Glucose metabolism and production of incretins in patients with obesity and type 2 diabetes mellitus after Biliopancreatic bypass surgery in the modification of Hess-Marceau the early stages of postoperative monitoring

Introduction: a significant improvement was shown in metabolic control at the early stages after BPD, which was associated with GLP-1 and was regardless of weight loss.Aim: to study the secretion of GLP-1, GIP, insulin and glucagon and their relationship to the parameters of the carbohydrate metabolism among patients with obesity and type 2 diabetes before and 3 months after BPD.Materials and Methods: the check-up involved 22 patients with obesity (BMI 50.1 [41.3; 53.8] kg/m²) and type 2 diabetes. Determined: glucose, HbA1c, insulin, glucagon, GLP-1, GIP.Results: after the surgery for weight loss of 15.8% was showed a reduction of fasting and postprandial glycemia, a reduction of AUCglucose, HbA1c, НОМА-IR and hyperinsulinemia. The secretion of GLP-1 with a peak at 30' (test with a standard breakfast) increased, AUCGLP-1 – to 1.8-fold, the basal secretion of GIP – almost 2-fold and AUCGIP – to 1.7-fold; decreased of a secretion of glucagon with a minimum at 60' and AUCglucagon. A negative correlation was revealed between GIP and glucagon, AUCglucose and AUCglucagon; a positive correlation was revealed between GLP-1 and insulin. The weight loss was accompanied by an inversely proportional increase of GLP-1.Conclusion: More than 90% of the surveyed patients achieved a satisfactory glycemic control as early as 3 months after BPD. The significant improvement of the parameters of the carbohydrate metabolism was associated with elevated levels of GLP-1 and this improvement does not depend of weight loss.

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Predictors of effectiveness of glucagon-like peptide-1 receptor agonist therapy in patients with type 2 diabetes and obesity

Obesity and metabolism ◽

10.14341/omet9584 ◽

2019 ◽

Vol 15 (4) ◽

pp. 22-30 ◽

Cited By ~ 1

Author(s):

Ekaterina V. Tikhonenko ◽

Alina Y. Babenko ◽

Evgeny V. Shlyakhto

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Weight Loss ◽

Visceral Obesity ◽

Metabolic Parameters ◽

Response Predictors ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Standard Breakfast

Background: Type 2 diabetes mellitus (DM2), which mainly develops from visceral obesity, is a socially significant disease. Reduction of losses from DM2 is a priority in modern medicine development. Glucagon-like peptide-1 receptor agonists (aGLP-1) present one of few groups of antidiabetic drugs that allows to reduce not only glycemia, but also weight in DM2. Taking into account predictors of response to the therapy will allow to reach trearment targets with the highest probability, maintaining a safety of treatment, to optimize recommendations for administration of aGPP-1 as much as possible. Aims: To assess dynamics of metabolic parameters, to identify predictors of reduction in blood glucose, body weight and other metabolic parameters on aGLP-1 therapy in patients with DM2 with body mass index (BMI) 35 kg/m2. Materials and methods: The study involved 33 patients (10 men, 23 women), who had been treated with aGLP-1, the observation period for 24 weeks was planned. 3 patients terminated the participation before the appointed time (1 due to pancreatitis development 2 due to the lack of financial opportunity to purchase the drug). So, 30 patients (10 men, 20 women) were included in the final analysis. Examination consisted of the survey, physical examination with measurement of anthropometric, clinical parameters, filling questionnaires. Data were evaluated at baseline and after 24 weeks of treatment. Results: The study found that patients who achieved weight loss 5% initially had higher BMI (p = 0.028), lower GLP-1 (p = 0.036), had lower level of ghrelin after standard breakfast test (p = 0.022). There was trend (p = 0.071) to greater decrease in BMI in patients with restrictive type of eating behavior compared to patients who had a mixed type. More pronounced decrease in glycemia was noted in patients who had higher fasting plasma glucose level at inclusion (p = 0.001). Dynamics of HbA1c was better in patients with initially higher GLP-1 (p = 0.016) and higher levels of glycemia (p = 0.001). Also, we revealed the statistically significant decrease in triglycerides level, blood pressure by end of the treatment period. Conclusions: Results indicate the different predictors for reduction in weight, glycemia and blood pressure on aGLP-1 therapy. In addition to the metabolic parameters, level of orexigenic and anorexigenic hormones and psycho-social characteristics of patients help to estimate an expected effect of aGLP-1 therapy. When being identifying, the predictors of weight loss and the predictors of carbohydrate metabolism compensation should be studied separately. Identification of response predictors is necessary to optimize indications for this group of drugs administration in DM2.

