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Maddaloni E, Naciu AM, Mignogna C, Galiero R, Amendolara R, Fogolari M, Satta C, Serafini C, Angeletti S, Cavallo MG, Cossu E, Sasso FC, Buzzetti R, Pozzilli P. Saxagliptin/dapagliflozin is non-inferior to insulin glargine in terms of β-cell function in subjects with latent autoimmune diabetes in adults: A 12-month, randomized, comparator-controlled pilot study. Diabetes Obes Metab 2024; 26:1670-1677. [PMID: 38297915 DOI: 10.1111/dom.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
AIM To compare the efficacy and safety of saxagliptin/dapagliflozin and insulin glargine in people with latent autoimmune diabetes in adults (LADA). METHODS In this phase 2b multicentre, open-label, comparator-controlled, parallel-group, non-inferiority study, we randomly assigned 33 people with LADA who had a fasting C-peptide concentration ≥0.2 nmol/L (0.6 ng/mL) to receive 1-year daily treatment with either the combination of saxagliptin (5 mg) plus dapagliflozin (10 mg) or insulin glargine (starting dose: 10 IU), both on top of metformin. The primary outcome was the 2-h mixed meal-stimulated C-peptide area under the curve (AUC), measured 12 months after randomization. Secondary outcomes were glycated haemoglobin (HbA1c) levels, change in body mass index (BMI), and hypoglycaemic events. RESULTS In the modified intention-to-treat analysis, the primary outcome was similar in participants assigned to saxagliptin/dapagliflozin or to insulin glargine (median C-peptide AUC: 152.0 ng*min/mL [95% confidence interval {CI} 68.2; 357.4] vs. 122.2 ng*min/mL [95% CI 84.3; 255.8]; p for noninferiority = 0.0087). Participants randomized to saxagliptin/dapagliflozin lost more weight than those randomized to insulin glargine (median BMI change at the end of the study: -0.4 kg/m2 [95% CI -1.6; -0.3] vs. +0.4 kg/m2 [95% CI -0.3; +1.1]; p = 0.0076). No differences in HbA1c or in the number of participants experiencing hypoglycaemic events were found. CONCLUSIONS Saxagliptin/dapagliflozin was non-inferior to glargine in terms of β-cell function in this 12-month, small, phase 2b study, enrolling people with LADA with still viable endogenous insulin production. Weight loss was greater with saxagliptin/dapagliflozin, with no differences in glycaemic control or hypoglycaemic risk.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Anda M Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rocco Amendolara
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Chiara Satta
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Chiara Serafini
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Diabetes, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, St. Bartholomew's and London School of Medicine, London, UK
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Lee Jia Jia I, Buzzetti R, Leslie RD, Pozzilli P. LADA 30th anniversary: A growing form of diabetes with persistent unresolved questions. Diabetes Metab Res Rev 2024; 40:e3800. [PMID: 38581397 DOI: 10.1002/dmrr.3800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Affiliation(s)
- Ivy Lee Jia Jia
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Richard David Leslie
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Paolo Pozzilli
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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Grando Alves G, Cunha L, Henkes Machado R, Lins de Menezes V. Safety and efficacy of teplizumab in the treatment of type 1 diabetes mellitus: An updated systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2024. [PMID: 38602411 DOI: 10.1111/dom.15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
AIM To provide updated efficacy and safety information for teplizumab in the treatment of Stage 3 type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS The PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) comparing teplizumab to placebo for T1DM that reported any of the following outcomes: (1) C-peptide area under the curve (AUC); (2) glycated haemoglobin (HbA1c) levels; (3) insulin requirements; and (4) adverse events. Heterogeneity was examined with I2 statistics. p values <0.05 were taken to indicate statistical significance. The continuous endpoints were compared through the pooled mean difference (MD) and binary endpoints were assessed using risk ratios, both with 95% confidence intervals (CIs). Statistical analyses were performed using Review Manager Web software. RESULTS Eight RCTs with 1052 patients (754 receiving teplizumab) were included. Teplizumab significantly increased the AUC of C-peptide levels at 6 (MD 0.10 nmol/L, 95% CI 0.05, 0.16), 12 (MD 0.13 nmol/L, 95% CI 0.06, 0.20), 18 (MD 0.18 nmol/L, 95% CI 0.09, 0.27) and 24 months (MD 0.16 nmol/L, 95% CI 0.02, 0.31), significantly reduced HbA1c levels at 6 (MD -0.57%, 95% CI -1.07, -0.08) and 12 months (MD -0.31%, 95% CI -0.59, -0.02), and significantly reduced insulin requirements at 6 (MD -0.12 U/kg, 95% CI -0.16, -0.08), 12 (MD -0.11 U/kg, 95% CI -0.15, -0.07), 18 (MD -0.17 U/kg, 95% CI -0.26, -0.09) and 24 months (MD -0.11 U/kg, 95% CI -0.22, -0.01). CONCLUSION Teplizumab increases AUC of C-peptide levels and decreases HbA1c levels and insulin use, without raising serious adverse event risk.
