1
|
Obura M, Beulens JWJ, Slieker R, Koopman ADM, Hoekstra T, Nijpels G, Elders P, Dekker JM, Koivula RW, Kurbasic A, Laakso M, Hansen TH, Ridderstråle M, Hansen T, Pavo I, Forgie I, Jablonka B, Ruetten H, Mari A, McCarthy MI, Walker M, McDonald TJ, Perry MH, Pearson ER, Franks PW, 't Hart LM, Rutters F. Clinical profiles of post-load glucose subgroups and their association with glycaemic traits over time: An IMI-DIRECT study. Diabet Med 2021; 38:e14428. [PMID: 33067862 DOI: 10.1111/dme.14428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/10/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
AIM To examine the hypothesis that, based on their glucose curves during a seven-point oral glucose tolerance test, people at elevated type 2 diabetes risk can be divided into subgroups with different clinical profiles at baseline and different degrees of subsequent glycaemic deterioration. METHODS We included 2126 participants at elevated type 2 diabetes risk from the Diabetes Research on Patient Stratification (IMI-DIRECT) study. Latent class trajectory analysis was used to identify subgroups from a seven-point oral glucose tolerance test at baseline and follow-up. Linear models quantified the associations between the subgroups with glycaemic traits at baseline and 18 months. RESULTS At baseline, we identified four glucose curve subgroups, labelled in order of increasing peak levels as 1-4. Participants in Subgroups 2-4, were more likely to have higher insulin resistance (homeostatic model assessment) and a lower Matsuda index, than those in Subgroup 1. Overall, participants in Subgroups 3 and 4, had higher glycaemic trait values, with the exception of the Matsuda and insulinogenic indices. At 18 months, change in homeostatic model assessment of insulin resistance was higher in Subgroup 4 (β = 0.36, 95% CI 0.13-0.58), Subgroup 3 (β = 0.30; 95% CI 0.10-0.50) and Subgroup 2 (β = 0.18; 95% CI 0.04-0.32), compared to Subgroup 1. The same was observed for C-peptide and insulin. Five subgroups were identified at follow-up, and the majority of participants remained in the same subgroup or progressed to higher peak subgroups after 18 months. CONCLUSIONS Using data from a frequently sampled oral glucose tolerance test, glucose curve patterns associated with different clinical characteristics and different rates of subsequent glycaemic deterioration can be identified.
Collapse
Affiliation(s)
- M Obura
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - J W J Beulens
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Slieker
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Cell and Chemical Biology, Leiden University Medical Centre, Leiden, The Netherlands
| | - A D M Koopman
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T Hoekstra
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - P Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - J M Dekker
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - R W Koivula
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
| | - A Kurbasic
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
| | - M Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Finland
| | - T H Hansen
- The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - M Ridderstråle
- The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Hansen
- The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - I Pavo
- Eli Lilly Regional Operations GmbH, Vienna, Austria
| | - I Forgie
- Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - B Jablonka
- Sanofi-Aventis Deutschland GmbH, R&D, Frankfurt am Main, Germany
| | - H Ruetten
- Sanofi-Aventis Deutschland GmbH, R&D, Frankfurt am Main, Germany
| | - A Mari
- Institute of Biomedical Engineering, National Research Council, Padova, Italy
| | - M I McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - M Walker
- Institute of Cellular Medicine (Diabetes), Newcastle University, Newcastle upon Tyne, UK
| | - T J McDonald
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School and Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - M H Perry
- Department of Blood Sciences, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - E R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - P W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - L M 't Hart
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Cell and Chemical Biology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Molecular Epidemiology Section, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Rutters
- Epidemiology and Data Science, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Singh JSS, Mordi I, Fathi A, Vickneson K, Donnan PT, Mohan M, Choy AM, Gandy SG, Pearson ER, Houston JG, Struthers AD, Lang CC. P905Research into the effect of sodium-glucose linked transporter inhibition in left ventricular remodelling in patients with heart failure and diabetes mellitus. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J S S Singh
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - I Mordi
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - A Fathi
- University of Dundee, Medical School, Dundee, United Kingdom
| | - K Vickneson
- University of Dundee, Medical School, Dundee, United Kingdom
| | - P T Donnan
- University of Dundee, Dundee Epidemiology and Biostatistics Unit, Dundee, United Kingdom
| | - M Mohan
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - A M Choy
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - S G Gandy
- NHS Tayside, Department of Medical Physics, Dundee, United Kingdom
| | - E R Pearson
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - J G Houston
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - A D Struthers
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - C C Lang
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| |
Collapse
|
3
|
Abstract
AIMS Increased visit-to-visit glycaemic variability is independently associated with adverse outcomes in Type 2 diabetes. Our aim was to identify the patient characteristics associated with raised visit-to-visit glycaemic variability in people with Type 2 diabetes. METHODS A case-control study was conducted to establish associations between HbA1c variability and clinical covariates in 10 130 people with Type 2 diabetes. Variability was calculated by two metrics [sd and coefficient of variation (CV)] from a minimum of four HbA1c readings obtained over a 4-year period. High and low variability groups were defined as the top and bottom tertile of the sd or CV, and used in logistic regression analyses including a number of clinical and biochemical covariates. The analyses were stratified into low mean (< 53 mmol/mol; 7%) and high mean (≥ 53 mmol/mol; 7%) HbA1c groups. RESULTS Findings were consistent across both HbA1c groups and variability metrics. Treatment, independent of other factors, was the most strongly associated covariate for the risk of high HbA1c variability. A six-fold increased risk was observed in the low HbA1c group, between the most and least intense treatment regimens (P < 0.001). Similar findings were present in the high HbA1c group with a three-fold increase in risk (P < 0.001). In addition, male gender, younger age, reduced HDL-cholesterol and increased BMI were all found to be independently associated with raised visit-to-visit glycaemic variability. CONCLUSIONS Intensive treatment resulting in low mean HbA1c was associated with marked increase in HbA1c variability. Irrespective of diabetes control, the greatest visit-to-visit variability was observed in young, insulin resistant men.
