Body composition in adults with newly diagnosed type 2 diabetes: effects of metformin

Journal of Diabetes & Metabolic Disorders

Mohammad Ebrahim Khamseh¹  Laily Najafi¹  Zahra Banazadeh²  Ameneh Ebrahim Valojerdi¹  Mojtaba Malek¹  Rokhsareh Aghili¹ 

[1] Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Firouzgar alley, Valadi St., Behafarin St., Karimkhan Ave., Vali-asr Sq., Tehran, Iran;Lolagar hospital, Iran University of Medical Sciences, Tehran, Iran

关键词: Dual Energy X-ray Absorptiometry;    Sarcopenia;    Insulin Resistance;    Insulin Sensitivity;    Type 2;    Diabetes Mellitus;   

Others  :  1136142
DOI  :  10.1186/s40200-014-0088-z

 received in 2014-03-16, accepted in 2014-08-11,  发布年份 2014

【 摘 要 】

Background

The aim of this study was to measure the body composition in adults with newly diagnosed type 2 diabetes mellitus and to explore the effect of metformin therapy on the various components of body composition, insulin sensitivity, and glucose homeostasis.

Methods

This was an observational study consisted of 51 newly diagnosed people with type 2 diabetes on 1000 mg metformin twice daily for 6 months. The body composition of each subject was measured by dual energy X-ray absorptiometry at enrollment and 24 weeks after metformin mono-therapy. Sarcopenia was defined and compared based on the ratio of appendicular skeletal muscle and height squared, skeletal muscle index and residual methods.

Homeostasis model assessment-insulin resistance and Quantitative Insulin Sensitivity Check Index were used for estimating insulin sensitivity. The level of physical activity was assessed using self-administered International physical Activity questionnaire.

Results

Forty one subjects (80.4%) completed the study. The mean age of the participants was 52.67 ± 10.43 years. Metformin treatment was associated with a significant decrease in total fat mass (−1.6 kg, P = 0.000). By week 24, the lean to fat ratio increased (P = 0.04) with men showing greater significant changes. Twenty percent of the female participants were detected to have sarcopenia.

In addition, there was a significant improvement of glucose homeostasis and insulin sensitivity.

Conclusions

Metformin therapy results in significant improvement in body composition and insulin sensitivity of adults with newly diagnosed type 2 diabetes. Furthermore, sarcopenia begins in women with diabetes much earlier than expected as an age related phenomenon.

【 授权许可】

   
2014 Aghili et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]McAlpine RR, Morris AD, Emslie-Smith A, James P, Evans JM: The annual incidence of diabetic complications in a population of patients with type 1 and type 2 diabetes. Diabet Med 2005, 22:348-352.
• [2]Amos AF, McCarty DJ, Zimmet P: The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997, 14(Suppl 5):S1-S85.
• [3]Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27:1047-1053.
• [4]Davies M, Khunti K: Insulin management in overweight or obese type 2 diabetes patients: the role of insulin glargine. Diabetes Obes Metab 2008, 10(Suppl 2):42-49.
• [5]Bailey CJ: Biguanides and NIDDM. Diabetes Care 1992, 15:755-772.
• [6]Lee A, Morley JE: Metformin decreases food consumption and induces weight loss in subjects with obesity with type II non-insulin-dependent diabetes. Obes Res 1998, 6:47-53.
• [7]Salpeter SR, Buckley NS, Kahn JA, Salpeter EE: Meta-analysis: metformin treatment in persons at risk for diabetes mellitus. Am J Med 2008, 121:149-157 e142.
• [8]Meneghini LF, Orozco-Beltran D, Khunti K, Caputo S, Damci T, Liebl A, Ross SA: Weight beneficial treatments for type 2 diabetes. J Clin Endocrinol Metab 2011, 96:3337-3353.
• [9]Rodriguez-Moctezuma JR, Robles-Lopez G, Lopez-Carmona JM, Gutierrez-Rosas MJ: Effects of metformin on the body composition in subjects with risk factors for type 2 diabetes. Diabetes Obes Metab 2005, 7:189-192.
• [10]Gallagher D, Song MY: Evaluation of body composition: practical guidelines. Prim Care 2003, 30:249-265.
• [11]Tylavsky F, Lohman T, Blunt BA, Schoeller DA, Fuerst T, Cauley JA, Nevitt MC, Visser M, Harris TB: QDR 4500A DXA overestimates fat-free mass compared with criterion methods. J Appl Physiol 2003, 94:959-965.
• [12]Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28:412-419.
• [13]Janssen I, Heymsfield SB, Ross R: Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002, 50:889-896.
• [14]Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y: Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 2000, 72:694-701.
• [15]Standards of medical care in diabetes--2012 Diabetes Care 2012, 35(Suppl 1):S11-S63.
• [16]Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD: Epidemiology of Sarcopenia among the Elderly in New Mexico. Am J Epidemiol 1998, 147:755-763.
• [17]Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB: Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003, 51:1602-1609.
• [18]Kim TN, Park MS, Yang SJ, Yoo HJ, Kang HJ, Song W, Seo JA, Kim SG, Kim NH, Baik SH, Choi DS, Choi K: Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS). Diabetes Care 2010, 33:1497-1499.
• [19]Khamseh ME, Malek M, Aghili R, Emami Z: Sarcopenia and diabetes: pathogenesis and consequences. Br J Diabetes Vasc Dis 2011, 11:230-234.
• [20]Arslanian SA, Lewy V, Danadian K, Saad R: Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002, 87:1555-1559.
• [21]Dufour AB, Hannan MT, Murabito JM, Kiel DP, McLean RR: Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study. J Gerontol A Biol Sci Med Sci 2013, 68:168-174.
• [22]Davison KK, Ford ES, Cogswell ME, Dietz WH: Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. J Am Geriatr Soc 2002, 50:1802-1809.
• [23]Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, Tylavsky FA, Newman AB: Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc 2007, 55:769-774.
• [24]Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ: Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000, 85:2402-2410.
• [25]Freemark M, Bursey D: The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics 2001, 107:E55.
• [26]Janssen I, Heymsfield SB, Wang ZM, Ross R: Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol 2000, 89:81-88.
• [27]Gallagher D, Visser M, De Meersman RE, Sepulveda D, Baumgartner RN, Pierson RN, Harris T, Heymsfield SB: Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol 1997, 83:229-239.
• [28]Park SW, Goodpaster BH, Lee JS, Kuller LH, Boudreau R, de Rekeneire N, Harris TB, Kritchevsky S, Tylavsky FA, Nevitt M, Cho YW, Newman AB: Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care 2009, 32:1993-1997.
• [29]Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M: Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 2010, 39:412-423.
• [30]Lau EM, Lynn HS, Woo JW, Kwok TC, Melton LJ 3rd: Prevalence of and risk factors for sarcopenia in elderly Chinese men and women. J Gerontol A Biol Sci Med Sci 2005, 60:213-216.