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Affiliation(s)
| | - Luisa Cunha
- Department of Medicine, Lusíada University Center, São Paulo, Brazil
| | | | - Vanessa Lins de Menezes
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Adusu‐Donkor L, Ofori EK, Kotey FCN, Dogodzi FK, Dziedzorm W, Buabeng A, Bernard SK, Amponsah SK, Asare‐Anane H. Blood C-peptide concentration as a proxy marker of cardiovascular disease: An observational cross-sectional study. Health Sci Rep 2023; 6:e1535. [PMID: 37662537 PMCID: PMC10472907 DOI: 10.1002/hsr2.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background and Aims Cardiovascular diseases (CVDs) are among the leading causes of disability and early death in sub-Saharan Africa. Most of the current blood tests for CVD diagnosis involve performing about three test profiles; often at additional cost to patients. C-peptide, a cleavage product of proinsulin, is a promising marker that has the potential to serve as a proxy marker for diagnosing CVDs in resource-poor settings. Methodology The study was an observational cross-sectional one and involved 127 consenting persons diagnosed with CVD and 127 individuals without CVD. The socio-demographic and clinical characteristics of participants were obtained. Blood levels of C-peptide, fasting plasma glucose (FPG), total creatinine kinase (CK), creatine kinase myocardial bound (CKMB), lactate dehydrogenase (LDH), propeptide of brain natriuretic peptide (PBNP), Troponin T, lipids, and biomarkers of kidney and liver function were analyzed using ELISA and an automated analyzer. Insulin resistance was computed using the modified homeostatic model assessment (HOMA-IR). Results The CVD Group had significantly higher levels of C-peptide, CK, CKMB, troponin T, PBNP, FPG, HOMA-IR, and several selected kidney, liver, and lipid parameters compared to the non-CVD Group (p < 0.05 for all). Troponin T recorded a positive correlation (r = 0.34, p < 0.001) with C-peptide among the CVD Group. The sensitivity and specificity of C-peptide in identifying CVD were 96.1% and 91.3% respectively (area under the curve = 0.938, p < 0.001). Conclusion C-peptide levels were higher in the CVD Group and appeared to be a valuable (high sensitivity and specificity) biomarker in detecting CVD.
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Affiliation(s)
- Laurinda Adusu‐Donkor
- Department of Chemical PathologyU.G.M.S, University of GhanaAccraGhana
- Department of Chemical Pathology37 Military HospitalAccraGhana
| | | | - Fleischer C. N. Kotey
- Department of Medical MicrobiologyU.G.M.S, University of GhanaAccraGhana
- FleRhoLife Research ConsultAccraGhana
| | | | | | - Alfred Buabeng
- Department of Chemical PathologyU.G.M.S, University of GhanaAccraGhana
| | | | - Seth K. Amponsah
- Department of Medical PharmacologyU.G.M.S, University of GhanaAccraGhana
| | - Henry Asare‐Anane
- Department of Chemical PathologyU.G.M.S, University of GhanaAccraGhana
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Fujiwara N, Watanabe M, Katayama A, Noda Y, Eguchi J, Kataoka H, Kagawa S, Wada J. Longitudinal observation of insulin secretory ability before and after the onset of immune checkpoint inhibitor-induced diabetes mellitus: A report of two cases. Clin Case Rep 2021; 9:e04574. [PMID: 34522382 PMCID: PMC8424178 DOI: 10.1002/ccr3.4574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 01/15/2023] Open
Abstract
Immune checkpoint inhibitor-induced diabetes mellitus is a rare immune-related adverse event. This report illustrates clinical data and insulin secretory ability before and after the onset of immune checkpoint inhibitor-induced diabetes.
