Insulin resistance, β-cell dysfunction and differences in curves of plasma glucose and insulin in the intermediate points of the standard glucose tolerance test in adults with cystic fibrosis

Megías, Marta Cano; Albarrán, Olga González; Vasco, Pablo Guisado; Ferreiro, Adelaida Lamas; Carro, Luís Máiz

doi:10.1016/j.endoen.2015.02.001

Cited by 12 publications

(8 citation statements)

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“…Similarly, 1-h postprandial glucose is associated with incident T2DM [60] and appears to be a more sensitive but also more time consuming alternative to HbA1c (5.7-6.4%) [61]. In over half of the cases, peak blood glucose levels during a standard OGTT are reached in the intermediate time points, rather than at 120 min [62]. For these reasons, some researchers have suggested shortening the standard OGTT to 1 h, arguing that this would improve the predictive value in determining the future risk of type 2 diabetes [63].…”

Section: Resultsmentioning

confidence: 99%

“…Meanwhile, there are no data for the insulin curves in the results of the mentioned study and it cannot be applicable for the OGTT evaluations, which are a substantial part of the functional test. Therefore, it is worth taking into account that plasma insulin concentrations are labile due to the physiology of insulin release from the pancreas [72] and patients with slightly impaired fasting results might have problems with the phases of insulin secretion [62], which makes reasonable to assess the full insulin curve with the purpose of early detection of glucose metabolism disorders since the postprandial insulin is the earliest marker of T2DM and cardiovascular risk [65].…”

Section: Resultsmentioning

confidence: 99%

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Difference in Insulin Resistance Assessment between European Union and Non-European Union Obesity Treatment Centers (ESPE Obesity Working Group Insulin Resistance Project)

et al. 2020

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Introduction: The obesity epidemic has become one of the most important public health issues of modern times. Impaired insulin sensitivity seems to be the cornerstone of multiple obesity related comorbidities. However, there is no accepted definition of impaired insulin sensitivity. Objective: We hypothesize that assessment of insulin resistance differs between centers. Methods: The ESPE Obesity Working Group (ESPE ObWG) Scientific Committee developed a questionnaire with a focus on the routine practices of assessment of hyperinsulinemia and insulin resistance, which was distributed through Google Docs platform to the clinicians and researchers from the current ESPE ObWG database (n = 73). Sixty-one complete responses (84% response rate) from clinicians and researchers were analyzed: 32 from European Union (EU) centers (representatives of 14 countries) and 29 from Non-EU centers (representatives from 10 countries). Standard statistics were used for the data analysis. Results: The majority of respondents considered insulin resistance (IR) as a clinical tool (85.2%) rather than a research instrument. For the purpose of IR assessment EU specialists prefer analysis of the oral glucose tolerance test (OGTT) results, whereas non-EU ones mainly use Homeostatic Model Assessment of Insulin Resistance (HOMA-IR; p = 0.032). There was no exact cutoff for the HOMA-IR in either EU or non-EU centers. A variety of OGTT time points and substances measured per local protocol were reported. Clinicians normally analyzed blood glucose (88.52% of centers) and insulin (67.21%, mainly in EU centers, p = 0.0051). Furthermore, most participants (70.5%) considered OGTT insulin levels as a more sensitive parameter of IR than glucose. Meanwhile, approximately two-thirds (63.9%) of the centers did not use any cutoffs for the insulin response to the glucose load. Conclusions: Since there is no standard for the IR evaluation and uniform accepted indication of performing, an OGTT the assessment of insulin sensitivity varies between EU and non-EU centers. A widely accepted standardized protocol is needed to allow comparison between centers.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Difference in Insulin Resistance Assessment between European Union and Non-European Union Obesity Treatment Centers (ESPE Obesity Working Group Insulin Resistance Project)

et al. 2020

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“…It is well established that insulin secretion loss over time is the main cause of glucose intolerance and CFRD onset [15,16]. A number of studies have demonstrated the relationship between CFRD onset and decreased insulin production [26] in the first phase of insulin secretion [27,28] due to impaired β-cells function in the pancreas [29]. Still especially in the context of this limited insulin secretion capacity, some additional mechanisms could play a role.…”

Section: Discussionmentioning

confidence: 99%

The main mechanism associated with progression of glucose intolerance in older patients with cystic fibrosis is insulin resistance and not reduced insulin secretion capacity

