Heterogeneidade dos índices de sensibilidade à insulina na avaliação da resposta à metformina em indivíduos adultos jovens com diabetes mellitus tipo 1
Data
2022-03-15
Autores
Oliveira, Luana Aparecida de Lima Ramaldes de 
Orientadores
Dib, Sergio Atala
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A prevalência de obesidade em indivíduos com diabetes tipo 1 (DM1) vêm aumentando nas últimas décadas, e assim, a resistência à insulina (RI). Porém, a RI e seu tratamento não são bem caracterizados, no DM1.
Objetivo: Avaliar se o efeito da metformina na resistência à insulina de adultos jovens com DM1 difere de acordo com o índice de sensibilidade à insulina avaliado e ao IMC.
Participantes e Métodos: estudo prospectivo de 35 indivíduos com DM1, 25,2 (4,44) anos (média/ SD), (51%) ♀, HbA1c 8,2% (0,54), IMC 27,4 kg / m² (4,15), insulina diária total 0,81 (0,2) U / kg / dia) e o uso de metformina (2g / dia) durante 26 semanas. Foram avaliados no estudo: IMC, tecido adiposo visceral (TAV), HbA1c, perfil lipídico, ácido úrico sérico, ferritina, PCR, Kitt, eGDR e SEARCH Is score. Os participantes foram divididos em peso normal (PN, n = 10), sobrepeso (SB, n = 12) e obesos (OB, n = 13).
Resultados: Ao final do acompanhamento eGDR aumentou em todos os grupos (PN: 7,37 vs 8,16, p = 0,002; SB: 7,28 vs 8,24, p <0,001; OB: 6,33 vs 7,52 p <0,001), Kitt e SEARCH Is score melhoraram apenas no grupo OB (2,15 vs 3,14, p <0,001 e 5,26 vs 5,72, p = 0,007, respectivamente). A redução da HbA1c e do IMC foi maior no grupo OB (-0,62%, p = <000,1; -1,12 kg / m², p = 0,031, respectivamente) do que no grupo SB (-0,19%, p = 0,16; -0,41, p = 0,13) e Grupo PN (-0,24%, p = 0,20; +0,25 p = 0,37). O ácido úrico plasmático está associado a todos os índices de sensibilidade à insulina e triglicerídeos ao Kitt e eGDR. O escore SEARCH Is também está associado com ferritina, PCR e TAV, enquanto eGDR com história familiar de DM2 e HAS.
Conclusão: o eGDR foi melhor que o escore de Kitt ou Search Is para mostrar o efeito da adição de metformina na sensibilidade à insulina em adultos jovens com DM1, apesar dos marcadores de IR séricos normais. O uso da metformina resultou em melhores resultados no IMC e no controle glicêmico nos indivíduos com DM1 obeso.
Introduction: The prevalence of obesity in individuals with type 1 diabetes (T1D) are increased in the last decades, and thereafter insulin resistance (IR). However, the IR and its treatment are not so well characterized, in T1D. Objective: To assess if the effect of metformin on insulin resistance of young adult T1D differs in according to insulin sensitivity index evaluated and weight phenotype. Design and Participants: Prospective study of 35 T1D, 25.2 (4.44) y.o (mean/SD), (51%) ♀, HbA1c 8.2% (0.54), BMI 27.4Kg/m² (4.15), total daily insulin 0.81 (0.2) U/Kg/day) plus metformin(2g/day) during 26 weeks. BMI, Visceral Adipose Tissue, HbA1c, lipid profile, serum uric acid, ferritin, PCR, Kitt, eGDR and SEARCH Is score were the outcomes and measures. They were divided in normal weight (NW, n= 10), overweight (OW, n=12) and obese (OB, n=23). Results: At the end of follow-up eGDR increase in all groups (NW:7.37 vs 8.16, p=0.002; OW:7.28 vs 8.24, p< 0.001; OB:6.33 vs 7.52 p <0.001) and Kitt and SEARCH Is score improve only in OB group (2.15 vs 3.14, p <0.001 and 5.26 vs 5.72, p=0.007, respectively). HbA1c and BMI reduction was greater in OB group (-0.62%, p= <000.1; -1.12Kg/m², p=0.031 respectively) than OW group (-0.19%, p=0.16; -0.41, p=0.13) and NW group (-0.24%, p=0.20; +0.25 p=0.37). Plasma uric acid is associated with all insulin sensitivity indexes. Triglycerides is associated with Kitt and eGDR. SEARCH Is score is also associated with ferritin, PCR and VAT while eGDR with family history of T2D and Systemic Arterial Hypertension. Conclusion: eGDR was better than Kitt or Search Is score to show the effect of addition metformin to insulin in young adult T1D insulin sensitivity beside normal seric IR markers. The metformin added shows better results on BMI and glycemic control in obese T1D.
Introduction: The prevalence of obesity in individuals with type 1 diabetes (T1D) are increased in the last decades, and thereafter insulin resistance (IR). However, the IR and its treatment are not so well characterized, in T1D. Objective: To assess if the effect of metformin on insulin resistance of young adult T1D differs in according to insulin sensitivity index evaluated and weight phenotype. Design and Participants: Prospective study of 35 T1D, 25.2 (4.44) y.o (mean/SD), (51%) ♀, HbA1c 8.2% (0.54), BMI 27.4Kg/m² (4.15), total daily insulin 0.81 (0.2) U/Kg/day) plus metformin(2g/day) during 26 weeks. BMI, Visceral Adipose Tissue, HbA1c, lipid profile, serum uric acid, ferritin, PCR, Kitt, eGDR and SEARCH Is score were the outcomes and measures. They were divided in normal weight (NW, n= 10), overweight (OW, n=12) and obese (OB, n=23). Results: At the end of follow-up eGDR increase in all groups (NW:7.37 vs 8.16, p=0.002; OW:7.28 vs 8.24, p< 0.001; OB:6.33 vs 7.52 p <0.001) and Kitt and SEARCH Is score improve only in OB group (2.15 vs 3.14, p <0.001 and 5.26 vs 5.72, p=0.007, respectively). HbA1c and BMI reduction was greater in OB group (-0.62%, p= <000.1; -1.12Kg/m², p=0.031 respectively) than OW group (-0.19%, p=0.16; -0.41, p=0.13) and NW group (-0.24%, p=0.20; +0.25 p=0.37). Plasma uric acid is associated with all insulin sensitivity indexes. Triglycerides is associated with Kitt and eGDR. SEARCH Is score is also associated with ferritin, PCR and VAT while eGDR with family history of T2D and Systemic Arterial Hypertension. Conclusion: eGDR was better than Kitt or Search Is score to show the effect of addition metformin to insulin in young adult T1D insulin sensitivity beside normal seric IR markers. The metformin added shows better results on BMI and glycemic control in obese T1D.
Descrição
Citação
OLIVEIRA, Luana Aparecida de Lima Ramaldes de. Heterogeneidade dos índices de sensibilidade à insulina na avaliação da resposta à metformina em indivíduos adultos jovens com diabetes mellitus tipo 1. São Paulo, 2022. 102 p. Dissertação (Mestrado em Endocrinologia e Metabologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2022.