Effect of Insulin Therapy on Plasma Leptin and Body Weight in Patients with Type 2 Diabetes

Objective:Insulin therapy is associated with weight gain in patients with type 2 diabetes mellitus (T2DM). Several peptides are implicated in appetite control. We evaluated the effects of insulin-induced improved glycaemic control on leptin, adiponectin, ghrelin, neuropeptide Y (NPY) levels and patient characteristics. Method:Consecutive T2DM patients (n = 90) were divided into 2 groups: Group A: 45 insulin-naïve uncontrolled (glycosylated haemoglobin A1c; HbA1c >7%) patients on oral hypoglycaemic agents (OHAs) who converted to insulin monotherapy. Group B: 45 well-controlled (HbA1c <7%) patients on OHAs. Both groups were monitored at baseline, 3 and 6 months. Males and females were analyzed separately because some hormone levels differ between genders. Results:In both genders, insulin therapy (Group A) was associated with significant (p = 0.003 to <0.001) increases in weight, body mass index and leptin levels and significant decreases in glucose, HbA1c and NPY levels. In male insulin-treated patients a significant increase in adiponectin levels (p = 0.008) was observed. There were significant correlations (p = 0.016 to <0.001) between leptin levels, waist circumference and body fat in all patient groups, except group B males. Conclusion:Changes in leptin, adiponectin and NPY levels may occur after insulin-induced improved glycaemic control. These changes may be influenced by gender, weight, body fat and HbA1c.

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“…These insulin-associated changes have been reported [29-32], although without considering genders separately. …”

Section: Discussionsupporting

confidence: 52%

“…The sustained rise in body weight despite the significant simultaneous increase in leptin levels may be explained by leptin resistance in diabetic patients [32]. …”

Section: Discussionmentioning

confidence: 99%

Effects of Improving Glycemic Control with Insulin on Leptin, Adiponectin, Ghrelin and Neuropeptidey Levels in Patients with Type 2 Diabetes Mellitus: a Pilot Study

Katsiki

Mikhailidis²,

Gotzamani-Psarrakou³

et al. 2011

TOCMJ

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“…Evidence of coherence arises in part from the interventional studies supporting plausibility, experimental, and analogy criteria (see preceding sections). Further evidence comes from the association of one disease with another, each of which is linked to higher blood glucose and insulin concentrations; thus, excess body weight 72 and CHD, diabetes, and certain cancers 73, 74. Meta-analysis has revealed that lower GL diets, achieved using lower GI carbohydrate foods, result in a dose-dependent reduction in body weight among persons with varied glycemic control from normal to the diabetic state 59 .…”

Section: Discussionmentioning

confidence: 99%

“…Beneficial effects of low GI and GL have become evident in long-term primary prevention of obesity-associated diseases 75 . In longitudinal trials, lower GI and GL due to ingestion of α-glucosidase inhibitors lowers not only the risk of CHD 72 but also the risk of diabetes76, 77, 78 and colorectal cancer 79 . Likewise, lower GI and GL diets also prospectively associate with a lower risk for type 2 diabetes,28, 29, 80, 81, 82 a disease that increases the risk of subsequent CHD83, 84, 85 and subsequent diagnosis of colon cancer 58 …”

