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SHR Neuro Cancer Cardio Lipid Metab Microb

Ferrannini, E; Baldi, S; Frascerra, S; Astiarraga, B; Heise, T; Bizzotto, R; Mari, A; Pieber, TR; Muscelli, E.
Shift to Fatty Substrate Utilization in Response to Sodium-Glucose Cotransporter 2 Inhibition in Subjects Without Diabetes and Patients With Type 2 Diabetes.
Diabetes. 2016; 65(5):1190-1195 Doi: 10.2337/db15-1356 [OPEN ACCESS]
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Co-authors Med Uni Graz: Pieber Thomas
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Abstract:: Pharmacologically induced glycosuria elicits adaptive responses in glucose homeostasis and hormone release. In type 2 diabetes (T2D), along with decrements in plasma glucose and insulin levels and increments in glucagon release, sodium-glucose cotransporter 2 (SGLT2) inhibitors induce stimulation of endogenous glucose production (EGP) and a suppression of tissue glucose disposal (TGD). We measured fasting and postmeal glucose fluxes in 25 subjects without diabetes using a double glucose tracer technique; in these subjects and in 66 previously reported patients with T2D, we also estimated lipolysis (from [(2)H5]glycerol turnover rate and circulating free fatty acids, glycerol, and triglycerides), lipid oxidation (LOx; by indirect calorimetry), and ketogenesis (from circulating β-hydroxybutyrate concentrations). In both groups, empagliflozin administration raised EGP, lowered TGD, and stimulated lipolysis, LOx, and ketogenesis. The pattern of glycosuria-induced changes was similar in subjects without diabetes and in those with T2D but quantitatively smaller in the former. With chronic (4 weeks) versus acute (first dose) drug administration, glucose flux responses were attenuated, whereas lipid responses were enhanced; in patients with T2D, fasting β-hydroxybutyrate levels rose from 246 ± 288 to 561 ± 596 µmol/L (P < 0.01). We conclude that by shunting substantial amounts of carbohydrate into urine, SGLT2-mediated glycosuria results in a progressive shift in fuel utilization toward fatty substrates. The associated hormonal milieu (lower insulin-to-glucagon ratio) favors glucose release and ketogenesis. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Find related publications in this database (using NLM MeSH Indexing): 3-Hydroxybutyric Acid - agonists; 3-Hydroxybutyric Acid - blood; 3-Hydroxybutyric Acid - metabolism; Algorithms -; Benzhydryl Compounds - administration & dosage; Benzhydryl Compounds - adverse effects; Benzhydryl Compounds - therapeutic use; C-Reactive Protein - analysis; Carbohydrate Metabolism - drug effects; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - urine; Energy Metabolism - drug effects; Glucagon - blood; Glucagon - metabolism; Glucagon-Like Peptide 1 - blood; Glucose Intolerance - blood; Glucose Intolerance - drug therapy; Glucose Intolerance - metabolism; Glucose Intolerance - urine; Glucosides - administration & dosage; Glucosides - adverse effects; Glucosides - therapeutic use; Glycosuria - chemically induced; Humans -; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin - blood; Insulin - metabolism; Insulin Secretion -; Lipid Metabolism - drug effects; Lipolysis - drug effects; Membrane Transport Modulators - administration & dosage; Membrane Transport Modulators - adverse effects; Membrane Transport Modulators - therapeutic use; Renal Elimination - drug effects; Sodium-Glucose Transporter 2 - metabolism; Sodium-Glucose Transporter 2 Inhibitors -; Time Factors -