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Hummel J, Benkendorff C, Fritsche L, Prystupa K, Vosseler A, Gancheva S, Trenkamp S, Birkenfeld AL, Preissl H, Roden M, Häring HU, Fritsche A, Peter A, Wagner R, Kullmann S, Heni M. Brain insulin action on peripheral insulin sensitivity in women depends on menstrual cycle phase. Nat Metab 2023; 5:1475-1482. [PMID: 37735274 PMCID: PMC10513929 DOI: 10.1038/s42255-023-00869-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/19/2023] [Indexed: 09/23/2023]
Abstract
Insulin action in the human brain modulates eating behaviour, whole-body metabolism and body fat distribution1,2. In particular, brain insulin action increases whole-body insulin sensitivity, but these studies were mainly performed in lean men3,4. Here we investigate metabolic and hypothalamic effects of brain insulin action in women with a focus on the impact of menstrual cycle ( ClinicalTrials.gov registration: NCT03929419 ).Eleven women underwent four hyperinsulinemic-euglycemic clamps, two in the follicular phase and two in the luteal phase. Brain insulin action was introduced using nasal insulin spray5-7 and compared to placebo spray in a fourfold crossover design with change in glucose infusion rate as the primary endpoint. Here we show that during the follicular phase, more glucose has to be infused after administration of nasal insulin than after administration of placebo. This remains significant after adjustment for blood glucose and insulin. During the luteal phase, no significant influence of brain insulin action on glucose infusion rate is detected after adjustment for blood glucose and insulin (secondary endpoint). In 15 other women, hypothalamic insulin sensitivity was assessed in a within-subject design by functional magnetic resonance imaging with intranasal insulin administration8. Hypothalamus responsivity is influenced by insulin in the follicular phase but not the luteal phase.Our study therefore highlights that brain insulin action improves peripheral insulin sensitivity also in women but only during the follicular phase. Thus, brain insulin resistance could contribute to whole-body insulin resistance in the luteal phase of the menstrual cycle.
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Affiliation(s)
- Julia Hummel
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University of Ulm, Ulm, Germany
| | - Charlotte Benkendorff
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Louise Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Katsiaryna Prystupa
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andreas Vosseler
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Sofiya Gancheva
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sandra Trenkamp
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Robert Wagner
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University of Ulm, Ulm, Germany.
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, Eberhard Karls University Tübingen, Tübingen, Germany.
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Vosseler A, Machann J, Fritsche L, Prystupa K, Kübler C, Häring HU, Birkenfeld AL, Stefan N, Peter A, Fritsche A, Wagner R, Heni M. Interscapular fat is associated with impaired glucose tolerance and insulin resistance independent of visceral fat mass. Obesity (Silver Spring) 2022; 30:2233-2241. [PMID: 36192827 DOI: 10.1002/oby.23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Dysregulated body fat distribution is a major determinant of various diseases. In particular, increased visceral fat mass and ectopic lipids in the liver are linked to metabolic disorders such as insulin resistance and type 2 diabetes. Furthermore, interscapular fat is considered to be a metabolically active fat compartment. METHODS This study measured interscapular fat mass and investigated its relationship with glucose metabolism in 822 individuals with a wide range of BMI values and different glucose tolerance statuses. Magnetic resonance imaging was used to quantify body fat depots, and an oral glucose tolerance test was performed to determine glucose metabolism. RESULTS Elevated interscapular fat mass was positively associated with age, BMI, and total body, visceral, and subcutaneous adipose tissue mass. High interscapular fat mass associated with elevated fasting glucose levels, glucose levels at 2 hours during the oral glucose tolerance test, glycated hemoglobin, and insulin resistance, independent of sex, age, and total body and visceral fat mass. CONCLUSIONS In conclusion, interscapular fat might be a highly specific fat compartment with a potential impact on glucose metabolism and the pathogenesis of diabetes mellitus.
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Affiliation(s)
- Andreas Vosseler
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jürgen Machann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Section of Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Louise Fritsche
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Katsiaryna Prystupa
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Kübler
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas L Birkenfeld
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Norbert Stefan
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Peter
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Robert Wagner
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Martin Heni
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
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3
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Kullmann S, Hummel J, Wagner R, Dannecker C, Vosseler A, Fritsche L, Veit R, Kantartzis K, Machann J, Birkenfeld AL, Stefan N, Häring HU, Peter A, Preissl H, Fritsche A, Heni M. Empagliflozin Improves Insulin Sensitivity of the Hypothalamus in Humans With Prediabetes: A Randomized, Double-Blind, Placebo-Controlled, Phase 2 Trial. Diabetes Care 2022; 45:398-406. [PMID: 34716213 PMCID: PMC8914418 DOI: 10.2337/dc21-1136] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin action in the human brain reduces food intake, improves whole-body insulin sensitivity, and modulates body fat mass and its distribution. Obesity and type 2 diabetes are often associated with brain insulin resistance, resulting in impaired brain-derived modulation of peripheral metabolism. So far, no pharmacological treatment for brain insulin resistance has been established. Since sodium-glucose cotransporter 2 (SGLT2) inhibitors lower glucose levels and modulate energy metabolism, we hypothesized that SGLT2 inhibition may be a pharmacological approach to reverse brain insulin resistance. RESEARCH DESIGN AND METHODS In this randomized, double-blind, placebo-controlled clinical trial, 40 patients (mean ± SD; age 60 ± 9 years; BMI 31.5 ± 3.8 kg/m2) with prediabetes were randomized to receive 25 mg empagliflozin every day or placebo. Before and after 8 weeks of treatment, brain insulin sensitivity was assessed by functional MRI combined with intranasal administration of insulin to the brain. RESULTS We identified a significant interaction between time and treatment in the hypothalamic response to insulin. Post hoc analyses revealed that only empagliflozin-treated patients experienced increased hypothalamic insulin responsiveness. Hypothalamic insulin action significantly mediated the empagliflozin-induced decrease in fasting glucose and liver fat. CONCLUSIONS Our results corroborate insulin resistance of the hypothalamus in humans with prediabetes. Treatment with empagliflozin for 8 weeks was able to restore hypothalamic insulin sensitivity, a favorable response that could contribute to the beneficial effects of SGLT2 inhibitors. Our findings position SGLT2 inhibition as the first pharmacological approach to reverse brain insulin resistance, with potential benefits for adiposity and whole-body metabolism.