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Affiliation(s)
- Noriko Fujiwara
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
- Division of Endocrinology and MetabolismHiroshima Red Cross Hospital and Atomic‐bomb Survivors HospitalHiroshimaJapan
| | - Mayu Watanabe
- Department of Primary Care and Medical EducationDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | | | - Yohei Noda
- Department of Otolaryngology‐Head and Neck SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Jun Eguchi
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Hitomi Kataoka
- Department of Primary Care and Medical EducationDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Shunsuke Kagawa
- Minimally Invasive Therapy CenterOkayama University HospitalOkayamaJapan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
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Bundy BN, Krischer JP. A quantitative measure of treatment response in recent-onset type 1 diabetes. Endocrinol Diabetes Metab 2020; 3:e00143. [PMID: 32704564 PMCID: PMC7375065 DOI: 10.1002/edm2.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/26/2020] [Accepted: 04/04/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This paper develops a methodology and defines a measure that can be used to separate subjects that received an experimental therapy into those that benefitted from those that did not in recent-onset type 1 diabetes. Benefit means a slowing (or arresting) the decline in beta-cell function over time. The measure can be applied to comparing treatment arms from a clinical trial or to response at the individual level. METHODS An analysis of covariance model was fitted to the 12-month area under the curve C-peptide following a 2-hour mixed meal tolerance test from 492 individuals enrolled on five TrialNet studies of recent-onset type 1 diabetes. Significant predictors in the model were age and C-peptide at study entry. The observed minus the model-based expected C-peptide value (quantitative response, QR) is defined to reflect the effect of the therapy. RESULTS A comparison of the primary hypothesis test for each study included and a t test of the QR value by treatment group were comparable. The results were also confirmed for a new TrialNet study, independent of the set of studies used to derive the model. With our proposed analytical method and using QR as the end-point, we conducted simulation studies, to estimate statistical power in detecting a biomarker that expresses differential treatment effect. The QR in its continuous form provided the greatest statistical power when compared to several ways of defining responder/non-responder using various QR thresholds. CONCLUSIONS This paper illustrates the use of the QR, as a measure of the magnitude of treatment effect at the aggregate and subject-level. We show that the QR distribution by treatment group provides a better sense of the treatment effect than simply giving the mean estimates. Using the QR in its continuous form is shown to have higher statistical power in comparison with dichotomized categorization.
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Affiliation(s)
- Brian N. Bundy
- Health Informatics InstituteUniversity of South FloridaTampaFLUSA
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Lindgren O, Ahrén B. Consequences on islet and incretin hormone responses to dinner by omission of lunch in healthy men. Endocrinol Diabetes Metab 2020; 3:e00141. [PMID: 32704562 PMCID: PMC7375076 DOI: 10.1002/edm2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Omission of breakfast results in higher glucose and lower insulin and incretin hormone levels after both lunch and dinner. Whether omission of lunch has a similar impact on the following meal is not known. AIM This study therefore explored whether omission of lunch ingestion affects glucose, islet and incretin hormones after dinner ingestion in healthy subjects. MATERIALS & METHODS Twelve male volunteers (mean age 22 years, BMI 22.5 kg/m2) underwent two test days in random order with standard breakfast and dinner on both days with provision or omission of standard lunch in between. RESULTS The results showed that throughout the 300 minutes study period, glucose, insulin, glucagon and GIP levels after dinner ingestion did not differ between the two tests. In contrast, C-peptide, and GLP-1 levels were 26%-35% higher at later time points after dinner ingestion when lunch had been omitted (P < .05). CONCLUSION We conclude that omission of lunch increases GLP-1 and insulin secretion and possibly also insulin clearance resulting in unchanged glucose and insulin levels after dinner ingestion.
