TY - JOUR
T1 - Effect of insulin versus triple oral therapy on the progression of hepatic steatosis in type 2 diabetes
AU - Lingvay, Ildiko
AU - Roe, Erin D.
AU - Duong, Jonathan
AU - Leonard, David
AU - Szczepaniak, Lidia S.
PY - 2012/10
Y1 - 2012/10
N2 - Background: Hyperinsulinemia has been associated with hepatic fat deposition and ensuing insulin resistance. It is unknown if treatment with exogenous insulin in patients with type 2 diabetes, who are most prone to hepatic fat accumulation, would promote the occurrence or worsening of nonalcoholic fatty liver disease. Methods: Patients with treatment-naive type 2 diabetes (N = 16) were treated with insulin and metformin for a 3-month lead-in period, then assigned triple oral therapy (metformin, glyburide, and pioglitazone) or continued treatment with insulin and metformin. Hepatic triglyceride content (HTC)Vmeasured by magnetic resonance spectroscopy, serum lipids, glucose, liver function tests, and inflammatory and thrombotic biomarkers were followed for a median of 31 months. Results: The 45% decline in HTC during the lead-in period persisted through the follow-up period with no difference between treatment groups at the end of the study (5.26 ± 4.21% in the triple oral therapy vs 7.47 ± 7.40% for insulin/metformin), whereas glycemic control was comparable. Conclusions: Improvements in HTC with initial insulin/metformin therapy persisted through the median 31-month follow-up period regardless of the treatment. More importantly, insulin-based treatment did not appear to promote or worsen nonalcoholic fatty liver disease.
AB - Background: Hyperinsulinemia has been associated with hepatic fat deposition and ensuing insulin resistance. It is unknown if treatment with exogenous insulin in patients with type 2 diabetes, who are most prone to hepatic fat accumulation, would promote the occurrence or worsening of nonalcoholic fatty liver disease. Methods: Patients with treatment-naive type 2 diabetes (N = 16) were treated with insulin and metformin for a 3-month lead-in period, then assigned triple oral therapy (metformin, glyburide, and pioglitazone) or continued treatment with insulin and metformin. Hepatic triglyceride content (HTC)Vmeasured by magnetic resonance spectroscopy, serum lipids, glucose, liver function tests, and inflammatory and thrombotic biomarkers were followed for a median of 31 months. Results: The 45% decline in HTC during the lead-in period persisted through the follow-up period with no difference between treatment groups at the end of the study (5.26 ± 4.21% in the triple oral therapy vs 7.47 ± 7.40% for insulin/metformin), whereas glycemic control was comparable. Conclusions: Improvements in HTC with initial insulin/metformin therapy persisted through the median 31-month follow-up period regardless of the treatment. More importantly, insulin-based treatment did not appear to promote or worsen nonalcoholic fatty liver disease.
KW - Hepatic steatosis
KW - Insulin
KW - NAFLD
KW - Triglyceride
KW - Type 2 diabetes
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U2 - 10.2310/JIM.0b013e3182621c5f
DO - 10.2310/JIM.0b013e3182621c5f
M3 - Article
C2 - 22801247
AN - SCOPUS:85006136707
SN - 1708-8267
VL - 60
SP - 1059
EP - 1063
JO - Journal of Investigative Medicine
JF - Journal of Investigative Medicine
IS - 7
ER -