Colomba

Boudreau

Lehoux-Dubois

et al. 2019

Journal of Cystic Fibrosis

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Background: Aging cystic fibrosis (CF) patients are at high risk of developing CF-related diabetes (CFRD). Decrease in insulin secretion over time is the main hypothesis to explain this increasing prevalence but mechanisms are still not well elucidated. The objective is to assess evolution of glucose tolerance and insulin secretion/sensitivity in aging CF patients. Methods: This is a retro-prospective observational analysis in the older adult CF patients from the Montreal Cystic Fibrosis Cohort (n = 46; at least 35 years old at follow-up) and followed for at least 4 years. Baseline and followup (last visit to date) 2-h oral glucose tolerance test (OGTT with glucose and insulin measurements every 30 min) were performed. Pulmonary function test (FEV 1 ) and anthropometric data were measured the same day. Insulin sensitivity was measured by the Stumvoll index. Results: After a mean follow-up of 9.9 ± 2.6 years, mean age at follow-up was 43.5 ± 8.1 years old. An increase of body weight (+2.6 ± 6.5 kg, p = 0.01) and a decrease in pulmonary function (FEV 1 ; 73.4 ± 21.2% to 64.5 ± 22.4%, p ≤ 0.001) were observed. Overall, insulin secretion is maintained at follow-up but all OGTT glucose values increased (for all values, p ≤ 0.028). At follow-up, 28.3% of patients had a normal glucose tolerance while 71.7% had abnormal glucose tolerance (AGT). AGT patients decreased their insulin sensitivity over time (p = 0.029) while it remained the same in NGT patients (p = 0.917). Conclusion:In older CF patients, the progression of impaired glucose tolerance is occurring with stable insulin secretion but reduced insulin sensitivity.

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“…However, single data sets have a high variation and physiological differences, such as the fasting insulin level being the primary regulator of hepatic glucose production but not of muscle glucose production ( 17 ). For the AUC approach, disease or drug treatment may alter only a portion of the area or slope—for example, patients may experience delayed insulin secretion due to loss of first-phase insulin secretion while maintaining normal overall insulin production ( 17 , 18 ). As an easy method, the homeostatic model assessment (HOMA) has been widely used for clinical and epidemiological research ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Dipeptidyl-Peptidase-IV Inhibitors, Imigliptin and Alogliptin, Improve Beta-Cell Function in Type 2 Diabetes

Liu

et al. 2021

Front. Endocrinol.

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ObjectsImigliptin is a novel dipeptidyl peptidase-4 inhibitor. In the present study, we aimed to evaluate the effects of imigliptin and alogliptin on insulin resistance and beta-cell function in Chinese patients with type-2 diabetes mellitus (T2DM).MethodsA total of 37 Chinese T2DM patients were randomized to receive 25 mg imigliptin, 50 mg imigliptin, placebo, and 25 mg alogliptin (positive drug) for 13 days. Oral glucose tolerance tests were conducted at baseline and on day 13, followed by the oral minimal model (OMM).ResultsImigliptin or alogliptin treatment, compared with their baseline or placebo, was associated with higher beta-cell function parameters (φs and φtot) and lower glucose area under the curve (AUC) and postprandial glucose levels. The changes in the AUC for the glucose appearance rate between 0 and 120 min also showed a decrease in imigliptin or alogliptin groups. However, the insulin resistance parameter, fasting glucose, was not changed. For the homeostatic model assessment (HOMA-β and HOMA-IR) parameters or secretory units of islets in transplantation index (SUIT), no statistically significant changes were found both within treatments and between treatments.ConclusionsAfter 13 days of treatment, imigliptin and alogliptin could decrease glycemic levels by improving beta-cell function. By comparing OMM with HOMA or SUIT results, glucose stimulation might be more sensitive for detecting changes in beta-cell function.

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Insulin resistance, β-cell dysfunction and differences in curves of plasma glucose and insulin in the intermediate points of the standard glucose tolerance test in adults with cystic fibrosis

Cited by 12 publications

References 37 publications

Difference in Insulin Resistance Assessment between European Union and Non-European Union Obesity Treatment Centers (ESPE Obesity Working Group Insulin Resistance Project)

Difference in Insulin Resistance Assessment between European Union and Non-European Union Obesity Treatment Centers (ESPE Obesity Working Group Insulin Resistance Project)

The main mechanism associated with progression of glucose intolerance in older patients with cystic fibrosis is insulin resistance and not reduced insulin secretion capacity

Dipeptidyl-Peptidase-IV Inhibitors, Imigliptin and Alogliptin, Improve Beta-Cell Function in Type 2 Diabetes

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