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Affiliation(s)
- Ola Lindgren
- Department of Clinical Sciences LundLund UniversityLundSweden
| | - Bo Ahrén
- Department of Clinical Sciences LundLund UniversityLundSweden
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Luppi P, Drain N, To R, Stolz D, Wallace C, Watkins S, Drain P. Autocrine C-peptide protects INS1 β cells against palmitic acid-induced oxidative stress in peroxisomes by inducing catalase. Endocrinol Diabetes Metab 2020; 3:e00147. [PMID: 32704568 PMCID: PMC7375117 DOI: 10.1002/edm2.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS C-peptide, produced by pancreatic β cells and co-secreted in the bloodstream with insulin, has antioxidant properties in glucose- and hydrogen peroxide (H2O2)-exposed INS1 β cells. Palmitic acid, the most physiologically abundant long-chain free fatty acid in humans, is metabolized in peroxisomes of β cells accumulating H2O2 that can lead to oxidative stress. Here, we tested the hypothesis that C-peptide protects β cells from palmitic acid-induced stress by lowering peroxisomal H2O2. MATERIALS AND METHODS We exposed INS1 β cells to palmitic acid and C-peptide in the setting of increasing glucose concentration and tested for changes in parameters of stress and death. To study the ability of C-peptide to lower peroxisomal H2O2, we engineered an INS1 β cell line stably expressing the peroxisomal-targeted H2O2 sensor HyPer, whose fluorescence increases with cellular H2O2. An INS1 β cell line stably expressing a live-cell fluorescent catalase reporter was used to detect changes in catalase gene expression. RESULTS C-peptide protects INS1 β cells from the combined effect of palmitic acid and glucose by reducing peroxisomal H2O2 to baseline levels and increasing expression of catalase. CONCLUSIONS In conditions of glucolipotoxicity, C-peptide increases catalase expression and reduces peroxisomal oxidative stress and death of INS1 β cells. Maintenance of C-peptide secretion is a pro-survival requisite for β cells in adverse conditions. Loss of C-peptide secretion would render β cells more vulnerable to stress and death leading to secretory dysfunction and diabetes.
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Affiliation(s)
- Patrizia Luppi
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Nicholas Drain
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Ramsey To
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Donna Stolz
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Callen Wallace
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Simon Watkins
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Peter Drain
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
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Sabek OM, Redondo MJ, Nguyen DT, Beamish CA, Fraga DW, Hampe CS, Mulukutla SN, Graviss EA, Gaber AO. Serum C-peptide and osteocalcin levels in children with recently diagnosed diabetes. Endocrinol Diabetes Metab 2020; 3:e00104. [PMID: 31922031 PMCID: PMC6947692 DOI: 10.1002/edm2.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We explored the association of C-peptide (marker of secreted insulin), proinsulin and proinsulin ⁄C-peptide ratio (PI/C) (markers of beta-cell endoplasmic reticulum [ER] stress) with undercarboxylated (uOC) and carboxylated osteocalcin (cOC) and their ratio (uOC/cOC) in children with recently diagnosed type 1 (T1D) or type 2 diabetes (T2D), and the correlation of these variables with partial remission (PR) in children with T1D. METHODS Demographic and clinical data of children with new-onset diabetes (n = 68; median age = 12.2 years; 33.8% non-Hispanic White, 45.6% Hispanic/Latino, 16.2% African American and 4.4% other) were collected at diagnosis and during the first (V1), second (V2) and third clinical visits at 9.0, 32.0 and 175.7 weeks, respectively. Serum proinsulin, C-peptide, uOC and cOC values were measured 7.0 weeks after diagnosis. PR was defined as insulin dose-adjusted HbA1c (IDAA1c) ≤9. RESULTS In children with new-onset T1D with DKA (33.3%) or T2D (29.4%), Spearman's correlation coefficient revealed a positive association between the C-peptide levels and both uOC and uOC/cOC ratio. In T1D (n = 48), both higher serum C-peptide levels and low PI:C ratio were associated with higher BMI percentile (β = 0.02, P = .001; β = -0.01, P = .02, respectively) and older age at diagnosis (β = 0.13, P = .001; β = -0.12, P = .001, respectively). Furthermore, in children with T1D, C-peptide levels at V1 correlated with IDAA1c ≤ 9 at V1 (P = .04). CONCLUSION C-peptide levels are associated with a higher uOC and uOC/cOC ratio in paediatric diabetes. In new-onset T1D children, older age and higher BMI were associated with lower beta-cell stress and higher preserved function, which was predictive of PR on follow-up.
