Sato Masahiro, Fujita Hiroki, Yokoyama Hiroki, Mikada Atsushi, Horikawa Yohei, Takahashi Yuya, Yamada Yuichiro, Waki Hironori, Narita Takuma
Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, Akita 010-8543, Japan.
Jiyugaoka Medical Clinic, Obihiro 080-0016, Japan.
J Clin Med. 2023 Apr 24;12(9):3104. doi: 10.3390/jcm12093104.
We previously conducted a pilot randomized controlled trial "the MASTER study" and demonstrated that alpha-glucosidase inhibitor miglitol and a dipeptidyl peptidase-4 inhibitor sitagliptin modified postprandial plasma excursions of active glucagon-like peptide-1 (aGLP-1) and active gastric inhibitory polypeptide (aGIP), and miglitol treatment decreased body fat mass in patients with type 2 diabetes (T2D). However, the details regarding the relationships among postprandial plasma aGLP-1 and aGIP excursions, skeletal muscle mass, and body fat mass are unclear.
We conducted a secondary analysis of the relationships among skeletal muscle mass index (SMI), total body fat mass index (TBFMI), and the incremental area under the curves (iAUC) of plasma aGLP-1 and aGIP excursions following mixed meal ingestion at baseline and after 24-week add-on treatment with either miglitol alone, sitagliptin alone, or their combination in T2D patients.
SMI was not changed after the 24-week treatment with miglitol and/or sitagliptin. TBFMI was reduced and the rates of aGIP-iAUC change were lowered in the two groups treated with miglitol, although their correlations did not reach statistical significance. We observed a positive correlation between the rates of aGIP-iAUC and TBFMI changes and a negative correlation between the rates of TBFMI and SMI changes in T2D patients treated with sitagliptin alone whose rates of aGIP-iAUC change were elevated.
Collectively, although T2D patients treated with miglitol and/or sitagliptin did not show altered SMI after 24-week treatment, the current study suggests that there are possible interrelationships among postprandial plasma aGIP excursion modified by sitagliptin, skeletal muscle mass, and body fat mass.
我们之前进行了一项先导性随机对照试验“MASTER研究”，结果表明，α-葡萄糖苷酶抑制剂米格列醇和二肽基肽酶-4抑制剂西格列汀可改善餐后活性胰高血糖素样肽-1（aGLP-1）和活性胃抑制多肽（aGIP）的血浆波动，且米格列醇治疗可降低2型糖尿病（T2D）患者的体脂量。然而，餐后血浆aGLP-1和aGIP波动、骨骼肌量和体脂量之间关系的具体细节尚不清楚。
我们对T2D患者在基线时以及接受米格列醇单药、西格列汀单药或二者联合的24周附加治疗后，混合餐摄入后骨骼肌量指数（SMI）、全身脂肪量指数（TBFMI）与血浆aGLP-1和aGIP波动的曲线下增量面积（iAUC）之间的关系进行了二次分析。
米格列醇和/或西格列汀治疗24周后，SMI未发生变化。米格列醇治疗的两组患者TBFMI降低，aGIP-iAUC变化率降低，尽管它们之间的相关性未达到统计学意义。在单独接受西格列汀治疗且aGIP-iAUC变化率升高的T2D患者中，我们观察到aGIP-iAUC变化率与TBFMI变化率之间呈正相关，TBFMI与SMI变化率之间呈负相关。
总体而言，尽管米格列醇和/或西格列汀治疗的T2D患者在24周治疗后SMI未改变，但本研究表明，西格列汀改变的餐后血浆aGIP波动、骨骼肌量和体脂量之间可能存在相互关系。