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SUN-696 Effect of Night Shifts on Glycemic Variability in Patients with Type 2 Diabetes

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1442 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Mayya Akakievna Garieva

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Carbohydrate Metabolism ◽

Work Experience ◽

High Variability ◽

Postprandial Glycemia ◽

Fasting Glycemia ◽

Night Shifts

Abstract The analysis of indicators of carbohydrate metabolism and variability of glycemia in patients with type 2 diabetes mellitus working in night shifts was carried out. As model patients with impaired circadian rhythm, the study included 34 patients, railway transport drivers, with shift mode and the presence of night shifts, with work experience of more than 5 years, the duration of type 2 diabetes mellitus (DM2) from 1 to 7 years, who are on oral therapy with hypoglycemic drugs. Simulation of different working conditions (day-night) was carried out in the simulator “driver’s cabin”. All patients underwent a study of the main indicators of carbohydrate metabolism (fasting glycemia, postprandial glycemia, glycated hemoglobin (HbA1c)), as well as continuous daily glucose monitoring (CGMS) using Medtronic MiniMed iPro2 system (from 3 to 7 days). Target glycemic levels were not achieved: fasting glycemia was 6.98±1.41 mmol/l; postprandial glycemia was 9.57±1.65 mmol/l; HbA1c was 7.23±1.62%. The analysis of CGMS revealed high variability of glycemic index MAGE-4.88±0.59 mmol/l. also calculated indicators SD - 1.52±0.63 mmol/l; Conga - 3.17±0.54 mmol/l; MODD - 2.27±0.12 mmol/l. The period of hyperglycemia (glucose value above 7.8 mmol/l) according to the results of CGMS was 43.5% (min 19-max 56). The duration of hypoglycemic States in patients without night shifts was 2.4% within 24 hours (min 0-max 6.6). Correlation analysis between carbohydrate metabolism and glucose variability revealed a significant strong relationship between the level of postprandial glycemia and modd (r=0.87, P=0.001) and MAGE (r=0.82, P=0.01), and also established a mean significant correlation between the level of postprandial glucose and Conga (r=0.52, P=0.01) and SD (r=0.61, P=0.05). Fasting glycemia and congas were moderately correlated (r=0.4, P=0.01). Weak reliable correlation was found only between HbA1c level and Conga variability index (r=0.27, P=0.04). Conclusions: the results of the study indicate the lack of adequate glycemic control in persons working night shifts, high variability of glycemia, which is an independent risk factor for cardiovascular disease in patients with DM2. The associative relationship of fasting glycemia and postprandial with the indicator of variability Conga shows that glucose fluctuations during the day in patients are constant.

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Predictors of effectiveness of glucagon-like peptide-1 receptor agonist therapy in patients with type 2 diabetes and obesity.

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2018-96-8-746-753 ◽

2018 ◽

Vol 96 (8) ◽

pp. 746-753

Author(s):

E. V. Tikhonenko ◽

A. G. Arkhipova ◽

A. Y. Babenko ◽

E. V. Shlyakhto

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Weight Loss ◽

Visceral Obesity ◽

Response To Therapy ◽

Metabolic Parameters ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Standard Breakfast

