Hepatic insulin resistance both in prediabetic and diabetic patients determines postprandial lipoprotein metabolism: from the CORDIOPREV studyReport as inadecuate




Hepatic insulin resistance both in prediabetic and diabetic patients determines postprandial lipoprotein metabolism: from the CORDIOPREV study - Download this document for free, or read online. Document in PDF available to download.

Cardiovascular Diabetology

, 15:68

First Online: 19 April 2016Received: 14 January 2016Accepted: 30 March 2016

Abstract

Background-aimsPrevious evidences have shown the presence of a prolonged and exaggerated postprandial response in type 2 diabetes mellitus T2DM and its relation with an increase of cardiovascular risk. However, the response in prediabetes population has not been established. The objective was to analyze the degree of postprandial lipemia response in the CORDIOPREV clinical trial NCT00924937 according to the diabetic status.

Methods1002 patients were submitted to an oral fat load test meal OFTT with 0.7 g fat-kg body weight 12 % saturated fatty acids SFA, 10 % polyunsaturated fatty acids PUFA, 43 % monounsaturated fatty acids MUFA, 10 % protein and 25 % carbohydrates. Serial blood test analyzing lipid fractions were drawn at 0, 1, 2, 3 and 4 h during postprandial state. Postprandial triglycerides TG concentration at any point >2.5 mmol-L 220 mg-dL has been established as undesirable response. We explored the dynamic response in 57 non-diabetic, 364 prediabetic and 581 type 2 diabetic patients. Additionally, the postprandial response was evaluated according to basal insulin resistance subgroups in patients non-diabetic and diabetic without pharmacological treatment N = 642.

ResultsPrevalence of undesirable postprandial TG was 35 % in non-diabetic, 48 % in prediabetic and 59 % in diabetic subgroup, respectively p < 0.001. Interestingly, prediabetic patients displayed higher plasma TG and large triacylglycerol-rich lipoproteins TRLs-TG postprandial response compared with those non-diabetic patients p < 0.001 and p = 0.003 respectively. Moreover, the area under the curve AUC of TG and AUC of TRLs-TG was greater in the prediabetic group compared with non-diabetic patients p < 0.001 and p < 0.005 respectively. Patients with liver insulin resistance liver-IR showed higher postprandial response of TG compared with those patients with muscle-IR or without any insulin-resistance respectively p < 0.001.

ConclusionsOur findings demonstrate that prediabetic patients show a lower phenotypic flexibility after external aggression, such as OFTT compared with nondiabetic patients. The postprandial response increases progressively according to non-diabetic, prediabetic and type 2 diabetic state and it is higher in patients with liver insulin-resistance. To identify this subgroup of patients is important to treat more intensively in order to avoid future cardiometabolic complications.

KeywordsPhenotypic flexibility Triglycerides Postprandial lipemia Prediabetic CORDIOPREV study Insulin resistance A. Leon-Acuña, J. F. Alcala-Diaz, P. Perez-Martinez and J. Lopez-Miranda contributed equally to this work

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Author: A. Leon-Acuña - J. F. Alcala-Diaz - J. Delgado-Lista - J. D. Torres-Peña - J. Lopez-Moreno - A. Camargo - A. Garcia-Rio

Source: https://link.springer.com/article/10.1186/s12933-016-0380-y







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