Collapse
Affiliation(s)
- J. D. Noyes
- School of MedicineNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - E. Soto‐Pedre
- Division of Molecular & Clinical MedicineNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - L. A. Donnelly
- Division of Molecular & Clinical MedicineNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - E. R. Pearson
- Division of Molecular & Clinical MedicineNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| |
Collapse
|
4
|
Dujic T, Zhou K, Yee SW, van Leeuwen N, de Keyser CE, Javorský M, Goswami S, Zaharenko L, Hougaard Christensen MM, Out M, Tavendale R, Kubo M, Hedderson MM, van der Heijden AA, Klimčáková L, Pirags V, Kooy A, Brøsen K, Klovins J, Semiz S, Tkáč I, Stricker BH, Palmer C, 't Hart LM, Giacomini KM, Pearson ER. Variants in Pharmacokinetic Transporters and Glycemic Response to Metformin: A Metgen Meta-Analysis. Clin Pharmacol Ther 2017; 101:763-772. [PMID: 27859023 PMCID: PMC5425333 DOI: 10.1002/cpt.567] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/26/2016] [Accepted: 11/06/2016] [Indexed: 12/25/2022]
Abstract
Therapeutic response to metformin, a first-line drug for type 2 diabetes (T2D), is highly variable, in part likely due to genetic factors. To date, metformin pharmacogenetic studies have mainly focused on the impact of variants in metformin transporter genes, with inconsistent results. To clarify the significance of these variants in glycemic response to metformin in T2D, we performed a large-scale meta-analysis across the cohorts of the Metformin Genetics Consortium (MetGen). Nine candidate polymorphisms in five transporter genes (organic cation transporter [OCT]1, OCT2, multidrug and toxin extrusion transporter [MATE]1, MATE2-K, and OCTN1) were analyzed in up to 7,968 individuals. None of the variants showed a significant effect on metformin response in the primary analysis, or in the exploratory secondary analyses, when patients were stratified according to possible confounding genotypes or prescribed a daily dose of metformin. Our results suggest that candidate transporter gene variants have little contribution to variability in glycemic response to metformin in T2D.
Collapse
Affiliation(s)
- T Dujic
- Department of Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - K Zhou
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - S W Yee
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - N van Leeuwen
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - C E de Keyser
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Inspectorate of Healthcare, Utrecht, The Netherlands
| | - M Javorský
- Department of Internal Medicine 4, Faculty of Medicine, Šafárik University, Košice, Slovakia.,Pasteur University Hospital, Košice, Slovakia
| | - S Goswami
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - L Zaharenko
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | | | - M Out
- Treant Zorggroep, Location Bethesda, Hoogeveen, The Netherlands.,Bethesda Diabetes Research Centre, Hoogeveen, The Netherlands
| | - R Tavendale
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - M Kubo
- Core for Genomic Medicine, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - M M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - A A van der Heijden
- Department of General Practice, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - L Klimčáková
- Department of Medical Biology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - V Pirags
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - A Kooy
- Treant Zorggroep, Location Bethesda, Hoogeveen, The Netherlands.,Bethesda Diabetes Research Centre, Hoogeveen, The Netherlands
| | - K Brøsen
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - J Klovins
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - S Semiz
- Department of Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,International University of Sarajevo, Faculty of Engineering and Natural Sciences, Sarajevo, Bosnia and Herzegovina
| | - I Tkáč
- Department of Internal Medicine 4, Faculty of Medicine, Šafárik University, Košice, Slovakia.,Pasteur University Hospital, Košice, Slovakia
| | - B H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Inspectorate of Healthcare, Utrecht, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cna Palmer
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - L M 't Hart
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - K M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, California, USA
| | - E R Pearson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| |
Collapse
|
5
|
Yew TW, McCreight L, Colclough K, Ellard S, Pearson ER. tRNA methyltransferase homologue gene TRMT10A mutation in young adult-onset diabetes with intellectual disability, microcephaly and epilepsy. Diabet Med 2016; 33:e21-5. [PMID: 26526202 PMCID: PMC4995728 DOI: 10.1111/dme.13024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/14/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND A syndrome of young-onset diabetes mellitus associated with microcephaly, epilepsy and intellectual disability caused by mutations in the tRNA methyltransferase 10 homologue A (TRMT10A) gene has recently been described. CASE REPORT We report two siblings from the fourth family reported to have diabetes mellitus as a result of a TRMT10A mutation. A homozygous nonsense mutation p.Glu27Ter in TRMT10A was identified using targeted next-generation sequencing and confirmed by PCR/Sanger sequencing. Diabetes was diagnosed while the subjects were in their 20s and was characterized by insulin resistance. Epilepsy and intellectual disability were features in common. Mild microcephaly was present at birth but their final head circumferences were normal. CONCLUSION Our report provides independent confirmation of the role of TRMT10A mutations in this syndrome and expands its phenotypic description. TRMT10A sequencing should be considered in children or adults with young-onset diabetes who have a history of intellectual disability, microcephaly and epilepsy. This report also shows the advantages of using a targeted panel to identify previously unsuspected monogenic diabetes among young-onset non-insulin-dependent diabetes in the absence of obesity and autoimmunity.
