the 3 days when metformin was given.

CONCLUSIONS/INTERPRETATION

In well-controlled metformin-treated type 2 diabetes, glucose-lowering by metformin is greater when it is given before, rather than with, enteral glucose, and this is associated with a greater GLP-1 response. These observations suggest that administration of metformin before meals may optimise its effect in improving postprandial glycaemic control.

TRIAL REGISTRATION

www.anzctr.org.au ACTRN12621000878875 FUNDING: The study was not funded by a specific research grant.