Disposition Index, Glucose Effectiveness, and Conversion to Type 2 Diabetes

Lorenzo, Carlos; Wagenknecht, Lynne E.; Rewers, Marian; Karter, Andrew J.; Bergman, Richard N.; Hanley, Anthony J.; Haffner, Steven M.

doi:10.2337/dc10-0165

Cited by 130 publications

(131 citation statements)

References 25 publications

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“…Epidemiological studies suggest that a reduced DI may be a risk factor for the development of diabetes, in addition to family history, age, sex, ethnicity, and obesity (37). However, whether changes in the DI associated with SSA or PEG therapy affect the incidence of DM in acromegalic patients remains to be addressed.…”

Section: Discussionmentioning

confidence: 99%

Effects of medical therapies for acromegaly on glucose metabolism

Urbani

Sardella

Calevro

et al. 2013

European Journal of Endocrinology

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Objective: Abnormalities of glucose metabolism are common findings of acromegaly. However, robust evidence on whether therapy with somatostatin analogs (SSAs) or pegvisomant (PEG) differently affects glucose metabolism is lacking. The purpose of this study was to evaluate the effects of therapy with SSAs, PEG, or their combination on glucose metabolism in a large series of acromegalic patients. Design: This was a historical-prospective study. Among 50 consecutive acromegalic patients under SSA therapy, acromegaly in 19 patients was controlled. PEG used in combination with SSA therapy allowed the control of acromegaly in the remaining 31 patients and was then continued as monotherapy in 18 patients. Methods: The following parameters were evaluated at the diagnosis of acromegaly and during different treatments: fasting plasma glucose (FPG) and insulin concentrations, insulin sensitivity (QUICK-I), homeostasis model assessment of insulin resistance (HOMA2-IR), and plasma glucose and insulin concentrations during the oral glucose tolerance test (OGTT). Comparison was made using analysis for paired data. Results: Insulin resistance improved when acromegaly was controlled with therapy with SSAs, PEG, or SSACPEG. However, FPG concentrations were higher during SSA therapy (alone or combined with PEG) than at the diagnosis of acromegaly, even when corrected for disease activity, whereas they were reduced during PEG therapy. Mean glucose concentrations during the OGTT were higher in patients receiving SSA therapy than in those receiving PEG therapy. In addition, the prevalence of diabetes or impaired glucose tolerance was higher during SSA therapy than at diagnosis or during PEG therapy and was not influenced by disease control. Conclusions: Medical therapies for acromegaly reduce insulin resistance and increase insulin sensitivity; on the contrary, glucose indexes may be differently affected by SSA or PEG therapy.

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Section: Discussionmentioning

confidence: 99%

Effects of medical therapies for acromegaly on glucose metabolism

Urbani

Sardella

Calevro

et al. 2013

European Journal of Endocrinology

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“…Furthermore, in the PCOS group, a strong independent inverse correlation was specific genetic loci [11,12] and the most powerful predictor of diabetes risk [13]. Unfortunately, there is no "gold standard" method for the evaluation of this aspect, although DI with insulin secretion assessed by the acute insulin response to glucose (AIRg) after an iv glucose bolus and insulin sensitivity assessed by Hyperinsulinemic-euglycemic clamp [14] or frequently sampled iv glucose tolerance test [FSIGT] [13] have been shown to predict the future development of T2D. Therefore, detailed study of these aspects can only be made using sophisticated and/or expensive diagnostic methods.…”

Section: Introductionmentioning

confidence: 92%

Hyperinsulinism and polycystic ovary syndrome (PCOS): role of insulin clearance

Amato

Vesco

Vigneri

et al. 2015

J Endocrinol Invest

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only observed between MCRI and AUC 2h-insulin (PCOS: β:−0.878; p < 0.001; Prediabetes: β:−0.501; p = 0.019). Conclusions Our study suggests that in normoglycemic women with PCOS there is peripheral insulin sensitivity similar to that of women with prediabetes. What sets PCOS apart is the hyperinsulinism, today still simplistically defined "compensatory"; actually this is mainly related to decreased insulin clearance whose specific causes and dynamics have yet to be clarified.

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“…This finding is similar to other reports of improvements in fitness with exercise in post-bariatric surgery patients (20) and is clinically important, as cardiorespiratory fitness is inversely correlated with BMI (41) and improved cardiorespiratory fitness is associated with a reduced risk of allcause mortality (42). Therefore, not only is an aerobic exercise training program feasible in this population, it is also effective at glucose tolerance, diabetes, and aging (36). S G is not affected by calorie restriction (37) or vertical banded gastroplasty (38).…”

Section: Discussionmentioning

confidence: 99%

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Coen¹,

Tanner²,

Helbling³

et al. 2014

J. Clin. Invest.

124

199

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nondiabetic patients following RYGB surgery are typically quite modest compared with the presurgery condition (3). Moreover, there appear to be 2 discrete periods of improvement. The first is immediately after surgery, at which time hepatic, but not peripheral, S I improves in response to acute energy restriction (4-6), while greater, protracted weight loss appears to be more strongly associated with improved peripheral S I (7,8). Even with significant weight loss 1 year following RYBG surgery, peripheral S I is still low compared with that of lean metabolically healthy individuals (3,5,6,9).Exercise is considered a cornerstone for obesity treatment, and while it is not generally viewed to cause substantial body weight reduction (10), it can potently improve peripheral S I and glucose control (11-13) and can reduce the risk of T2D and cardiovascular disease (14,15). There is general consensus that even a single session of moderate intensity exercise can induce an improvement in S I (16). There is also evidence that exercise can BACKGROUND. Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (S I ) in obese patients. Regular exercise can also improve S I in obese individuals; however, it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S I and other cardiometabolic factors. METHODS.We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1-3 months). Participants were randomized to either a 6-month semi-supervised moderate exercise protocol (EX, n = 66) or a health education control (CON; n = 62) intervention. Main outcomes measured included S I and glucose effectiveness (S G ), which were determined from an intravenous glucose tolerance test and minimal modeling. Secondary outcomes measured were cardiorespiratory fitness (VO 2 peak) and body composition. Data were analyzed using an intention-to-treat (ITT) and per-protocol (PP) approach to assess the efficacy of the exercise intervention (>120 min of exercise/week).RESULTS. 119 (93%) participants completed the interventions, 95% for CON and 91% for EX. There was a significant decrease in body weight and fat mass for both groups (P < 0.001 for time effect). S I improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min -1 /μU/ml, P = 0.18 for Δ, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive S I improvement (PP: CON vs. EX; +1.57 vs. +2.69 min

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Disposition Index, Glucose Effectiveness, and Conversion to Type 2 Diabetes

Cited by 130 publications

References 25 publications

Effects of medical therapies for acromegaly on glucose metabolism

Effects of medical therapies for acromegaly on glucose metabolism

Hyperinsulinism and polycystic ovary syndrome (PCOS): role of insulin clearance

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

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