Karin Zibar

Relationship between Adiponectin Level, Insulin Sensitivity, and Metabolic Syndrome in Type 1 Diabetic Patients

Objective. Adiponectin is known to be decreased in insulin resistance (IR) and metabolic syndrome (MS) which can be present in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to evaluate the relationship between adiponectin level, MS, and insulin sensitivity in T1DM. Research Design and Methods. The study included 77 T1DM patients divided into two groups based on the total plasma adiponectin median value. Insulin sensitivity was calculated with the equation for eGDR, and MS was defined according to International Diabetes Federation criteria. Results. Patients with higher adiponectin level (n = 39) had significantly lower waist circumference (P < 0.002), fasting venous glucose levels (P < 0.001), higher HDL3-cholesterol (P = 0.011), and eGDR (P = 0.003) in comparison to the group with lower adiponectin who showed higher prevalence of MS (P = 0.045). eGDR increased for 1.09 mg/kg−1 min−1 by each increase of 1 µg/mL total fasting plasma adiponectin (P = 0.003). In the logistic regression model, adiponectin was inversely associated with the presence of MS (P = 0.014). Conclusion. Higher adiponectin concentration is associated with lower prevalence of MS in T1DM. Whether higher adiponectin concentration has a protective role in the development of the MS in T1DM needs to be clarified in future follow-up studies.

Incretin based therapies:A novel treatment approach for non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome (MS). The current treatment of non-alcoholic fatty liver disease (NAFLD) principally includes amelioration of MS components by lifestyle modifications but the lack of success in their implementation and sustainment arises the need for effective pharmacological agent in fatty liver treatment. Incretins are gut derived hormones secreted into the circulation in response to nutrient ingestion that enhances glucose-stimulated insulin secretion. Glucagon-like peptide-1 (GLP-1) is the most important incretin. Its receptor agonist and inhibitors of dipeptidyl peptidase-4 (DPP-4) are used in treatment of type 2 diabetes mellitus. DPP-4 serum activity and hepatic expression are shown to be elevated in several hepatic diseases. There are several experimental and clinical trials exploring the efficacy of incretin based therapies in NAFLD treatment. They suggest that GLP-1 analogues might have beneficial effect on hepatic steatosis acting as insulin sensitizers and directly by stimulating GLP-1 receptors expressed on hepatocytes. The use of DPP-4 inhibitors also results in hepatic fat reduction but the mechanism of action remains unclear. There is growing evidence that incretin based therapies have beneficial effects on hepatocytes, however further study analysis are needed to assess the long term effect of incretin based therapies on NAFLD.

Difference in glucagon-like peptide-1 concentrations between C-peptide negative type 1 diabetes mellitus patients and healthy controls.

Background The role of glucagon-like peptide-1 (GLP-1) has become a new scientific interest in the field of pathophysiology of type 1 diabetes mellitus (T1DM), but the results of the published studies were contradictory. The aim of our study was therefore to measure fasting and postprandial GLP-1 concentrations in T1DM patients and in healthy controls and to examine the difference in those concentrations between the two groups of subjects. Methods The cross-sectional study included 30 C-peptide negative T1DM patients, median age 37 years (20–59), with disease duration 22 years (3–45), and 10 healthy controls, median age 30 years (27–47). Fasting and postprandial total and active GLP-1 concentrations were measured by ELISA (ALPCO, USA). The data were statistically analysed by SPSS, and significance level was accepted at P < 0.05. Results Both fasting total and active GLP-1 concentrations were significantly lower in T1DM patients (total 0.4 pmol/L, 0–6.4 and active 0.2 pmol/L, 0–1.9) compared with healthy controls (total 3.23 pmol/L, 0.2–5.5 and active 0.8 pmol/L, 0.2–3.6), P = 0.008 for total GLP-1 and P = 0.001 for active GLP-1. After adjustment for age, sex and body mass index, binary logistic regression showed that both fasting total and active GLP-1 remained significantly independently lower in T1DM patients (total GLP-1: OR 2.43, 95% CI 1.203–4.909 and active GLP-1: OR 8.73, 95% CI 1.472–51.787). Conclusions T1DM patients had independently lower total and active GLP-1 fasting concentrations in comparison with healthy people, which supports the potential therapeutic role of incretin therapy, along with insulin therapy, in T1DM patients.

