Early changes in respiratory quotient and resting energy expenditure predict later weight changes in patients treated for poorly controlled type 2 diabetes

This study looked at whether early changes in resting energy expenditure (REE) and respiratory quotient (RQ) are correlated with later weight changes in patients with type 2 diabetes (T2D) being treated with insulin or GLP-1 analogues, or diet. A total of 67 patients (age: 57±9 years; BMI: 33.7±5.0k...

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Bibliographic Details
Published in:Diabetes & metabolism Vol. 40; no. 4; pp. 299 - 304
Main Authors: Gonzalez, C., Fagour, C., Maury, E., Cherifi, B., Salandini, S., Pierreisnard, A., Masquefa-Giraud, P., Gin, H., Rigalleau, V.
Format: Journal Article
Language:English
Published: Paris Elsevier Masson SAS 01.09.2014
Masson
Subjects:
Aged
Biological and medical sciences
Blood Glucose - drug effects
Blood Glucose - metabolism
Body Weight - drug effects
Cohort Studies
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - metabolism
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinology & Metabolism
Endocrinopathies
Energy Metabolism - drug effects
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
Glycated Hemoglobin A - metabolism
Humans
Insulin - administration & dosage
Insulin - analogs & derivatives
Insulin therapy
Internal Medicine
Male
Medical sciences
Middle Aged
Respiratory quotient
Respiratory Rate - drug effects
Rest
Resting energy expenditure
Type 2 diabetes
Type 2 diabetes
Insulin therapy
GLP-1
REE
Resting energy expenditure
T2D
Respiratory quotient
BMI
RQ
body mass index
glucagon-like peptide-1
Endocrinopathy
Human
Pancreatic hormone
Controlled diabetes
Metabolic diseases
Insulin
ISSN:1262-3636, 1878-1780, 1878-1780
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Summary:This study looked at whether early changes in resting energy expenditure (REE) and respiratory quotient (RQ) are correlated with later weight changes in patients with type 2 diabetes (T2D) being treated with insulin or GLP-1 analogues, or diet. A total of 67 patients (age: 57±9 years; BMI: 33.7±5.0kg/m2; HbA1c: 9.9±1.5%) began taking an insulin analogue at bedtime (INS, n=28; initial dose: 0.2 IU/kg) or a GLP-1 analogue (GLP-1, n=23), or only a dietary intervention (diet, n=16; restricted carbohydrates and calories). Their respiratory exchanges were monitored on days 0, 1 and 2 before breakfast. Two days after starting the bedtime insulin analogue, fasting glycaemia improved (INS: −65±41mg/dL; GLP-1: −29±48mg/dL; diet: −31±46mg/dL; P<0.05), REE decreased (INS: −162±241kcal/24h; GLP-1: 0±141kcal/24h; diet: −41±154kcal/24h; P<0.05) and RQ increased (from 0.76±0.04 to 0.80±0.04; P<0.01), whereas only RQ decreased with diet (from 0.79±0.05 to 0.76±0.04; P<0.05) and remained unchanged with GLP-1 (P<0.005 for ΔRQ across treatments). Only 33 patients attended the scheduled examination three months later. HbA1c improved (INS, n=16: −1.7±1.4%; GLP-1, n=12: −2.1±1.4%; diet, n=5: −1.7±2.8%; NS), while weight changes differed (INS: +1.5±4.3kg; GLP-1: −2.8±2.8kg; diet: −2.2±2.7kg; P<0.005). After three months, weight changes correlated with early changes in REE (r=−0.37, P<0.05) and RQ (r=+0.43, P<0.01), and remained correlated when both changes were included in a multivariate regression analysis (r=0.58, P<0.005). In poorly controlled patients with T2D and two days after the introduction of a bedtime insulin analogue, REE decreased by −9% while RQ increased by +5%, pointing to a reduction of lipid oxidation. These changes were predictive of later weight gain.
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ISSN:1262-3636
1878-1780
1878-1780
DOI:10.1016/j.diabet.2014.02.001