Collapse
Affiliation(s)
- T W Yew
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
- Department of Medicine, National University Health System, Singapore
| | - L McCreight
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - K Colclough
- Department of Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - S Ellard
- Department of Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - E R Pearson
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| |
Collapse
|
6
|
Abstract
Personalized medicine, otherwise called stratified or precision medicine, aims to better target intervention to the individual to maximize benefit and minimize harm. This review discusses how diabetes aetiology, pathophysiology and patient genotype influence response to or side effects of the commonly used diabetes treatments. C-peptide is a useful biomarker that is underused to guide treatment choice, severe insulin deficiency predicts non-response to glucagon-like peptide-1 receptor agonists, and thiazolidinediones are more effective in insulin-resistant patients. The field of pharmacogenetics is now yielding clinically important results, with three examples outlined: sulphonylurea sensitivity in patients with HNF1A maturity-onset diabetes of the young; sulphonylurea sensitivity in patients with Type 2 diabetes with reduced function alleles at CYP2C9, resulting in reduced metabolism of sulphonylureas; and severe metformin intolerance associated with reduced function organic cation transporter 1 (OCT1) variants, exacerbated by drugs that also inhibit OCT1. Genome-wide approaches and the potential of other 'omics', including metagenomics and metabolomics, are then outlined, highlighting the complex interacting networks that we need to understand before we can truly personalize diabetes treatments.
Collapse
Affiliation(s)
- E R Pearson
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| |
Collapse
|
7
|
Dujic T, Causevic A, Bego T, Malenica M, Velija‐Asimi Z, Pearson ER, Semiz S. Organic cation transporter 1 variants and gastrointestinal side effects of metformin in patients with Type 2 diabetes. Diabet Med 2016; 33:511-4. [PMID: 26605869 PMCID: PMC5064645 DOI: 10.1111/dme.13040] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 01/22/2023]
Abstract
AIMS Metformin is the most widely used oral anti-diabetes agent and has considerable benefits over other therapies, yet 20-30% of people develop gastrointestinal side effects, and 5% are unable to tolerate metformin due to the severity of these side effects. The mechanism for gastrointestinal side effects and their considerable inter-individual variability is unclear. We have recently shown the association between organic cation transporter 1 (OCT1) variants and severe intolerance to metformin in people with Type 2 diabetes. The aim of this study was to explore the association of OCT1 reduced-function polymorphisms with common metformin-induced gastrointestinal side effects in Type 2 diabetes. METHODS This prospective observational cohort study included 92 patients with newly diagnosed Type 2 diabetes, incident users of metformin. Patients were genotyped for two common loss-of-function variants in the OCT1 gene (SLC22A1): R61C (rs12208357) and M420del (rs72552763). The association of OCT1 reduced-function alleles with gastrointestinal side effects was analysed using logistic regression. RESULTS Forty-three patients (47%) experienced gastrointestinal adverse effects in the first 6 months of metformin treatment. Interestingly, the number of OCT1 reduced-function alleles was significantly associated with over two-fold higher odds of the common metformin-induced gastrointestinal side effects (odds ratio = 2.31, 95% confidence interval 1.07-5.01, P = 0.034). CONCLUSIONS In conclusion, we showed for the first time the association between OCT1 variants and common metformin-induced gastrointestinal side effects. These results confirm recent findings related to the role of OCT1 in severe metformin intolerance, and suggest that high inter-individual variability in mild/moderate and severe gastrointestinal intolerance share a common underlying mechanism. These data could contribute to more personalized and safer metformin treatment.
Collapse
Affiliation(s)
- T. Dujic
- Department of Biochemistry and Clinical AnalysisUniversity of SarajevoSarajevoBosnia and Herzegovina
| | - A. Causevic
- Department of Biochemistry and Clinical AnalysisUniversity of SarajevoSarajevoBosnia and Herzegovina
| | - T. Bego
- Department of Biochemistry and Clinical AnalysisUniversity of SarajevoSarajevoBosnia and Herzegovina
| | - M. Malenica
- Department of Biochemistry and Clinical AnalysisUniversity of SarajevoSarajevoBosnia and Herzegovina
| | - Z. Velija‐Asimi
- Clinic for EndocrinologyDiabetes and Metabolism DiseasesUniversity Clinical Centre of SarajevoSarajevoBosnia and Herzegovina
| | - E. R. Pearson
- Division of Cardiovascular & Diabetes MedicineSchool of MedicineUniversity of DundeeDundeeUK
| | - S. Semiz
- Department of Biochemistry and Clinical AnalysisUniversity of SarajevoSarajevoBosnia and Herzegovina
- Faculty of Engineering and Natural SciencesInternational University of SarajevoSarajevoBosnia and Herzegovina
| |
Collapse
|
8
|
Connelly PJ, Smith N, Chadwick R, Exley AR, Shneerson JM, Pearson ER. Recessive mutations in the cancer gene Ataxia Telangiectasia Mutated (ATM), at a locus previously associated with metformin response, cause dysglycaemia and insulin resistance. Diabet Med 2016; 33:371-5. [PMID: 26606753 PMCID: PMC4832393 DOI: 10.1111/dme.13037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 12/31/2022]
Abstract
AIM To investigate glucose and insulin metabolism in participants with ataxia telangiectasia in the absence of a diagnosis of diabetes. METHODS A standard oral glucose tolerance test was performed in participants with ataxia telangiectasia (n = 10) and in a control cohort (n = 10). Serial glucose and insulin measurements were taken to permit cohort comparisons of glucose-insulin homeostasis and indices of insulin secretion and sensitivity. RESULTS During the oral glucose tolerance test, the 2-h glucose (6.75 vs 4.93 mmol/l; P = 0.029), insulin concentrations (285.6 vs 148.5 pmol/l; P = 0.043), incremental area under the curve for glucose (314 vs 161 mmol/l/min; P = 0.036) and incremental area under the curve for insulin (37,720 vs 18,080 pmol/l/min; P = 0.03) were higher in participants with ataxia telangiectasia than in the controls. There were no significant differences between groups in fasting glucose, insulin concentrations or insulinogenic index measurement (0.94 vs 0.95; P = 0.95). The Matsuda index, reflecting whole-body insulin sensitivity, was lower in participants with ataxia telangiectasia (5.96 vs 11.03; P = 0.019) than in control subjects. CONCLUSIONS Mutations in Ataxia Telangiectasia Mutated (ATM) that cause ataxia telangiectasia are associated with elevated glycaemia and low insulin sensitivity in participants without diabetes. This indicates a role of ATM in glucose and insulin metabolic pathways.
