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- Title
Determinants of the increase in ketone concentration during SGLT2 inhibition in NGT, IFG and T2DM patients.
- Authors
Al Jobori, Hussein; Daniele, Giuseppe; Adams, John; Cersosimo, Eugenio; Triplitt, Curtis; DeFronzo, Ralph A.; Abdul‐Ghani, Muhammad
- Abstract
Aim To examine metabolic factors that influence ketone production after sodium-glucose cotransport inhibitor ( SGLT2) administration. Research design and methods Fasting plasma glucose ( FPG), insulin, glucagon, free fatty acid and ketone concentrations were measured in 15 type 2 diabetes mellitus ( T2DM) and 16 non-diabetic subjects before and at day 1 and day 14 after treatment with empagliflozin. Results Empagliflozin caused a 38 mg/d L reduction in FPG concentration in T2DM patients. However, it caused only a small but significant (7 mg/d L) reduction in the FPG concentration in impaired fasting glucose ( IFG) subjects and did not affect FPG concentration in normal glucose tolerant ( NGT) subjects. Empagliflozin caused a significant increase in mean plasma glucagon, free fatty acid ( FFA) and ketone concentrations in T2DM subjects. However, empagliflozin did not cause a significant change in mean plasma insulin, glucagon or ketone concentrations in non-diabetic subjects. An index that integrates change in plasma glucose, insulin and FFA concentration at day 1 strongly correlates with plasma ketone concentration at day 1 (r = 0.85, P < .001) and day 14 (r = 0.63, r = 0.01) and predicts, with 86% sensitivity and 83% specificity, subjects at the top tertile for plasma ketone concentration after empagliflozin treatment. Conclusion Results of the present study demonstrate that SGLT2 inhibition exerts different metabolic effects in non-diabetic individuals as compared to diabetic patients.
- Subjects
EMPAGLIFLOZIN; FREE fatty acids; SODIUM-glucose cotransporters; KETONES; GLUCOSE
- Publication
Diabetes, Obesity & Metabolism, 2017, Vol 19, Issue 6, p809
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.12881