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Affiliation(s)
- Omaima M. Sabek
- Department of SurgeryThe Methodist HospitalHoustonTXUSA
- Weill Cornell Medical CollegeNew YorkNYUSA
| | - Maria J. Redondo
- Section of Diabetes and EndocrinologyTexas Children's HospitalBaylor College of MedicineHoustonTXUSA
| | - Duc T. Nguyen
- Department of Pathology and Genomic MedicineHouston Methodist HospitalHoustonTXUSA
| | | | | | | | - Surya N. Mulukutla
- Section of Diabetes and EndocrinologyTexas Children's HospitalBaylor College of MedicineHoustonTXUSA
| | - Edward A. Graviss
- Department of SurgeryThe Methodist HospitalHoustonTXUSA
- Department of Pathology and Genomic MedicineHouston Methodist HospitalHoustonTXUSA
| | - A. Osama Gaber
- Department of SurgeryThe Methodist HospitalHoustonTXUSA
- Weill Cornell Medical CollegeNew YorkNYUSA
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Koga M, Murai J, Saito H, Kasayama S, Kobayashi T, Imagawa A, Hanafusa T. Correlation of glycated albumin but not hemoglobin A1c with endogenous insulin secretion in fulminant type 1 diabetes mellitus. J Diabetes Investig 2014; 1:279-82. [PMID: 24843444 PMCID: PMC4014892 DOI: 10.1111/j.2040-1124.2010.00050.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aims/Introduction: Fulminant type 1 diabetes mellitus (FT1DM) develops as a result of very rapid and almost complete pancreatic β‐cell destruction. We hypothesized that in patients with FT1DM who have less endogenous insulin secretion, disease progression is more rapid, and thus glycated albumin (GA) levels are lower. This study was designed to prove this hypothesis. Materials and Methods: The present study included 42 patients with FT1DM (24 men, 18 women) in whom glycated hemoglobin (HbA1c), GA and daily urinary C‐peptide (CPR) were measured at the time of diagnosis. Patients with complications, such as liver disease, kidney disease, anemia, or who were pregnant were excluded. Results: Urinary CPR (log transformed) was not correlated with HbA1c (R = 0.168, P = 0.287), but was positively correlated with GA (R = 0.336, P = 0.030). It was weakly, but not significantly, correlated with GA/HbA1c ratio (R = 0.281, P = 0.072). In patients with GA < 24.0%, urinary CPR was significantly lower than in patients with GA ≥ 24.0%. In addition, in patients with GA/HbA1c ratio <3.8, urinary CPR was significantly lower than in patients with GA/HbA1c ratio ≥ 3.8. Conclusions: Our findings suggest that in patients with FT1DM, GA at the time of diagnosis was correlated with endogenous insulin secretion. GA < 24.0% at the time of diagnosis is predictive for less endogenous insulin secretion in patients with FT1DM. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00050.x, 2010)
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Affiliation(s)
- Masafumi Koga
- Department of Internal Medicine, Kinki Central Hospital, Hyogo
| | - Jun Murai
- Department of Internal Medicine, Kinki Central Hospital, Hyogo
| | - Hiroshi Saito
- Department of Internal Medicine, Kinki Central Hospital, Hyogo
| | | | - Tetsuro Kobayashi
- Third Department of Internal Medicine, University of Yamanashi School of Medicine, Yamanashi
| | - Akihisa Imagawa
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Toshiaki Hanafusa
- First Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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11
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Funakoshi S, Fujimoto S, Hamasaki A, Fujiwara H, Fujita Y, Ikeda K, Takahara S, Seino Y, Inagaki N. Analysis of factors influencing postprandial C-peptide levels in Japanese patients with type 2 diabetes: Comparison with C-peptide levels after glucagon load. J Diabetes Investig 2014; 2:429-34. [PMID: 24843526 PMCID: PMC4014901 DOI: 10.1111/j.2040-1124.2011.00126.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction: Postprandial serum C‐peptide levels are readily determined in clinical practice and have a good correlation with serum C‐peptide levels after glucagon load; the measurement is often used as an index of endogenous insulin secretion. However, the factors affecting postprandial serum C‐peptide levels remain to be evaluated. Materials and Methods: To investigate the clinical factors affecting postprandial serum C‐peptide, 2‐h postprandial C‐peptide levels after breakfast (PPCPR) were analyzed retrospectively for comparison with glucagon‐stimulated C‐peptide (CPR‐6min) levels measured during hospital admission in 273 Japanese patients with type 2 diabetes. Results: Multiple regression analysis showed that years from diagnosis, body mass index (BMI) and HbA1c were the major independent variables predicting PPCPR (R2 = 0.315). HbA1c was a major factor predicting PPCPR, but did not predict CPR‐6min. In addition, HbA1c was negatively correlated with PPCPR (r = −0.410, P < 0.0001) and PPCPR/CPR‐6min (r = −0.313, P < 0.0001). Conclusions: PPCPR was correlated with common factors predicting CPR, including years from diagnosis and BMI, but also was negatively correlated with HbA1c, a unique factor. These results show that chronic elevation of the glucose level might impair endogenous insulin secretion after meal load, but might have little effect on endogenous insulin secretion after glucagon load. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00126.x, 2011)
