Favorable Effect of Anti-TNF Therapy on Insulin Sensitivity in Nonobese, Nondiabetic Patients with Inflammatory Bowel Disease

Abstract

Background The aim of this study was to investigate the effect of anti-TNF therapy on glucose and lipid metabolism in nondiabetic, nonobese patients with inflammatory bowel disease (IBD). Patients and Methods We studied 44 patients with IBD, without a known history of diabetes. Three of the patients were diagnosed with overt diabetes and were excluded. Eighteen of the remaining patients (9 M/9 F, 33.6 ± 8.8 years) were on anti-TNF therapy for longer than 1 year, while 23 patients (16 M/7 F, 38.7 ± 12.5 years) were treated with aminosalicylates (AMSs). Twelve of the patients from the second group were then treated with anti-TNF and reassessed 6 months later. Fasting glucose, insulin, c-peptide, HbA1c, lipid, CRP, and fibrinogen levels were determined, and HOMA-IR index was calculated in all patients. Results Patients from the two therapy groups were matched for age and BMI and were not obese. We did not find any differences between patients from the two therapy groups regarding fasting glucose, c-peptide, HbA1c, total cholesterol, HDL, LDL, triglycerides, CRP, and HOMA-IR index. In patients who were treated for 6 months with anti-TNF, a statistically significant decrease in insulin (before 15.5 ± 5.9 versus after 9.9 ± 2.9 μIU/ml, p = 0.042) and c-peptide (before 2.4 ± 1 versus after 1.3 ± 0.4 ng/ml, p = 0.030) levels as well as the HOMA-IR index (before 4.2 ± 1.9 versus after 2.2 ± 0.9, p = 0.045) was observed, without any changes in weight, BMI, glucose, HbA1c, lipid, CRP, and fibrinogen levels. Conclusion Anti-TNF therapy exerts a favorable effect on insulin sensitivity, while it has no effect on lipid levels in nondiabetic, nonobese patients with inflammatory bowel disease.

Six‐year follow‐up study on the association between white blood cell count and fasting blood glucose level in Chinese adults: A community‐based health examination survey

“…As one of the markers of low‐grade inflammatory, white blood cell (WBC) is widely used in the evaluation of inflammation and metabolic related diseases because of its ease of monitoring and identification …”

<p>Cardiovascular Risk in Individuals with Inflammatory Bowel Disease</p>

“…7 With the advent of new drugs that enable better control of inflammatory activity and the establishment of treatment strategies with defined therapeutic targets, a reduction of the cardiovascular risk in this population is expected. A study conducted by Paschou et al 31 observed a decrease in insulin levels and homeostatic model assessment for insulin resistance index in patients with IBD after receiving treatment with biological therapy for a period of six months. These data suggest that clinical treatment can promote not only controlling intestinal inflammation, but also controlling risk factors for cardiovascular disease, resulting in the reduction of the overall risk of cardiovascular events in the long term.…”

Chronic inflammatory diseases, myocardial function and cardioprotection

“…TNF-α along with other released cytokines then targets endothelium, producing an impairment of vasorelaxation pathways and an increase in adhesion molecules that trigger leukocyte infiltration, both phenomena implicated in atherosclerosis initiation and progression (Steyers & Miller, 2014). Accordingly, the levels of the endothelium NO synthase inhibitor asymmetric dimethylarginine are higher in inflammatory bowel disease patients than in controls, and such increase correlates with platelet count and other inflammation parameters (Owczarek, Cibor, & Mach, 2010). Moreover, inflammatory bowel disease endothelium exhibits abnormally high levels of CD40 whereas soluble CD40 levels, produced by platelets, are also high in inflammatory bowel disease patients, reflecting an enhanced platelet activation state (Danese et al, 2003).…”

“…More recently, anti‐TNF‐α agents, infliximab and adalimumab, were shown to lower plasma insulin levels and the homeostatic model assessment of insulin resistance index in inflammatory bowel disease patients. Hence, such drugs could reduce the risk of CVD (Paschou et al, 2018).…”