Collapse
Affiliation(s)
- P J Connelly
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - N Smith
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - R Chadwick
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - A R Exley
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - J M Shneerson
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - E R Pearson
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| |
Collapse
|
9
|
Macfarlane DP, O'Sullivan EP, Dorman S, Allison J, Ellingford A, Pearson ER, Mires GJ, Leese GP. The utility of retinal screening in gestational diabetes. Diabet Med 2013; 30:1009-10. [PMID: 23398520 DOI: 10.1111/dme.12152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/03/2013] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
|
10
|
|
11
|
Abstract
AIMS To systematically review the evidence for the effect of vitamin D supplementation on glycaemia, insulin resistance, progression to diabetes and complications of diabetes. METHODS Systematic review and meta-analysis. We searched databases including MEDLINE, EMBASE and the Cochrane Library for randomized controlled trials comparing vitamin D or analogues with placebo. We extracted data on fasting glucose, glycaemic control, insulin resistance, insulin/C-peptide levels, micro- and macrovascular outcomes and progression from non-diabetes to diabetes. Studies were assessed independently by two reviewers according to a pre-specified protocol. RESULTS Fifteen trials were included in the systematic review. Trial reporting was of moderate, variable quality. Combining all studies, no significant improvement was seen in fasting glucose, HbA(1c) or insulin resistance in those treated with vitamin D compared with placebo. For patients with diabetes or impaired glucose tolerance, meta-analysis showed a small effect on fasting glucose (-0.32 mmol/l, 95%CI -0.57 to -0.07) and a small improvement in insulin resistance (standard mean difference -0.25, 95%CI -0.48 to -0.03). No effect was seen on glycated haemoglobin in patients with diabetes and no differences were seen for any outcome in patients with normal fasting glucose. Insufficient data were available to draw conclusions regarding micro- or macrovascular events; two trials failed to show a reduction in new cases of diabetes in patients treated with vitamin D. CONCLUSIONS There is currently insufficient evidence of beneficial effect to recommend vitamin D supplementation as a means of improving glycaemia or insulin resistance in patients with diabetes, normal fasting glucose or impaired glucose tolerance.
Collapse
Affiliation(s)
- P S George
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | | | | |
Collapse
|
12
|
van Leeuwen N, Nijpels G, Becker ML, Deshmukh H, Zhou K, Stricker BHC, Uitterlinden AG, Hofman A, van ’t Riet E, Palmer CNA, Guigas B, Slagboom PE, Durrington P, Calle RA, Neil A, Hitman G, Livingstone SJ, Colhoun H, Holman RR, McCarthy MI, Dekker JM, ’t Hart LM, Pearson ER. A gene variant near ATM is significantly associated with metformin treatment response in type 2 diabetes: a replication and meta-analysis of five cohorts. Diabetologia 2012; 55:1971-7. [PMID: 22453232 PMCID: PMC3369131 DOI: 10.1007/s00125-012-2537-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
AIMS/HYPOTHESIS In this study we aimed to replicate the previously reported association between the glycaemic response to metformin and the SNP rs11212617 at a locus that includes the ataxia telangiectasia mutated (ATM) gene in multiple additional populations. METHODS Incident users of metformin selected from the Diabetes Care System West-Friesland (DCS, n = 929) and the Rotterdam Study (n = 182) from the Netherlands, and the CARDS Trial (n = 254) from the UK were genotyped for rs11212617 and tested for an association with both HbA(1c) reduction and treatment success, defined as the ability to reach the treatment target of an HbA(1c) ≤ 7 % (53 mmol/mol). Finally, a meta-analysis including data from literature was performed. RESULTS In the DCS cohort, we observed an association between rs11212617 genotype and treatment success on metformin (OR 1.27, 95% CI 1.03, 1.58, p = 0.028); in the smaller Rotterdam Study cohort, a numerically similar but non-significant trend was observed (OR 1.45, 95% CI 0.87, 2.39, p = 0.15); while in the CARDS cohort there was no significant association. In meta-analyses of these three cohorts separately or combined with the previously published cohorts, rs11212617 genotype is associated with metformin treatment success (OR 1.24, 95% CI 1.04, 1.49, p = 0.016 and OR 1.25, 95% CI 1.33, 1.38, p = 7.8 × 10(-6), respectively). CONCLUSIONS/INTERPRETATION A gene variant near ATM is significantly associated with metformin treatment response in type 2 diabetic patients from the Netherlands and the UK. This is the first robustly replicated common susceptibility locus found to be associated with metformin treatment response.