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Affiliation(s)
- Shogo Funakoshi
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shimpei Fujimoto
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Akihiro Hamasaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hideya Fujiwara
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Yoshihito Fujita
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kaori Ikeda
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shiho Takahara
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | | | - Nobuya Inagaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
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Funakoshi S, Fujimoto S, Hamasaki A, Fujiwara H, Fujita Y, Ikeda K, Takahara S, Nagashima K, Hosokawa M, Seino Y, Inagaki N. Utility of indices using C-peptide levels for indication of insulin therapy to achieve good glycemic control in Japanese patients with type 2 diabetes. J Diabetes Investig 2014; 2:297-303. [PMID: 24843502 PMCID: PMC4014971 DOI: 10.1111/j.2040-1124.2010.00096.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims/Introduction: Type 2 diabetes is progressive in that therapy must be altered over time, which is partly as a result of the progressive loss of pancreatic β‐cell function. To elucidate the relationship between residual endogenous insulin secretion and the necessity of insulin therapy to achieve good glycemic control, indices using serum C‐peptide immunoreactivity (CPR) were analyzed in patients with type 2 diabetes. Materials and Methods: The data of 201 Japanese patients with type 2 diabetes who achieved the target of glycemic control during admission were analyzed retrospectively. Indices using CPR including fasting CPR (FCPR), CPR 6 min after intravenous injection of glucagon (CPR‐6 min), increment of CPR (ΔCPR), secretory unit of islet in transplantation index (SUIT) and C‐peptide index (CPI) were compared between the group requiring insulin (insulin group) and the group not requiring insulin (non‐insulin group). A receiver–operator characteristic (ROC) curve was made, and optimal cut‐off point and likelihood ratio were determined for each index. Results: All indices of CPR were lower in the insulin group compared with those in the non‐insulin group. Likelihood ratios at the optimal point of FCPR, CPR‐6 min, ΔCPR, SUIT, and CPI were 2.0, 2.1, 1.6, 2.3 and 2.8, respectively. Optimal cut‐off point of CPI was 1.1 ng/mg. Sensitivity and specificity at optimal point of CPI were 61 and 78%, respectively. Conclusions: The advantage of CPI of the indices of CPR to select insulin therapy to achieve good glycemic control was shown, but limitations of the predictive abilities of the indices using CPR should be taken into account. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00096.x, 2011)
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Affiliation(s)
- Shogo Funakoshi
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shimpei Fujimoto
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Akihiro Hamasaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hideya Fujiwara
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Yoshihito Fujita
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kaori Ikeda
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shiho Takahara
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kazuaki Nagashima
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | - Masaya Hosokawa
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
| | | | - Nobuya Inagaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto
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13