Section: Discussionmentioning

confidence: 99%

Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Livesey

2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo clarify the role of dietary carbohydrate, glycemic index (GI), and glycemic load (GL) in progression from health to coronary heart disease (CHD) by determining disease-nutrient risk relation (RR) values needed for intake ranges within jurisdictions and across the globe.MethodsWe performed a literature search of MEDLINE and EMBASE for prospective cohort studies that used truly valid dietary instruments in heathy adults published from January 1, 2000, to June 5, 2018. Relevant observations were extracted by 2 reviewers independently. We used dose-response meta-analysis accounting for nonindependence of results within studies. Bradford-Hill criteria were used to assess causality.ResultsEligible studies had a mean follow-up of 11 years (range, 5-19 years), were conducted in North America, Europe, and East Asia, and yielded combined RRs of 1.44 (95% CI, 1.25-1.65) per 65 g/d GL (11 studies) and 1.24 (95% CI, 1.12-1.38) per 10 U GI (10 studies) (glucose scale). The CHD-carbohydrate RR on GI was 1.66 (95% CI, 1.23-2.25) per 98 g/d of carbohydrates per 10 units GI. The 65 g/d GL, 10 U GI, and 98 g/d carbohydrate values corresponded to oral intakes from the 10th to the 90th percentiles within sampled populations. Inconsistencies were minor (I2≤20%), as were small-study effects (P=.61 for GL and P=.26 for GI). Funnel plots were symmetric. Cubic spline dose-response meta-analysis yielded RRs as follows: across the global range for GL (55-290 g/d), 5.5 (95% CI, 3.1-9.8) (I2=0); for GI (47-82 U), 2.71 (95% CI, 1.47-4.40) (I2=0); and for the CHD-carbohydrate dependence on GI (50-80 U), 4.57 (95% CI, 1.86-11.4) (I2=16%). Bradford-Hill criteria indicated that these relations were probably causal.ConclusionStrong and probably causal CHD-GL and GI RRs exist within populations. The RRs were remarkably higher across global exposures. The results support the consideration of these markers of carbohydrate food quality in dietary guidelines for general populations.Trial RegistrationPROSPERO Identifier: CRD42013004504

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“…In Caucasian patients with type 2 diabetes who were also overweight and middle-aged, leptin levels were significantly associated with insulin secretion and insulin resistance (16), and with insulin secretion in patients undergoing oral drug therapy (38). Increased leptin levels following insulin treatment in rodents (39) and in diabetic patients (40) suggest the insulin deficiency as the cause of altered leptin levels in diabetes. Similar to our data, leptin levels in lean diabetic women from Bangladesh were reported to be related to fasting insulin in diabetic women (41).…”

Section: Discussionmentioning

confidence: 99%

Serum Leptin Level is Reduced in Non-Obese Subjects with Type 2 Diabetes

Mohammadzadeh

Zarghami

2012

Int J Endocrinol Metab

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BackgroundLeptin, a protein released from adipose tissue, could have significant role in pathogenesis of obesity and type 2 diabetes mellitus.ObjectivesThis study aimed to evaluate variations in serum leptin levels in non-obese subjects with type 2 diabetes mellitus (T2DM).Patients and MethodsWe studied forty-one patients with type 2 diabetes. Fasting lipid profile, Hemoglobin A1c (HbA1c), serum leptin, insulin, and glucose levels were measured by standard methods.ResultsThe serum leptin level in type 2 diabetic patients (19.32 ± 11.43 ng/mL) was significantly lower than that in non-diabetic subjects (32.16 ± 11.02 ng/mL). Serum leptin level was strongly and positively correlated with body mass index (BMI) (r = 0.658, P < 0.0001) and calculated body fat percentage (r = 0.431, P < 0.0001) in all the study subjects with a better corrlation in the control subjcts compared to control cases (r = 0.661 for BMI and r = 0.466 for body fat). On the other hand, leptin showed a positive and significant correlation with insulin and HOMA- β (homeostasis model assessment for β-cell function) in both groups. Furthermore, leptin related to homeostasis model assessment for insulin resistance (HOMA-IR) (r = 0.422, P = 0.006) was observed only in T2DM subjects. Leptin showed negative correlation with waist to hip ratio in diabetic (r = -0.407, P =0.008) and non-diabetic subjects (r = -0.318, P =0.049). In the regression model, BMI, HOMA-β, and gender were independent predictors of leptin in all subjects. However, in non-diabetic and diabetic subjects, β-cell function and insulin were independent predictors, respectively (P =0.01).ConclusionsIt is speculated that lower serum leptin levels in diabetic patients may be a consequence of male gender. Moreover, results suggest that serum leptin level in women is influenced differently than that in men.

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Effect of Insulin Therapy on Plasma Leptin and Body Weight in Patients with Type 2 Diabetes

Cited by 11 publications

References 19 publications

Effects of Improving Glycemic Control with Insulin on Leptin, Adiponectin, Ghrelin and Neuropeptidey Levels in Patients with Type 2 Diabetes Mellitus: a Pilot Study

Effects of Improving Glycemic Control with Insulin on Leptin, Adiponectin, Ghrelin and Neuropeptidey Levels in Patients with Type 2 Diabetes Mellitus: a Pilot Study

Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Serum Leptin Level is Reduced in Non-Obese Subjects with Type 2 Diabetes

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