Beta cell functionality and hepatic insulin resistance are major contributors to type 2 diabetes remission and starting pharmacological therapy: from CORDIOPREV randomized controlled trial
2021; Elsevier BV; Volume: 238; Linguagem: Inglês
10.1016/j.trsl.2021.07.001
ISSN1931-5244
AutoresIrene Roncero‐Ramos, Francisco M. Gutierrez‐Mariscal, Francisco Gómez-Delgado, Alejandro Villasanta‐Gonzalez, José D. Torres‐Peña, Silvia de la Cruz, Oriol Alberto Rangel-Zúñiga, Raúl M. Luque, José M. Ordovás, Javier Delgado‐Lista, Pablo Pérez‐Martínez, Antonio Camargo, Juan F. Alcalá‐Díaz, José López‐Miranda,
Tópico(s)Metabolism, Diabetes, and Cancer
ResumoIn order to assess whether previous hepatic IR (Hepatic-IRfasting) and beta-cell functionality could modulate type 2 diabetes remission and the need for starting glucose-lowering treatment, newly-diagnosed type 2 diabetes participants who had never received glucose-lowering treatment (190 out of 1002) from the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (a prospective, randomized and controlled clinical trial), were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was defined according to the American Diabetes Association recommendation for levels of HbA1c, fasting plasma glucose and 2h plasma glucose after oral glucose tolerance test, and having maintained them for at least 2 consecutive years. Patients were classified according to the median of Hepatic-IRfasting and beta-cell functionality, measured as the disposition index (DI) at baseline. Cox proportional hazards regression determined the potential for Hepatic-IRfasting and DI indexes as predictors of diabetes remission and the probability of starting pharmacological treatment after a 5-year follow-up. Low-Hepatic-IRfasting or high-DI patients had a higher probability of diabetes remission than high-Hepatic-IRfasting or low-DI subjects (HR:1.79; 95% CI 1.06–3.05; and HR:2.66; 95% CI 1.60–4.43, respectively) after a dietary intervention with no pharmacological treatment and no weight loss. The combination of low-Hepatic-IRfasting and high-DI presented the highest probability of remission (HR:4.63; 95% CI 2.00–10.70). Among patients maintaining diabetes, those with high- Hepatic-IRfasting and low-DI showed the highest risk of starting glucose-lowering therapy (HR:3.24;95% CI 1.50–7.02). Newly-diagnosed type 2 diabetes patients with better beta-cell functionality and lower Hepatic-IRfasting had a higher probability of type 2 diabetes remission in a dietary intervention without pharmacological treatment or weight loss, whereas among patients not achieving remission, those with worse beta-cell functionality and higher Hepatic-IRfasting index had the highest risk of starting glucose-lowering treatment after 5 years of follow-up. In order to assess whether previous hepatic IR (Hepatic-IRfasting) and beta-cell functionality could modulate type 2 diabetes remission and the need for starting glucose-lowering treatment, newly-diagnosed type 2 diabetes participants who had never received glucose-lowering treatment (190 out of 1002) from the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (a prospective, randomized and controlled clinical trial), were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was defined according to the American Diabetes Association recommendation for levels of HbA1c, fasting plasma glucose and 2h plasma glucose after oral glucose tolerance test, and having maintained them for at least 2 consecutive years. Patients were classified according to the median of Hepatic-IRfasting and beta-cell functionality, measured as the disposition index (DI) at baseline. Cox proportional hazards regression determined the potential for Hepatic-IRfasting and DI indexes as predictors of diabetes remission and the probability of starting pharmacological treatment after a 5-year follow-up. Low-Hepatic-IRfasting or high-DI patients had a higher probability of diabetes remission than high-Hepatic-IRfasting or low-DI subjects (HR:1.79; 95% CI 1.06–3.05; and HR:2.66; 95% CI 1.60–4.43, respectively) after a dietary intervention with no pharmacological treatment and no weight loss. The combination of low-Hepatic-IRfasting and high-DI presented the highest probability of remission (HR:4.63; 95% CI 2.00–10.70). Among patients maintaining diabetes, those with high- Hepatic-IRfasting and low-DI showed the highest risk of starting glucose-lowering therapy (HR:3.24;95% CI 1.50–7.02). Newly-diagnosed type 2 diabetes patients with better beta-cell functionality and lower Hepatic-IRfasting had a higher probability of type 2 diabetes remission in a dietary intervention without pharmacological treatment or weight loss, whereas among patients not achieving remission, those with worse beta-cell functionality and higher Hepatic-IRfasting index had the highest risk of starting glucose-lowering treatment after 5 years of follow-up. At A Glance CommentaryRoncero-Ramos, et al.BackgroundOur current knowledge regarding the etiology of type 2 diabetes points to hepatic insulin resistance and beta cell functionality as two 2 major abnormalities underlying the disease. Previous studies have associated type 2 diabetes remission with weight loss, together with a decrease in liver fat content and a higher beta cell recovery.Translational SignificancePatients with lower hepatic insulin resistance and better beta cell functionality had a higher probability of remission without significant weight loss or pharmacological treatment. These results suggest that clinicians could identify patients with specific phenotypes in early-diagnosed type 2 diabetes that could be the key to achieve higher remission rates without weight loss or pharmacological treatment. Roncero-Ramos, et al. Our current knowledge regarding the etiology of type 2 diabetes points to hepatic insulin resistance and beta cell functionality as two 2 major abnormalities underlying the disease. Previous studies have associated type 2 diabetes remission with weight loss, together with a decrease in liver fat content and a higher beta cell recovery. Patients with lower hepatic insulin resistance and better beta cell functionality had a higher probability of remission without significant weight loss or pharmacological treatment. These results suggest that clinicians could identify patients with specific phenotypes in early-diagnosed type 2 diabetes that could be the key to achieve higher remission rates without weight loss or pharmacological treatment.
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