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Lee EY, Hwang S, Lee SH, Lee YH, Choi AR, Lee Y, Lee BW, Kang ES, Ahn CW, Cha BS, Lee HC. Postprandial C-peptide to glucose ratio as a predictor of β-cell function and its usefulness for staged management of type 2 diabetes. J Diabetes Investig 2014; 5:517-24. [PMID: 25411619 PMCID: PMC4188109 DOI: 10.1111/jdi.12187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/24/2013] [Accepted: 10/20/2013] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction Type 2 diabetes is characterized by progressive deterioration of β‐cell function. Recently, it was suggested that the C‐peptide‐to‐glucose ratio after oral glucose ingestion is a better predictor of β‐cell mass than that during fasting. We investigated whether postprandial C‐peptide‐to‐glucose ratio (PCGR) reflects β‐cell function, and its clinical application for management of type 2 diabetes. Materials and Methods We carried out a two‐step retrospective study of 919 Korean participants with type 2 diabetes. In the first step, we evaluated the correlation of PCGR level with various markers for β‐cell function in newly diagnosed and drug‐naïve patients after a mixed meal test. In the second step, participants with well‐controlled diabetes (glycated hemoglobin <7%) were divided into four groups according to treatment modality (group I: insulin, group II: sulfonylurea and/or dipeptityl peptidase IV inhibitor, group III: metformin and/or thiazolidinedione and group IV: diet and exercise group). Results In the first step, PCGR was significantly correlated with various insulin secretory indices. Furthermore, PCGR showed better correlation with glycemic indices than homeostatic model assessment of β‐cell function (HOMA‐β). In the second step, the PCGR value significantly increased according to the following order: group I, II, III, and IV after adjusting for age, sex, body mass index and duration of diabetes. The cut‐off values of PCGR for separating each group were 1.457, 2.870 and 3.790, respectively (P < 0.001). Conclusions We suggest that PCGR might be a useful marker for β‐cell function and an ancillary parameter in the choice of antidiabetic medication in type 2 diabetes.
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Affiliation(s)
- Eun Young Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Sena Hwang
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea ; International Health Care Center Yonsei Medical Health System Seoul Korea
| | - Seo Hee Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Yong-Ho Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - A Ra Choi
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Youngki Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Byung-Wan Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Eun Seok Kang
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Chul Woo Ahn
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Bong Soo Cha
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Hyun Chul Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
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14
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Song SO, Kim KJ, Lee BW, Kang ES, Cha BS, Lee HC. Tolerability, effectiveness and predictive parameters for the therapeutic usefulness of exenatide in obese, Korean patients with type 2 diabetes. J Diabetes Investig 2013; 5:554-62. [PMID: 25411624 PMCID: PMC4188114 DOI: 10.1111/jdi.12184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 09/03/2013] [Accepted: 10/24/2013] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction We assessed the tolerability, effectiveness and predictive parameters for the therapeutic usefulness of exenatide in obese Korean participants with type 2 diabetes. We also evaluated the characteristics of participants who respond adequately to glucagon‐like peptide‐1 (GLP‐1) analog therapy in terms of glycated hemoglobin (HbA1c) level reductions and weight loss. Materials and Methods This prospective, observational, single‐arm (exenatide b.i.d. in combination with both metformin and sulphonylurea), open‐label study of GLP‐1 analog treatment with close monitoring of metabolic parameters and weight changes was carried out for up to 22 weeks. Results Of the 110 enrolled obese participants, 37 participants dropped out during the 22‐week treatment period. A total of 73 participants completed the study (median age 55.0 years, interquartile range 44.0–65.0). The median duration of diabetes was 8.0 years (interquartile range 3.5–12.5) with a mean HbA1c value of 7.6% (interquartile range 7.00–8.55). The median body mass index was 30.78 kg/m2 (interquartile range 27.89–33.92). After 22 weeks, median changes from baseline for HbA1c levels and weight were −0.7% and −3.0 kg, respectively, which were significant. No severe hypoglycemic events were observed. Multivariate regression analysis showed that C‐peptide values were a significant independent predictor for a reduction in HbA1c levels (β = 0.865, P = 0.018) with exenatide BID in combination with both sulphonylurea and metformin in obese Korean participants with type 2 diabetes and insulin naïveté. Conclusions Clinical and laboratory parameters, such as insulin naïveté and preserved β‐cell function, should be taken into consideration as important factors in the choice of GLP‐1 analog when predicting GLP‐1 analog responsiveness. This trial was registered with the local committee at Yonsei University in Korea (4‐2011‐0032).
