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Herring RA, Parsons I, Shojaee-Moradie F, Stevenage M, Jackson N, Manders R, Umpleby AM, Fielding BA, Davies M, Russell-Jones DL. Effect of Dapagliflozin on Cardiac Function and Metabolic and Hormonal Responses to Exercise. J Clin Endocrinol Metab 2023; 108:888-896. [PMID: 36274035 DOI: 10.1210/clinem/dgac617] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/03/2022] [Indexed: 02/13/2023]
Abstract
OBJECTIVE This work aimed to investigate the effect of the SGLT2 inhibitor, dapagliflozin (DAPA), on cardiac function and the metabolic and hormonal response to moderate exercise in people with type 2 diabetes. METHODS This was a double-blind, placebo-controlled crossover study with a 4-week washout period. Nine participants were randomly assigned to receive either 4 weeks of DAPA or 4 weeks of placebo. After each treatment, they underwent an exercise protocol with 2 consecutive 10-minute stages at a constant load corresponding to 40% and 70% maximal oxygen consumption (VO2max), coupled with hormonal and metabolic analysis. A blinded transthoracic echocardiogram was performed 3 days later. RESULTS During the exercise protocol, glucose and lactate were lower (P < .0001 and P < .05, respectively) and β-hydroxybutyrate (BOBH) and growth hormone (GH) were higher (P < .0005 and P = .01) following DAPA treatment compared to placebo. There was a trend for lower insulin with DAPA. Adrenalin, noradrenalin, and glucagon were not different. Following DAPA participants demonstrated an increased mean peak diastolic mitral annular velocity (e') in comparison to placebo (P = .03). The indexed left atrial volume and right ventricular e" were reduced following DAPA compared with placebo (P = .045 and P = .042, respectively). Arterial stiffness was not different between treatments (DAPA 9.35 ± 0.60 m/s; placebo 9.07 ± 0.72 m/s). CONCLUSION During exercise, GH may be more important than catecholamines in driving the shift from glucose to fatty acid metabolism by SGLT2 inhibitors. The 4-week crossover design showed changes in cardiac function were rapid in onset and reversible.
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Affiliation(s)
- Roselle A Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Iain Parsons
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Fariba Shojaee-Moradie
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Mary Stevenage
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Nicola Jackson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Ralph Manders
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - A Margot Umpleby
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Barbara A Fielding
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - David L Russell-Jones
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Herring RA, Shojaee-Moradie F, Stevenage M, Parsons I, Jackson N, Mendis J, Middleton B, Umpleby AM, Fielding BA, Davies M, Russell-Jones DL. The SGLT2 Inhibitor Dapagliflozin Increases the Oxidation of Ingested Fatty Acids to Ketones in Type 2 Diabetes. Diabetes Care 2022; 45:1408-1415. [PMID: 35312749 DOI: 10.2337/dc21-2043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/22/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the mechanism for increased ketogenesis following treatment with the SGLT2 inhibitor dapagliflozin in people with type 2 diabetes. RESEARCH DESIGN AND METHODS The design was a double-blind, placebo-controlled, crossover study with a 4-week washout period. Participants received dapagliflozin or placebo in random order for 4 weeks. After each treatment, they ingested 30 mL of olive oil containing [U-13C]palmitate to measure ketogenesis, with blood sampling for 480 min. Stable isotopes of glucose and glycerol were infused to measure glucose flux and lipolysis, respectively, at 450-480 min. RESULTS Glucose excretion rate was higher and peripheral glucose uptake lower with dapagliflozin than placebo. Plasma β-hydroxybutyrate (BOHB) concentrations and [13C2]BOHB concentrations were higher and glucose concentrations lower with dapagliflozin than placebo. Nonesterified fatty acids (NEFAs) were higher with dapagliflozin at 300 and 420 min, but lipolysis at 450-480 min was not different. Triacylglycerol at all time points and endogenous glucose production rate at 450-480 min were not different between treatments. CONCLUSIONS The increase in ketone enrichment from the ingested palmitic acid tracer suggests that meal-derived fatty acids contribute to the increase in ketones during treatment with dapagliflozin. The increase in BOHB concentration with dapagliflozin occurred with only minimal changes in plasma NEFA concentration and no change in lipolysis. This finding suggests a metabolic switch to increase ketogenesis within the liver.