Collapse
Affiliation(s)
- N. van Leeuwen
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - G. Nijpels
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Department of General Practice, VU University Medical Center, Amsterdam, the Netherlands
| | - M. L. Becker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, the Netherlands
| | - H. Deshmukh
- University of Dundee, Medical Research Institute, Dundee, DD1 9SY UK
| | - K. Zhou
- University of Dundee, Medical Research Institute, Dundee, DD1 9SY UK
| | - B. H. C. Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A. G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A. Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - E. van ’t Riet
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - C. N. A. Palmer
- University of Dundee, Medical Research Institute, Dundee, DD1 9SY UK
| | - B. Guigas
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - P. E. Slagboom
- Leiden University Medical Center Molecular Epidemiology, Postzone S5-P, PO box 9600, 2300RC Leiden, the Netherlands
- Netherlands Consortium for Healthy Ageing, the Netherlands, www.healthy-ageing.nl
| | - P. Durrington
- University of Manchester, School of Medicine, Manchester, UK
| | | | - A. Neil
- Department of Primary Health Care, University of Oxford, Oxford, UK
| | - G. Hitman
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S. J. Livingstone
- University of Dundee, Medical Research Institute, Dundee, DD1 9SY UK
| | - H. Colhoun
- University of Dundee, Medical Research Institute, Dundee, DD1 9SY UK
| | - R. R. Holman
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
| | - M. I. McCarthy
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - J. M. Dekker
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - L. M. ’t Hart
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands
- Leiden University Medical Center Molecular Epidemiology, Postzone S5-P, PO box 9600, 2300RC Leiden, the Netherlands
| | - E. R. Pearson
- University of Dundee, Medical Research Institute, Dundee, DD1 9SY UK
| |
Collapse
|
13
|
Steele AM, Shields BM, Shepherd M, Ellard S, Hattersley AT, Pearson ER. Increased all-cause and cardiovascular mortality in monogenic diabetes as a result of mutations in the HNF1A gene. Diabet Med 2010; 27:157-61. [PMID: 20546258 DOI: 10.1111/j.1464-5491.2009.02913.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To investigate all-cause and cardiovascular mortality in subjects with diabetes caused by a mutation in the hepatocyte nuclear factor 1alpha gene (HNF1A). METHODS We identified 39 British families with HNF1A mutations. Consenting individuals were asked details of age and cause of death of parents and siblings. Copies of death certificates were requested from the family or were obtained via the Offices for National Statistics. RESULTS Data were collated on 241 control subjects and 153 mutation carriers. Of those who died, 66% of mutation carriers died from a cardiovascular-related illness compared with 43% of control subjects (P = 0.02). Family members with HNF1A mutations died at a younger age than familial control subjects [all-cause hazard ratio, adjusting for sex and smoking status: 1.9 (95% confidence interval 1.2, 2.9, P = 0.006; cardiovascular hazard ratio: 2.3, confidence interval 1.3, 4.2, P = 0.006)]. CONCLUSIONS We have shown that individuals known to have diabetes caused by a mutation in the HNF1A gene have an increased risk of cardiovascular mortality compared with their unaffected family members. As with other forms of diabetes, consideration should be given to early statin therapy despite a seemingly protective lipid profile.
Collapse
Affiliation(s)
- A M Steele
- Peninsula NIHR Clinical Research Facility, Peninsula Medical School, Exeter
| | | | | | | | | | | |
Collapse
|
14
|
Affiliation(s)
- E R Pearson
- Biomedical Research Institute, University of Dundee, Dundee, UK.
| |
Collapse
|
15
|
Abstract
AIM Metformin is the most commonly prescribed oral agent used in the treatment of type 2 diabetes. It is effective at reducing glycosylated Haemoglobin (HbA1c) and decreasing microvascular and macrovascular disease. However, up to 25% of patients develop gastrointestinal side effects leading to cessation in 5-10% of users. Metformin XL (glucophage SR) is a once a day preparation that delays absorption, leading to decreased peak metformin concentrations. We hypothesised that the XL preparation of metformin would be better tolerated than the standard immediate release (IR) preparation leading to improved adherence to therapy. METHODS In a retrospective observational study, we studied adherence and glycaemic control in patients prescribed metformin IR and XL preparations in Tayside, UK. RESULTS Metformin XL was used by 137 patients during the study period. Overall adherence was greater in the XL group (80%) compared with the 10,772 patients in the IR group (72%, p = 0.0026). In the 40 patients who changed from metformin IR to metformin XL who had sufficient data to determine adherence, the adherence increased from 62% in the IR group to 81% in the XL group (p < 0.0001). This was associated with an HbA1c reduction from 9.1 to 8.4% (p = 0.0739, n = 29). CONCLUSIONS Metformin XL use is associated with increased adherence compared with the IR preparation, although the mechanism for this cannot be determined from this study. In patients intolerant of metformin IR the XL preparation should be considered.
Collapse
Affiliation(s)
- L A Donnelly
- Health Informatics Centre, University of Dundee, Dundee, UK
| | | | | |
Collapse
|
16
|
Kimber CH, Doney ASF, Pearson ER, McCarthy MI, Hattersley AT, Leese GP, Morris AD, Palmer CNA. TCF7L2 in the Go-DARTS study: evidence for a gene dose effect on both diabetes susceptibility and control of glucose levels. Diabetologia 2007; 50:1186-91. [PMID: 17429603 DOI: 10.1007/s00125-007-0661-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 02/19/2007] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS The gene encoding transcription factor 7-like 2 (TCF7L2) has been identified as a type 2 diabetes locus from genome-wide linkage studies and subsequent association analysis. We investigated the role of two common variants in TCF7L2 in a large case-control study recruited from the Tayside region of Scotland, UK. SUBJECTS AND METHODS We genotyped 6,516 participants for rs12255372 and rs7903146 and analysed the role in type 2 diabetes susceptibility using binary logistic regression. Age, sex and obesity status were examined as covariates. The distribution of the genotypes within different treatment groups of cases was examined. RESULTS Both variants were associated with type 2 diabetes (p < 10(-13)). The variants were present at very similar frequencies and were in strong linkage disequilibrium (R(2) = 0.88, D' = 0.89). A gene dosage effect of the rare allele of both variants was observed, the heterozygote CT group of rs7903146 having an odds ratio of 1.36 (95% CI 1.2-1.5, p=1.54 x 10(-7)) for type 2 diabetes and the TT homozygote having a greater risk (OR = 2.03, 95% CI 1.7-2.5, p=1.40 x 10(-12)). An interaction with sex was observed, the males displaying a higher degree of genotype-associated risk compared with the females (p = 0.023). The T allele was associated with increased HbA(1c) levels in both cases and controls, and with decreased BMI and waist circumference in case but not controls. The T allele was overrepresented in individuals requiring insulin treatment and underrepresented in the patients being managed by diet alone (p = 0.006). CONCLUSIONS We have confirmed TCF7L2 to be a diabetes locus in a large case-control study in Tayside, UK. Our data suggest that variants of TCF7L2 may be associated with increased disease severity and therapeutic failure.