Diabetes type 2 (CD2), which develops mainly against visceral obesity, is socially significant disease, reduction of losses from which is priority in development of modern medicine. Glucagon-like peptide-1 receptor agonists (aGPP-1) is one of few groups of antidiabetic drugs that allows to reduce not only glycemia, but also weight with CD2. Taking into account predictors of response to therapy will allow highest probability to reach targets while maintaining safety of treatment, optimize recommendations for appointment of aGPP-1 as much as possible. Aims: to assess dynamics of metabolic parameters, to determine predictors of reduction in blood glucose, body weight and other metabolic parameters in AGPP-1 therapy in patients with type 2 diabetes with body mass index (BMI) >35 kg/m. Material and methods. Study involved 33 patients (10 men, 23 women) who had been treated with aGPP-1, planned period of observation for 24 weeks. Early termination ofparticipation of 3 patients (1 - due to development ofpancreatitis, 2 - due to lack of financial opportunity to purchase the drug). Accordingly, 30 patients (10 men, 20 women) were included in final analysis. Examination consisted of survey, physical examination with measurement of anthropometric, clinical parameters, filling questionnaires. Data were evaluated initially and after 24 weeks of treatment. Results. Study found that patients who achieved weight loss > 5% initially had higher BMI (p = 0.028), lower GLP-1 (p = 0.036), had lower level of ghrelin after sample with standard breakfast (p = 0.022). There was trend (p = 0.071) to greater decrease in BMI in patients with restrictive type of eating behavior compared to patients who had mixed type. More pronounced decrease in glycemia was noted in patients who had higher fasting plasma glucose level at inclusion (p = 0.001). Dynamics of HbA1C was better in patients with initially higher GLP-1 (p = 0.016) and higher levels of glycemia (p = 0.001). Also, in examined patients, there was statistically significant decrease in level of triglycerides, blood pressure by end of treatment period. Conclusions. Results indicate that there are different predictors for weight loss, glycemia and blood pressure in aGPP-1 therapy. In addition to metabolic parameters, level of orexigenic and anorexigenic hormones and psycho-social characteristics ofpatients help to estimate expected effect of therapy for ARP1. When predictors are identified, predictors of weight loss and carbohydrate metabolism compensation should be studied separately. Identification of response predictors is necessary to optimize indications for prescribing this group of drugs with CD2.

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Abstract #806359: SGLT 2 Inhibitors; Glycemic Control, Weight Loss and Safety Profile in Patients with Type 2 Diabetes, at Medicell Institute: a Private Care Facility

Endocrine Practice ◽

10.1016/s1530-891x(20)39691-9 ◽

2020 ◽

Vol 26 ◽

pp. 126

Author(s):

Erum Sohail

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Glycemic Control ◽

Safety Profile ◽

Care Facility ◽

Private Care

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How to Maintain a Healthy Body Weight

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.76.4.208 ◽

2006 ◽

Vol 76 (4) ◽

pp. 208-215 ◽

Cited By ~ 10

Author(s):

Astrup

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Body Weight ◽

Glycemic Index ◽

Dairy Products ◽

Weight Control ◽

Healthy Body Weight ◽

Healthy Body

The epidemic of both obesity and type 2 diabetes is due to environmental factors, but the individuals developing the conditions possess a strong genetic predisposition. Observational surveys and intervention studies have shown that excess body fatness is the major environmental cause of type 2 diabetes, and that even a minor weight loss can prevent its development in high-risk subjects. Maintenance of a healthy body weight in susceptible individuals requires 45–60 minutes physical activity daily, a fat-reduced diet with plenty of fruit, vegetables, whole grain, and lean meat and dairy products, and moderate consumption of calorie containing beverages. The use of table values to predict the glycemic index of meals is of little – if any – value, and the role of a low-glycemic index diet for body weight control is controversial. The replacement of starchy carbohydrates with protein from lean meat and lean dairy products enhances satiety, and facilitate weight control. It is possible that dairy calcium also promotes weight loss, although the mechanism of action remains unclear. A weight loss of 5–10% can be induced in almost all obese patients providing treatment is offered by a professional team consisting of a physician and dieticians or nurses trained to focus on weight loss and maintenance. Whereas increasing daily physical activity and regular exercise does not significantly effect the rate of weight loss in the induction phase, it plays an important role in the weight maintenance phase due to an impact on daily energy expenditure and also to a direct enhancement of insulin sensitivity.

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