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Horm Metab Res 2016; 48(01): 42-47
DOI: 10.1055/s-0035-1554688
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Body Composition and Epicardial Fat in Type 2 Diabetes Patients Following Insulin Detemir Versus Insulin Glargine Initiation

B. Elisha   *
1   Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
2   Institut de Recherches Cliniques de Montréal (IRCM), Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
,
M. Azar   *
2   Institut de Recherches Cliniques de Montréal (IRCM), Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
3   Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
,
N. Taleb
2   Institut de Recherches Cliniques de Montréal (IRCM), Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
3   Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
,
S. Bernard
2   Institut de Recherches Cliniques de Montréal (IRCM), Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
3   Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
4   Endrocrinology Division, Centre Hospitalier Universitaire de l’université de Montréal (CHUM Hotel-Dieu), Montreal, Quebec, Canada
,
G. Iacobellis
5   Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
,
R. Rabasa-Lhoret
1   Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
2   Institut de Recherches Cliniques de Montréal (IRCM), Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
3   Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
4   Endrocrinology Division, Centre Hospitalier Universitaire de l’université de Montréal (CHUM Hotel-Dieu), Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

received 30 October 2014

accepted 20 May 2015

Publication Date:
04 September 2015 (online)

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Abstract

The aim of the study was to compare body composition and epicardial fat thickness changes in insulin-naïve inadequately controlled patients with type 2 diabetes following basal insulin initiation with detemir vs. glargine. Six-month, open-label, interventional randomized pilot study was conducted. Dual-energy X-ray absorptiometry and echocardiography were used to estimate the body composition and epicardial fat thickness respectively. Thirty-six patients in the detemir group and 20 in the glargine group completed the study. Study groups baseline characteristics were comparable. At 6 months, for similar glycemic control, those on detemir significantly gained less total weight (0.6±2.5 vs. 4.2±4.1 kg, p=0.004), total fat mass (0.9±2.2 vs. 2.9±2.4 kg, p=0.02), and truncal fat mass (0.8±1.5 vs. 2.1±1.7 kg, p=0.02), with a loss in truncal lean mass (− 0.8±1.9 kg vs. 0.3±1.7 kg; p=0.02). EFT significantly decreased from baseline in both group (detemir − 1.7±0.52−mm, glargine − 1.1±1.6−mm; p<0.05, without significant difference inter-groups). Within the detemir group, epicardial fat thickness change correlated with truncal fat and total fat mass changes (r=0.65, p=0.06 and r=0.60, p=0.07). In conclusion, detemir resulted in less fat mass gain, a trend for a more pronounced epicardial fat thickness reduction when compared with glargine.

Key words

insulin analogues - total body weight - truncal fat mass

* Equal 1st co-authorship


Supporting Information

 