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Affiliation(s)
- Roselle A Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Fariba Shojaee-Moradie
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K
| | - Mary Stevenage
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K
| | - Iain Parsons
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K
| | - Nicola Jackson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Jeewaka Mendis
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Benita Middleton
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - A Margot Umpleby
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Barbara A Fielding
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - David L Russell-Jones
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
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Herring RA, Shojaee-Moradie F, Garesse R, Stevenage M, Jackson N, Fielding BA, Mendis A, Johnsen S, Umpleby AM, Davies M, Russell-Jones DL. Response to Comment on Herring et al. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020;43:2128-2136. Diabetes Care 2021; 44:e61. [PMID: 33608329 DOI: 10.2337/dci20-0072] [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: 02/03/2023]
Affiliation(s)
- Roselle A Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K.
| | - Fariba Shojaee-Moradie
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Robert Garesse
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Mary Stevenage
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Nicola Jackson
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Barbara A Fielding
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Agampodi Mendis
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Sigurd Johnsen
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - A Margot Umpleby
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Melanie Davies
- Diabetes Research Centre, Department of Health Sciences, University of Leicester, Leicester, U.K
| | - David L Russell-Jones
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
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Herring RA, Shojaee-Moradie F, Garesse R, Stevenage M, Jackson N, Fielding BA, Mendis A, Johnsen S, Umpleby AM, Davies M, Russell-Jones DL. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020; 43:2128-2136. [PMID: 32641376 DOI: 10.2337/dc19-2579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/30/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on glucose flux, lipolysis, and ketone body concentrations during insulin withdrawal in people with type 1 diabetes. RESEARCH DESIGN AND METHODS A double-blind, placebo-controlled crossover study with a 4-week washout period was performed in 12 people with type 1 diabetes using insulin pump therapy. Participants received dapagliflozin or placebo in random order for 7 days. Stable isotopes were infused to measure the glucose Ra, Rd, and lipolysis. At isotopic steady state, insulin was withdrawn, and the study was terminated after 600 min or earlier if blood glucose reached 18 mmol/L, bicarbonate <15 mmol/L, venous pH <7.35, or capillary ketones >5.0 mmol/L. RESULTS At baseline, glucose Ra was significantly higher for the dapagliflozin group than the placebo group. Following insulin withdrawal, plasma glucose concentrations at the end point were significantly lower with dapagliflozin than placebo and glucose Rd area under the curve (AUC)0-180 min and β-hydroxybutyrate (BOHB) AUC0-180 min were significantly higher. There was a small but significantly higher glycerol Ra (measure of lipolysis) AUC0-180 min with dapagliflozin. Nonesterified fatty acid concentrations were not different between treatments. When divided by BMI >27 and <27 kg/m2, basal glucose Ra, BOHB, and glycerol Ra AUC0-180 min were significantly higher in the low-BMI group with dapagliflozin treatment versus the low-BMI group with placebo. CONCLUSIONS During insulin withdrawal, the increase in BOHB with dapagliflozin may be partially due to increased lipolysis. However, reduced renal excretion, reduced BOHB uptake by peripheral tissues, or a metabolic switch to increased ketogenesis within the liver may also play a role.
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Affiliation(s)
- Roselle A Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K.
| | - Fariba Shojaee-Moradie
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Robert Garesse
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Mary Stevenage
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Nicola Jackson
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Barbara A Fielding
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Agampodi Mendis
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Sigurd Johnsen
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - A Margot Umpleby
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Melanie Davies
- Diabetes Research Centre, Department of Health Sciences, University of Leicester, Leicester, U.K
| | - David L Russell-Jones
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
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Stevenage M, Theochari E, Johnson D, Warner G. 0948 (An) Exercise in diagnosing (a rare cause of) double vision. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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