SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes
Abstract Objective Based on the whole-body energy metabolism and insulin action, the difference between increased excretion of carbohydrate in urine by SGLT2i and reduced same amount of oral carbohydrate intake are scarce. This study aimed to compare the effect of carbohydrate availability with redu...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Diabetology & Metabolic Syndrome |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13098-023-00990-6 |
| _version_ | 1827983173612470272 |
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| author | Hiroyuki Igarashi Hiroshi Uchino Momoko Kanaguchi Kaori Hisanaga Genki Sato Fukumi Yoshikawa Masashi Furuta Naohiro Washizawa Shuki Usui Masahiko Miyagi Takahisa Hirose |
| author_facet | Hiroyuki Igarashi Hiroshi Uchino Momoko Kanaguchi Kaori Hisanaga Genki Sato Fukumi Yoshikawa Masashi Furuta Naohiro Washizawa Shuki Usui Masahiko Miyagi Takahisa Hirose |
| author_sort | Hiroyuki Igarashi |
| collection | DOAJ |
| description | Abstract Objective Based on the whole-body energy metabolism and insulin action, the difference between increased excretion of carbohydrate in urine by SGLT2i and reduced same amount of oral carbohydrate intake are scarce. This study aimed to compare the effect of carbohydrate availability with reduced oral intake (carbohydrate-restricted isocaloric diet: CRIC diet) or lost in urine, as urinary glucosuria on sodium/glucose cotransporter-2 inhibitor (SGLT2i) treatment, focus on the insulin requirement and the macronutrient oxidation within insulin treated type 2 diabetes. Methods This is randomized 3-arm open-label prospective study. Subjects treated with titrated basal-bolus insulin regimen subsequent to three diet regimens, control diet (CON), administration of canagliflozin 100 mg/day to CON (SGLT2i), or CRIC diet, with a week admission to the endocrinology ward followed by 12 weeks outpatients’ management. The main outcome measures including the total insulin dose (TID) required to achieve euglycemia, fasting and postprandial energy expenditure (EE) and respiratory quotient (RQ) at 1-week and 12-week. Results We enrolled 23 patients with type 2 diabetes (male/female: 14/9, age: 53.6 ± 14.2 years, body mass index: 26.9 ± 4.8 kg/m2, HbA1c: 12.5 ± 1.6%). The TID was similar with CON and SGLT2i at both 1 and 12-weeks. Although comparable net carbohydrate availability in SGLT2i and CRIC groups, the TID was significantly higher in the CRIC (p = 0.02) compare to the SGLT2i at both 1 and 12-weeks. Fasting EE was similar in all groups, postprandial EE was significantly elevated in the SGLT2i and CRIC groups compared to the CON group (p = 0.03 and 0.04). Compare to the CON, lower basal fasting RQ (p = 0.049) and decreased delta-RQ (postprandial RQ/fasting RQ) indicated continuous lipid substrate utilization in the SGLT2i (p = 0.04) and CRIC (p = 0.03) groups. Conclusion The CRIC diet resulted in a similar fasting and postprandial EE and substrate oxidation compared to the SGLT2i. The increased insulin requirement in the CRIC diet indicates that a relatively highly lipid and protein consumption, compared to the SGLT2i and CON, may influence insulin requirement. |
| first_indexed | 2024-04-09T22:44:36Z |
| format | Article |
| id | doaj.art-2de870791c864be793bc4dbf85e98e8b |
| institution | Directory Open Access Journal |
| issn | 1758-5996 |
| language | English |
| last_indexed | 2024-04-09T22:44:36Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj.art-2de870791c864be793bc4dbf85e98e8b2023-03-22T11:55:58ZengBMCDiabetology & Metabolic Syndrome1758-59962023-02-0115111010.1186/s13098-023-00990-6SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetesHiroyuki Igarashi0Hiroshi Uchino1Momoko Kanaguchi2Kaori Hisanaga3Genki Sato4Fukumi Yoshikawa5Masashi Furuta6Naohiro Washizawa7Shuki Usui8Masahiko Miyagi9Takahisa Hirose10Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineNutrition Therapy Center, Toho University Omori Medical CenterNutrition Therapy Center, Toho University Omori Medical CenterDivision of Diabetes and Endocrinology, Department of Internal Medicine, Saiseikai Kanagawaken HospitalDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineDivision of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of MedicineAbstract Objective Based on the whole-body energy metabolism and insulin action, the difference between increased excretion of carbohydrate in urine by SGLT2i and reduced same amount of oral carbohydrate intake are scarce. This study aimed to compare the effect of carbohydrate availability with reduced oral intake (carbohydrate-restricted isocaloric diet: CRIC diet) or lost in urine, as urinary glucosuria on sodium/glucose cotransporter-2 inhibitor (SGLT2i) treatment, focus on the insulin requirement and the macronutrient oxidation within insulin treated type 2 diabetes. Methods This is randomized 3-arm open-label prospective study. Subjects treated with titrated basal-bolus insulin regimen subsequent to three diet regimens, control diet (CON), administration of canagliflozin 100 mg/day to CON (SGLT2i), or CRIC diet, with a week admission to the endocrinology ward followed by 12 weeks outpatients’ management. The main outcome measures including the total insulin dose (TID) required to achieve euglycemia, fasting and postprandial energy expenditure (EE) and respiratory quotient (RQ) at 1-week and 12-week. Results We enrolled 23 patients with type 2 diabetes (male/female: 14/9, age: 53.6 ± 14.2 years, body mass index: 26.9 ± 4.8 kg/m2, HbA1c: 12.5 ± 1.6%). The TID was similar with CON and SGLT2i at both 1 and 12-weeks. Although comparable net carbohydrate availability in SGLT2i and CRIC groups, the TID was significantly higher in the CRIC (p = 0.02) compare to the SGLT2i at both 1 and 12-weeks. Fasting EE was similar in all groups, postprandial EE was significantly elevated in the SGLT2i and CRIC groups compared to the CON group (p = 0.03 and 0.04). Compare to the CON, lower basal fasting RQ (p = 0.049) and decreased delta-RQ (postprandial RQ/fasting RQ) indicated continuous lipid substrate utilization in the SGLT2i (p = 0.04) and CRIC (p = 0.03) groups. Conclusion The CRIC diet resulted in a similar fasting and postprandial EE and substrate oxidation compared to the SGLT2i. The increased insulin requirement in the CRIC diet indicates that a relatively highly lipid and protein consumption, compared to the SGLT2i and CON, may influence insulin requirement.https://doi.org/10.1186/s13098-023-00990-6Sodium/glucose cotransporter-2 inhibitorCarbohydrate-restricted isocaloric diet |
| spellingShingle | Hiroyuki Igarashi Hiroshi Uchino Momoko Kanaguchi Kaori Hisanaga Genki Sato Fukumi Yoshikawa Masashi Furuta Naohiro Washizawa Shuki Usui Masahiko Miyagi Takahisa Hirose SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes Diabetology & Metabolic Syndrome Sodium/glucose cotransporter-2 inhibitor Carbohydrate-restricted isocaloric diet |
| title | SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes |
| title_full | SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes |
| title_fullStr | SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes |
| title_full_unstemmed | SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes |
| title_short | SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes |
| title_sort | sglt2 inhibitor versus carbohydrate restricted isocaloric diet reprogramming substrate oxidation in type 2 diabetes |
| topic | Sodium/glucose cotransporter-2 inhibitor Carbohydrate-restricted isocaloric diet |
| url | https://doi.org/10.1186/s13098-023-00990-6 |
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