  • References

  • 1 Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus – present and future perspectives. Nat Rev Endocrinol 2012; 8: 228-236
    PubMedGoogle Scholar
  • 2 Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87: 4-14
    CrossrefPubMedGoogle Scholar
  • 3 Imran SA, Rabasa-Lhoret R, Ross S. Targets for glycemic control. Can J diabetes 2013; 37 (Suppl. 01) S31-S34
    PubMedGoogle Scholar
  • 4 Harper W, Clement M, Goldenberg R, Hanna A, Main A, Retnakaran R, Sherifali D, Woo V, Yale JF. Pharmacologic management of type 2 diabetes. Can J diabetes 2013; 37 (Suppl. 01) S61-S68
    PubMedGoogle Scholar
  • 5 Roman G, Hancu N. Early insulin treatment to prevent cardiovascular disease in prediabetes and overt diabetes. Horm Metab Res 2009; 41: 116-122
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 ORIGIN Trial Investigators . Gerstein HC, Bosch J, Dagenais GR, Díaz R, Jung H, Maggioni AP, Pogue J, Probstfield J, Ramachandran A, Riddle MC, Rydén LE, Yusuf S. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012; 367: 319-328
    CrossrefPubMedGoogle Scholar
  • 7 Holman RR, Farmer AJ, Davies MJ, Levy JC, Darbyshire JL, Keenan JF, Paul SK. 4-T Study Group . Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med 2009; 361: 1736-1747
    CrossrefPubMedGoogle Scholar
  • 8 Massi Benedetti M, Humburg E, Dressler A, Ziemen M. A one-year, randomised, multicentre trial comparing insulin glargine with NPH insulin in combination with oral agents in patients with type 2 diabetes. Horm Metab Res 2003; 35: 189-196
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Philis-Tsimikas A, Charpentier G, Clauson P, Ravn G, Roberts V, Thorsteinsson B. Comparison of once-daily insulin detemir with NPH insulin added to a regimen of oral antidiabetic drugs in poorly controlled type 2 diabetes. Clin Ther 2006; 28: 1569-1581
    CrossrefPubMedGoogle Scholar
  • 10 Rosak C, Jung R, Hofmann U. Insulin glargine maintains equivalent glycemic control andbetter lipometabolic control than NPH insulin in type 1 diabetes patients who missed a meal. Horm Metab Res 2008; 40: 544-548
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Yki-Järvinen H. Combination therapies with insulin in type 2 diabetes. Diabetes Care 2001; 24: 758-767
    CrossrefPubMedGoogle Scholar
  • 12 Swinnen S, Simon A, Holleman F, Hoekstra J, Devries J. Insulin detemir versus insulin glargine for type 2 diabetes mellitus. Cochrane Database Syst Rev 2011; CD006383
    PubMedGoogle Scholar
  • 13 Rosenstock J, Davies M, Home P, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008; 51: 408-416
    CrossrefPubMedGoogle Scholar
  • 14 Hollander P, Cooper J, Bregnhøj J, Pedersen C. A 52-week, multinational, open-label, parallel-group, noninferiority, treat-to-target trial comparing insulin detemir with insulin glargine in a basal-bolus regimen with mealtime insulin aspart in patients with type 2 diabetes. Clin Ther 2008; 30: 1976-1987
    CrossrefPubMedGoogle Scholar
  • 15 Després J, Lemieux I. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 2008; 28: 1039-1049
    CrossrefPubMedGoogle Scholar
  • 16 Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes–causes, effects and coping strategies. Diabetes Obes Metab 2007; 9: 799-812
    CrossrefPubMedGoogle Scholar
  • 17 Gaborit B, Abdesselam I, Dutour A. Epicardial fat: more than just an “epi” phenomenon?. Horm Metab Res 2013; 45: 991-1001
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Iacobellis G, Singh N, Wharton S, Sharma A. Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity 2008; 16: 1693-1697
    CrossrefPubMedGoogle Scholar
  • 19 Iacobellis G, Bianco A. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011; 22: 450-457
    CrossrefPubMedGoogle Scholar
  • 20 Malavazos AE, Di Leo G, Secchi F, Lupo EN, Dogliotti G, Coman C, Morricone L, Corsi MM, Sardanelli F, Iacobellis G. Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol 2010; 105: 1831-1835
    CrossrefPubMedGoogle Scholar
  • 21 Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, Leonetti F. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304-310
    CrossrefPubMedGoogle Scholar