Collapse
Affiliation(s)
- C H Kimber
- Population Pharmacogenetics Group, Biomedical Research Centre, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Singh R, Pearson ER, Clark PM, Hattersley AT. The long-term impact on offspring of exposure to hyperglycaemia in utero due to maternal glucokinase gene mutations. Diabetologia 2007; 50:620-4. [PMID: 17216282 DOI: 10.1007/s00125-006-0541-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 10/19/2006] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS There is strong evidence that maternal diabetes while offspring are in utero results in offspring beta cell dysfunction and diabetes or glucose intolerance. Offspring born to mothers with a mutation in the glucokinase gene (GCK) are a good model for studying exposure to moderate hyperglycaemia, as mutation carriers have fasting hyperglycaemia throughout life including during pregnancy. We assessed the long term effects of exposure to maternal hyperglycaemia in utero on beta cell function and glucose tolerance in adult offspring. MATERIALS AND METHODS We studied 86 adult offspring (mean age 40 years), 49 born to glucokinase mothers (exposed to hyperglycaemia in utero) and 37 born to glucokinase fathers (controls). We measured glucose tolerance during an OGTT and beta cell function using early insulin response (EIR); we also measured anthropometric data including birthweight. RESULTS Offspring of glucokinase mothers had a higher birthweight by 450 g (p<0.001), but no evidence of deterioration in glucose tolerance (2-h glucose 9.1 vs 8.6 mmol/l p=0.50) or reduced beta cell function (log EIR 1.40 vs 1.26, p=0.11) compared with offspring born to glucokinase fathers. CONCLUSIONS/INTERPRETATION The marked increase in birthweight shows that offspring born to affected mothers were exposed to increased glycaemia in utero. Despite this, there was no evidence of altered beta cell function or glucose tolerance. As previous human examples of marked programming by hyperglycaemia in utero have been in genetically predisposed offspring, we propose that our finding reflects the lack of genetic predisposition in the offspring to progressive beta cell dysfunction.
Collapse
Affiliation(s)
- R Singh
- Department of Molecular Medicine, Institute of Biomedical and Clinical Sciences, Peninsula Medical School, Exeter, and Division of Medicine and Therapeutics, Ninewells Hospital, Dundee, UK
| | | | | | | |
Collapse
|
18
|
Castleden HAJ, Shields B, Bingley PJ, Williams AJK, Sampson M, Walker M, Gibson JM, McCarthy MI, Hitman GA, Levy JC, Hattersley AT, Vaidya B, Pearson ER. GAD antibodies in probands and their relatives in a cohort clinically selected for Type 2 diabetes. Diabet Med 2006; 23:834-8. [PMID: 16911619 DOI: 10.1111/j.1464-5491.2006.01915.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS A subset of patients who present as if they have Type 2 diabetes have positive pancreatic autoantibodies, and have been referred to as having latent autoimmune diabetes in adults (LADA). We assessed the prevalence and clinical characteristics of patients with glutamic acid decarboxylase antibodies (GADA) in a cohort clinically selected for Type 2 diabetes and determined the presence of diabetes and GADA in their first-degree relatives. METHODS GADA were measured in 2059 subjects, not known to be related, and clinically selected as having Type 2 diabetes for genetic studies. Clinical characteristics were compared in GADA positive and GADA negative subjects. Diabetes and GAD antibody status were compared in 208 first-degree relatives of GADA positive and GADA negative probands. RESULTS Of the subjects, 136 (7%) were GADA positive. Compared with the GADA negative subjects, they were slimmer (P < 0.001), diagnosed at a younger age (P = 0.011) and progressed to insulin faster (P < 0.001). Thirty-three per cent of GADA positive subjects had a first-degree relative with diabetes compared with 42% of GADA negative subjects (P = 0.034). The overall prevalence of GADA was similar in the first-degree relatives of GADA positive and GADA negative probands (4 v 5%), and 19 of 22 (86%) diabetic relatives of GADA positive probands were GADA negative. CONCLUSION Despite clinically selecting a Type 2 diabetes cohort, 7% were GADA positive with an altered phenotype. These GADA positive patients had a strong family history of non-autoimmune diabetes. This suggests that, in this subgroup of patients, autoimmune pancreatic beta-cell destruction occurs on a background of Type 2 diabetes genetic susceptibility.
Collapse
Affiliation(s)
- H A J Castleden
- Institute of Biomedical and Clinical Sciences, Peninsula Medical School, Exeter, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
AIMS In treating Type 2 diabetes (T2DM), UK guidelines recommend metformin in obese and overweight patients, and either sulphonylureas or metformin in normal weight patients. Although other factors influence prescribing choice, a key objective in treating T2DM is to lower plasma glucose. There is little data on how glycaemic response to oral agents varies with body mass index (BMI). Therefore, we assessed current prescribing practice and effect of BMI on glycaemic response to sulphonylureas and metformin in a large population T2DM cohort. METHODS BMI was determined in 3856 T2DM patients on sulphonylurea or metformin monotherapy in 2001-2002. Patients were identified from the Diabetes Audit and Research in Tayside, Scotland (DARTS) database. In a linear regression, the effect of BMI and other confounders on drug response was assessed in 2064 treatment-naïve patients commencing sulphonylureas or metformin between 1994 and 2002. RESULTS In 2001-2002, metformin was more likely to be used in obese than non-obese patients: 13% normal weight, 33.6% overweight and 62.1% obese patients were treated with metformin. Glycaemic response to sulphonylureas was not influenced by BMI (P = 0.81). Metformin was more effective in lowering glucose in those with a lower BMI (r = -0.02, P = 0.02), although the clinical impact of this was small. The HbA(1c) reduction in non-obese patients was similar to that in obese patients (1.46% vs. 1.34%, P = 0.11). CONCLUSIONS Glycaemic response to metformin in non-obese and obese patients is similar, suggesting that an individual's BMI should not influence the choice of oral agent. Given the non-glycaemia-related benefits of metformin, it should be used in more non-obese patients than is current practice in Tayside, Scotland.