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Affiliation(s)
- Sun Ok Song
- Division of Endocrinology Department of Internal Medicine National Health Insurance Service Ilsan Hospital Seoul Korea ; Department of Medicine Graduate School of Yonsei University Seoul Korea
| | - Kwang Joon Kim
- Division of Endocrinology and Metabolism Department of Internal Medicine Severance Hospital Yonsei University College of Medicine Seoul Korea ; Severance Executive Healthcare Clinic Severance Hospital Yonsei University Health System Seoul Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism Department of Internal Medicine Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism Department of Internal Medicine Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism Department of Internal Medicine Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Hyun Chul Lee
- Division of Endocrinology and Metabolism Department of Internal Medicine Severance Hospital Yonsei University College of Medicine Seoul Korea
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15
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Fujiwara D, Takahashi K, Suzuki T, Shii M, Nakashima Y, Takekawa S, Yoshida A, Matsuoka T. Postprandial serum C-peptide value is the optimal index to identify patients with non-obese type 2 diabetes who require multiple daily insulin injection: Analysis of C-peptide values before and after short-term intensive insulin therapy. J Diabetes Investig 2013; 4:618-25. [PMID: 24843717 PMCID: PMC4020258 DOI: 10.1111/jdi.12103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 12/20/2022] Open
Abstract
Aims/Introduction Type 2 diabetes is a progressive disease characterized by a yearly decline in insulin secretion; however, no definitive evidence exists showing the relationship between decreased insulin secretion and the need for insulin treatment. To determine the optimal insulin secretory index for identifying patients with non‐obese type 2 diabetes who require multiple daily insulin injection (MDI), we evaluated various serum C‐peptide immunoreactivity (CPR) values. Materials and Methods We near‐normalized blood glucose with intensive insulin therapy (IIT) over a 2‐week period in 291 patients with non‐obese type 2 diabetes, based on our treatment protocol. After improving hyperglycemia, we challenged with oral hypoglycemic agent (OHA), and according to the responsiveness to OHA, patients were classified into three therapy groups: OHA alone (n = 103), basal insulin plus OHA (basal insulin‐supported oral therapy [BOT]; n = 56) and MDI (n = 132). Glucagon‐loading CPR increment (ΔCPR), fasting CPR (FCPR), CPR 2 h after breakfast (CPR2h), the ratio of FCPR to FPG (CPI), CPI 2 h after breakfast (CPI2h) and secretory unit of islets in transplantation (SUIT) were submitted for the analyses. Receiver operating characteristic (ROC) and multiple logistic analyses for these CPR indices were carried out. Results Many CPR values were significantly lower in the MDI group compared with the OHA alone or BOT groups. ROC and multiple logistic analyses disclosed that post‐prandial CPR indices (CPR2h and CPI2h) were the most reliable CPR markers to identify patients requiring MDI. Conclusions Postprandial CPR level after breakfast is the most useful index for identifying patients with non‐obese type 2 diabetes who require MDI therapy.
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Affiliation(s)
- Daisuke Fujiwara
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Kenji Takahashi
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Takahiro Suzuki
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Masakazu Shii
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Yukako Nakashima
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Sato Takekawa
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Atsushi Yoshida
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Takashi Matsuoka
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
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16
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Abstract
A fairly large body of evidence has shown that insulin is a tumour-promoting agent, especially for breast cancer. High circulating and microenvironmental levels of insulin may directly increase the risk of breast cancer via the activation of cognate receptors expressed on normal and cancer cells and indirectly be associated with other known metabolic risk factors of cancer that usually are present in conjunction with the hyperinsulinic state. The focus of this review is to analyse and discuss available data in the literature on the possible causative/prognostic role of insulin resistance/hyperinsulinemia in breast cancer development and progression.
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Affiliation(s)
- V Formica
- Medical Oncology Unit, Tor Vergata Clinical Center, University of Rome and IRCCS San Raffaele, Rome, ItalyDepartment of Internal Medicine, Tor Vergata Clinical Center, University of Rome, ItalyDepartment of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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