Relationship between metabolic syndrome and meal-induced glucagon like peptide-1 response in type 1 diabetic patients在1型糖尿病患者中代谢综合征与进餐诱导的胰高血糖素样肽-1应答之间的关系

Metabolic syndrome (MS) is found in approximately% 30–40% of patients with type 1 diabetes mellitus (T1DM). Meal‐induced glucagon‐like peptide‐1 (GLP‐1) secretion in T1DM patients with MS is yet to be clarified. The aim of the present study was to analyse the relationship between total fasting GLP‐1 concentrations and the meal‐induced GLP‐1 response with MS prevalence in T1DM patients compared with lean, normal glucose tolerance (NGT), control subjects.

Effect of exenatide therapy on hepatic fat quantity and hepatic biomarkers in type 2 diabetic patients.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver disease characterized by hepatic fat accumulation. The aim of this study was to to evaluate the effect of exenatide therapy on NAFLD markers, namely concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK), γ-glutamyltransferase (GGT), and hepatic fat in type 2 diabetic patients. Study included 102 patients with type 2 diabetes without clinical evidence of cirrhosis or other causes of chronic liver disease. Thirty-five were on stabile doses of oral hypoglycemic agents (OHA) metformin or/and sulphonylurea and 67 starting exenatide therapy. Fatty liver index (FLI) is calculated using an equation including body mass index (BMI), waist circumference, tryglicerides (TG) and GGT. We assessed changes in NAFLD markers, FLI, BMI, waist circumference, and HbA1c levels in two T2DM groups of patients, one treated with exenatide and the other treated with metformin or/and sulphonylurea. Patients treated with exenatide had significantly lower levels of AST (24 vs 23 U/L), ALT (36 vs 27 U/L), ALK (83 vs 73 U/L), GGT (38 vs 23 U/L), FLI (24 vs 9), BMI (39 vs 35), waist circumference (119 vs 111) and HbA1c (8.4 vs 7.3) after 24 weeks of therapy. These differences in NAFLD markers and FLI were independent of BMI, waist circumference or HbA1c. No significant differences in NAFLD markers and FLI were observed in group of patients treated with metformin or/and sulphonylurea. In the exenatide group there was no statistical significant difference in the between group comparrison concidering exenatide concomitant therapy in the observed laboratory measurements. The median change in FLI for group treated with 5µg of exenatede was -13.6 and for group treated with 10µg of exenatide was -6.5. Introduction of exenatide therapy to T2DM patients seems to have positive pleiotropic effect in liver, especially in hepatic fat metabolism.

Relationship between metabolic syndrome and meal-induced glucagon like peptide-1 response in type 1 diabetic patients在1型糖尿病患者中代谢综合征与进餐诱导的胰高血糖素样肽-1应答之间的关系: Metabolic syndrome and GLP-1 in T1DM

Metabolic syndrome (MS) is found in approximately% 30–40% of patients with type 1 diabetes mellitus (T1DM). Meal‐induced glucagon‐like peptide‐1 (GLP‐1) secretion in T1DM patients with MS is yet to be clarified. The aim of the present study was to analyse the relationship between total fasting GLP‐1 concentrations and the meal‐induced GLP‐1 response with MS prevalence in T1DM patients compared with lean, normal glucose tolerance (NGT), control subjects.

Relationship between metabolic syndrome and meal-induced glucagon like peptide-1 response in type 1 diabetic patients1-1.

Metabolic syndrome (MS) is found in approximately% 30–40% of patients with type 1 diabetes mellitus (T1DM). Meal‐induced glucagon‐like peptide‐1 (GLP‐1) secretion in T1DM patients with MS is yet to be clarified. The aim of the present study was to analyse the relationship between total fasting GLP‐1 concentrations and the meal‐induced GLP‐1 response with MS prevalence in T1DM patients compared with lean, normal glucose tolerance (NGT), control subjects.