Collapse
Affiliation(s)
- L A Donnelly
- Department of Clinical Pharmacology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | | | | | | | | |
Collapse
|
20
|
Pearson ER, Pruhova S, Tack CJ, Johansen A, Castleden HAJ, Lumb PJ, Wierzbicki AS, Clark PM, Lebl J, Pedersen O, Ellard S, Hansen T, Hattersley AT. Molecular genetics and phenotypic characteristics of MODY caused by hepatocyte nuclear factor 4alpha mutations in a large European collection. Diabetologia 2005; 48:878-85. [PMID: 15830177 DOI: 10.1007/s00125-005-1738-y] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 12/16/2004] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Heterozygous mutations in the gene of the transcription factor hepatocyte nuclear factor 4alpha (HNF-4alpha) are considered a rare cause of MODY with only 14 mutations reported to date. The description of the phenotype is limited to single families. We investigated the genetics and phenotype of HNF-4alpha mutations in a large European Caucasian collection. METHODS HNF-4alpha was sequenced in 48 MODY probands, selected for a phenotype of HNF-1alpha MODY but negative for HNF-1alpha mutations. Clinical characteristics and biochemistry were compared between 54 HNF-4alpha mutation carriers and 32 familial controls from ten newly detected or previously described families. RESULTS Mutations in HNF-4alpha were found in 14/48 (29%) probands negative for HNF-1alpha mutations. The mutations found included seven novel mutations: S34X, D206Y, E276D, L332P, I314F, L332insCTG and IVS5nt+1G>A. I314F is the first reported de novo HNF-4alpha mutation. The average age of diagnosis was 22.9 years with frequent clinical evidence of sensitivity to sulphonylureas. Beta cell function, but not insulin sensitivity, was reduced in diabetic mutation carriers compared to control subjects (homeostasis model assessment of beta cell function 29% p<0.001 vs controls). HNF-4alpha mutations were associated with lower apolipoprotein A2 (p=0.001), A1 (p=0.04) and total HDL-cholesterol (p=0.02) than in control subjects. However, in contrast to some previous reports, levels of triglycerides and apolipoprotein C3 were normal. CONCLUSIONS/INTERPRETATION HNF-4alpha mutations are common when no HNF-1alpha mutation is found in strictly defined MODY families. The HNF-4alpha clinical phenotype and beta cell dysfunction are similar to HNF-1alpha MODY and are associated with reduced apolipoprotein A2 levels. We suggest that sequencing of HNF-4alpha should be performed in patients with clinical characteristics of HNF-1alpha MODY in whom mutations in HNF-1alpha are not found.
Collapse
Affiliation(s)
- E R Pearson
- Diabetes and Vascular Medicine, Institute of Biomedical and Clinical Science, Peninsula Medical School, Barrack Road, Exeter EX2 5AX, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sagen JV, Pearson ER, Johansen A, Spyer G, Søvik O, Pedersen O, Njølstad PR, Hattersley AT, Hansen T. Preserved insulin response to tolbutamide in hepatocyte nuclear factor-1alpha mutation carriers. Diabet Med 2005; 22:406-9. [PMID: 15787664 DOI: 10.1111/j.1464-5491.2005.01439.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Diabetic subjects with mutations in the gene encoding hepatocyte nuclear factor (HNF)-1alpha (MODY3) are prone to develop hypoglycaemia at low doses of glibenclamide, interpreted as sulphonylurea hypersensitivity. The present study was undertaken to compare the plasma insulin responses to glucose and tolbutamide in HNF-1alpha mutation carriers with those of healthy control subjects. METHODS Seven mutation carriers; three normoglycaemic, two with impaired glucose tolerance, and two with newly detected diabetes, underwent an oral glucose tolerance test and a tolbutamide-modified intravenous glucose tolerance test with measurements of plasma insulin. Twenty-two healthy subjects served as controls. RESULTS The plasma insulin response to intravenous glucose was reduced in the HNF-1alpha mutation carriers compared to the control subjects, with an area under the curve (median (interquartile range)) of 812 min pmol/l (421, 1647) and 1933 min pmol/l (1521, 2908), respectively (P = 0.03). In striking contrast, the plasma insulin response to tolbutamide was preserved, with an area under the curve of 2109 min pmol/l (1126, 3172) and 2250 min pmol/l (1614, 3276) in the mutation carriers and control subjects, respectively. CONCLUSIONS HNF-1alpha mutation carriers are characterized by preserved tolbutamide-induced insulin secretion. Compared to healthy subjects, our MODY3 individuals did not show any increased serum insulin response to tolbutamide, suggesting that HNF-1alpha mutation carriers are not characterized by sulphonylurea hypersensitivity.
Collapse
Affiliation(s)
- J V Sagen
- Section of Paediatrics, Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
AIMS Knockout mice lacking both copies of the hepatocyte nuclear factor 1 (HNF1) gene have altered serum levels of amino acids and generalized aminoaciduria. The aim of our study was to test whether alterations in serum amino acid levels were found in patients with mutations in the hepatocyte nuclear factor-1 alpha (HNF-1alpha) gene compared with controls. METHODS Fasting serum from 20 patients with HNF-1alpha mutations and 20 age, sex and body mass index-matched controls was analysed for 16 amino acids. Means were compared between the two groups and Z scores calculated. RESULTS There was no significant difference between patients with HNF-1alpha mutations and controls in serum levels of phenylalanine, arginine, citrulline or lysine as suggested by knockout mice models. Although serum levels of eight amino acids were different in the two groups, these were not significant after Bonferroni correction. CONCLUSIONS The alterations in serum amino acid levels seen in mice models are not seen in patients with mutations in the HNF-1alpha gene. This suggests differences in mouse and man in the regulation of amino acid transport and has not provided us with a phenotypic marker to use before confirmatory genetic testing.