  • 22 Brochu M, Mathieu ME, Karelis AD, Doucet E, Lavoie ME, Garrel D, Rabasa-Lhoret R. Contribution of the lean body mass to insulin resistance in postmenopausal women with visceral obesity: a Monet study. Obesity (Silver Spring) 2008; 16: 1085-1093
    CrossrefPubMedGoogle Scholar
  • 23 Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011; 34: e61-e99
    CrossrefPubMedGoogle Scholar
  • 24 Iacobellis G. Echocardiographic epicardial fat: a new tool in the white coat pocket. Nutr Metab Cardiovasc Dis 2008; 18: 519-522
    CrossrefPubMedGoogle Scholar
  • 25 Iacobellis G, Barbaro G, Gerstein HC. Relationship of epicardial fat thickness and fasting glucose. Int J Cardiol 2008; 128: 424-426
    CrossrefPubMedGoogle Scholar
  • 26 Fritsche A, Häring H. At last, a weight neutral insulin?. Int J Obes Relat Metab Disord 2004; 28 (Suppl. 02) S41-S46
    PubMedGoogle Scholar
  • 27 Rojas JM, Printz RL, Niswender KD. Insulin detemir attenuates food intake, body weight gain and fat mass gain in diet-induced obese Sprague-Dawley rats. Nutr Diabetes 2011; 1: e10
    CrossrefPubMedGoogle Scholar
  • 28 Havelund S, Plum A, Ribel U, Jonassen I, Vølund A, Markussen J, Kurtzhals P. The mechanism of protraction of insulin detemir, a long-acting, acylated analog of human insulin. Pharm Res 2004; 21: 1498-1504
    CrossrefPubMedGoogle Scholar
  • 29 Zafar MI, Hu C, Liu D, Shafqat RA, Gao F. Insulin detemir causes lesser weight gain in comparison to insulin glargine: role on hypothalamic NPY and galanin. J Diabetes Res 2014; 458104
    PubMedGoogle Scholar
  • 30 Wang J, Leibowitz KL. Central insulin inhibits hypothalamic galanin and neuropeptide Y gene expression and peptide release in intact rats. Brain Res 1997; 777: 231-236
    CrossrefPubMedGoogle Scholar
  • 31 Mahabadi A, Berg MH, Lehmann N, K€alsch H, Bauer M, Kara K, Dragano N, Moebus S, Jockel K-H, Erbel R, Möhlenkamp S. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population. J Am Coll Cardiol 2013; 61: 1388-1395
    CrossrefPubMedGoogle Scholar
  • 32 Mazurek T, Opolski G. Pericoronary Adipose Tissue: A Novel Therapeutic Target in Obesity-Related Coronary Atherosclerosis. J Am Coll Nutr 2015; 1-11
    PubMedGoogle Scholar
  • 33 Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol 2015; 11: 363-371
    CrossrefPubMedGoogle Scholar
  • 34 Son JW, Jeong HK, Lee SS, Kim SR, Cha BY, Son HY, Yoo SJ. The Effect of Early Intensive Insulin Therapy on Body Fat Distribution and b-Cell Function in Newly Diagnosed Type 2 Diabetes. Endocr Res 2013; 38: 160-167
    CrossrefPubMedGoogle Scholar
  • 35 Takei I, Takayama S, Yamauchi A, Nakamoto S, Kitamura Y, Katsukawa F, Yamazaki H, Saruta T, Inoue S. Effect of insulin therapy on body fat distribution in NIDDM patients with secondary sulfonylurea failure: a preliminary report. Eur J Clin Nutr 1998; 52: 153-154
    CrossrefPubMedGoogle Scholar
  • 36 Preis SR, Massaro JM, Robins SJ, Hoffmann U, Vasan RS, Irlbeck T, Meigs JB, Sutherland P, D’Agostino Sr RB, O’Donnell CJ, Fox CS. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham Heart Study. Obesity (Silver Spring) 2010; 18: 2191-2198
    CrossrefPubMedGoogle Scholar
  • 37 Kelley DE, Thaete FL, Troost F, Huwe T, Goodpaster BH. Subdivisions of subcutaneous abdominal adipose tissue and insulin resistance. Am J Physiol Endocrinol Metab 2000; 278: E941-E948
    PubMedGoogle Scholar
  • 38 Lebovitz HE, Banerji MA. Point: Visceral adiposity is causally related to insulin resistance. Diabetes Care 2005; 28: 2322-2325
    CrossrefPubMedGoogle Scholar
  • 39 Glickman SG, Marn CS, Supiano MA, Dengel DR. Validity and reliability of dual-energy X-ray absorptiometry for the assessment of abdominal adiposity. J Appl Physiol (1985) 2004; 97: 509-514
    CrossrefPubMedGoogle Scholar
  • 40 Snijder MB, Visser M, Dekker JM, Seidell JC, Fuerst T, Tylavsky F, Cauley J, Lang T, Nevitt M, Harris TB. The prediction of visceral fat by dual-energy X-ray absorptiometry in the elderly a comparison with computed tomography and anthropometry. Int J Obes Relat Metab Disord 2002; 26: 984-993
    CrossrefPubMedGoogle Scholar
  • 41 Park YW, Heymsfield SB, Gallagher D. Are dual-energy X-ray absorptiometry regional estimates associated with visceral adipose tissue mass?. Int J Obes Relat Metab Disord 2002; 26: 978-983
    CrossrefPubMedGoogle Scholar