Collapse
Affiliation(s)
- A Stride
- Department of Diabetes and Vascular Medicine, Peninsula Medical School, Exeter, UK
| | | | | | | | | | | |
Collapse
|
23
|
Pearson ER, Velho G, Clark P, Stride A, Shepherd M, Frayling TM, Bulman MP, Ellard S, Froguel P, Hattersley AT. beta-cell genes and diabetes: quantitative and qualitative differences in the pathophysiology of hepatic nuclear factor-1alpha and glucokinase mutations. Diabetes 2001; 50 Suppl 1:S101-7. [PMID: 11272165 DOI: 10.2337/diabetes.50.2007.s101] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mutations in the beta-cell genes encoding the glycolytic enzyme glucokinase (GCK) and the transcription factor hepatocyte nuclear factor (HNF)-1alpha are the most common causes of maturity-onset diabetes of the young (MODY). Studying patients with mutations in these genes gives insights into the functions of these two critical beta-cell genes in humans. We studied 178 U.K. and French MODY family members, including 45 GCK mutation carriers and 40 HNF-1alpha mutation carriers. Homeostasis model assessment of fasting insulin and glucose showed reduced beta-cell function in both GCK (48% controls, P<0.0001) and HNF-1alpha (42% controls, P<0.0001). Insulin sensitivity was similar to that of control subjects in the GCK subjects (93% controls, P = 0.78) but increased in the HNF-1alpha subjects (134.5% controls, P = 0.005). The GCK patients showed a similar phenotype between and within families with mild lifelong fasting hyperglycemia (fasting plasma glucose [FPG] 5.5-9.2 mmol/l, interquartile [IQ] range 6.6-7.4), which declined slightly with age (0.017 mmol/l per year) and rarely required pharmacological treatment (17% oral hypoglycemic agents, 4% insulin). HNF-1alpha patients showed far greater variation in fasting glucose both between and within families (FPG 4.1-18.5 mmol/l, IQ range 5.45-10.4), with a marked deterioration with age (0.06 mmol/l per year), and 59% of patients required treatment with tablets or insulin. Proinsulin-to-insulin ratios are increased in HNF-1alpha subjects (29.5%) but not in GCK (18.5%) subjects. In an oral glucose tolerance test, the 0- to 120-min glucose increment was small in GCK patients (2.4+/-1.8 mmol/l) but large in HNF-1alpha patients (8.5+/-3.0 mmol/l, P< 0.0001). This comparison shows that the clear clinical differences in these two genetic subgroups of diabetes reflect the quantitative and qualitative differences in beta-cell dysfunction. The defect in GCK is a stable defect of glucose sensing, whereas the HNF-1alpha mutation causes a progressive defect that alters beta-cell insulin secretion directly rather than the sensing of glucose.
Collapse
Affiliation(s)
- E R Pearson
- Department of Vascular Medicine and Diabetes Research, School of Postgraduate Medicine and Health Sciences, University of Exeter, Devon, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pearson ER, Liddell WG, Shepherd M, Corrall RJ, Hattersley AT. Sensitivity to sulphonylureas in patients with hepatocyte nuclear factor-1alpha gene mutations: evidence for pharmacogenetics in diabetes. Diabet Med 2000; 17:543-5. [PMID: 10972586 DOI: 10.1046/j.1464-5491.2000.00305.x] [Citation(s) in RCA: 198] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Maturity-onset diabetes of the young (MODY) is characterized by autosomal dominantly inherited, early-onset, non-insulin-dependent diabetes. Mutations in the hepatocyte nuclear factor (HNF)-1alpha gene are the commonest cause of MODY. Individual patients with HNF-1alpha mutations have been reported as being unusually sensitive to the hypoglycaemic effects of sulphonylurea therapy. We report three patients, attending a single clinic, with HNF-1alpha mutations that show marked hypersensitivity to sulphonylureas. CASE REPORTS In cases 1 and 2 there were marked changes in HbA1c on cessation (4.4% and 5.8%, respectively) and reintroduction (5.0% and 2.6%) of sulphonylureas. Case 3 had severe hypoglycaemic symptoms on the introduction of sulphonylureas despite poor glycaemic control and was shown with a test dose of 2.5 mg glibenclamide to have symptomatic hypoglycaemia (blood glucose 2 mmol/l) after 4 h despite eating. CONCLUSIONS HNF-1alpha MODY diabetic subjects are more sensitive to sulphonylureas than Type 2 diabetic subjects and this is seen in different families, with different mutations and may continue up to 13 years from diagnosis. This is an example of pharmacogenetics, with the underlying aetiological genetic defect altering the pharmacological response to treatment. The present cases suggest that in HNF-1alpha MODY patients: (i) sulphonylureas can dramatically improve glycaemic control and should be considered as initial treatment for patients with poor glycaemic control on an appropriate diet; (ii) hypoglycaemia may complicate the introduction of sulphonylureas and therefore very low doses of short acting sulphonylureas should be used initially; and (iii) cessation of sulphonylureas should be undertaken cautiously as there may be marked deterioration in glycaemic control.
Collapse
Affiliation(s)
- E R Pearson
- Department of Diabetes and Vascular Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK
| | | | | | | | | |
Collapse
|
25
|
Pearson ER, Hattersley AT. Unravelling the heterogeneity of non insulin dependent diabetes. J R Coll Physicians Lond 2000; 34:332-5. [PMID: 11005066 PMCID: PMC9665487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
26
|
Pearson ER, D'Souza RJ, Hamilton-Wood C, Nicholls AJ, Beaman M. Hypertensive encephalopathy and nephrotic syndrome: a possible link? Nephrol Dial Transplant 1999; 14:1750-2. [PMID: 10435888 DOI: 10.1093/ndt/14.7.1750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E R Pearson
- Renal Unit, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | | | | | | | | |
Collapse
|