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Affiliation(s)
- Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Julia Hummel
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Robert Wagner
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Corinna Dannecker
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Andreas Vosseler
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Louise Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Konstantinos Kantartzis
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Jürgen Machann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Department of Diagnostic and Interventional Radiology, Section of Experimental Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany.,Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Interfaculty Center for Pharmacogenomics and Pharma Research at the Eberhard Karls University Tübingen, Tübingen, Germany.,Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine, Eberhard Karls University Tübingen, Tübingen, Germany.,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
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Morgalla MH, Fritschle H, Vosseler A, Benkendorff C, Lamprinou A, Heni M, Fritsche A. Influence of Spinal Cord Stimulation on Insulin Sensitivity in Chronic Pain Patients. Exp Clin Endocrinol Diabetes 2021; 130:17-21. [PMID: 34255321 DOI: 10.1055/a-1525-3339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This prospective, sham-controlled, randomized, cross-over study (NCT03637075), was designed to test the hypothesis that spinal cord stimulation (SCS) for the treatment of pain can also improve glucose metabolism and insulin sensitivity when compared to sham stimulation. METHODS Ten non-diabetic participants (5 females, mean age 48.8 years) who had an SCS system implanted for the treatment of chronic neuropathic pain were studied. Whilst applying a hyperinsulinemic-euglycemic clamp, sham-stimulation and tonic stimulation were performed for 45 min (n=4) or 60 min (n=6) in each case randomly. The insulin sensitivity index and pain levels were determined. A second investigation, BurstDR stimulation was also conducted and the result was compared to that of sham stimulation (cross-over design). RESULTS The insulin sensitivity improved significantly under the tonic stimulation when compared to the sham stimulation (p=0.037). BurstDR stimulation independently did not lead to a significantly improved insulin sensitivity compared to that after sham stimulation (p=0.16). We also examined the pain during the test and found no significant difference between sham and tonic stimulation (p=0.687). CONCLUSION The results of this study show that tonic stimulation used for the treatment of pain could also improve glucose metabolism and insulin sensitivity. Further investigations are required to investigate the clinical relevance of the role of glucose metabolism in diabetic chronic pain participants and its underlying mechanisms.
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Affiliation(s)
| | | | - Andreas Vosseler
- Medical Clinic IV, University of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | - Apostolia Lamprinou
- Medical Clinic IV, University of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Heni
- Medical Clinic IV, University of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Fritsche
- Medical Clinic IV, University of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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5
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Dannecker C, Wagner R, Peter A, Hummel J, Vosseler A, Häring HU, Fritsche A, Birkenfeld AL, Stefan N, Heni M. Low-Density Lipoprotein Cholesterol Is Associated With Insulin Secretion. J Clin Endocrinol Metab 2021; 106:1576-1584. [PMID: 33693827 PMCID: PMC8118579 DOI: 10.1210/clinem/dgab147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Pharmacological lowering of low-density lipoprotein (LDL) cholesterol potently reduces cardiovascular risk while concurrently increasing type 2 diabetes risk. OBJECTIVE The aim of this study was to investigate the relationship between LDL cholesterol concentrations and insulin secretion and glucagon levels. METHODS A total of 3039 individuals without cholesterol-lowering therapy, but with increased risk for diabetes, underwent routine blood tests and a 5-point oral glucose tolerance test (OGTT). Glucagon concentrations, insulin secretion, and insulin clearance indices were derived from the OGTT. RESULTS There was no association between LDL cholesterol and fasting glucagon (P = .7, β = -.01) or post-glucose load glucagon levels (P = .7, β = -.07), but we detected significant positive associations of LDL cholesterol and C-peptide-based indices of insulin secretion (area under the curve [AUC]C-Peptide(0-30min)/AUCGlucose(0-30min): P < .001, β = .06; AUCC-Peptide(0-120min) /AUCGlucose(0-120min): P < .001, β = -.08). In contrast, we found a negative association of insulin-based insulin secretion indices with LDL concentrations (insulinogenic index: P = .01, β = -.04; disposition index: P < .001, β = -.06). LDL cholesterol levels, however, were positively associated with insulin clearance assessed from C-peptide and insulin concentrations, both in the fasting state and post-glucose load (P < .001, β = .09 and P < .001, β = .06, respectively). CONCLUSION As C-peptide based indices reflect insulin secretion independent of hepatic clearance, our results indicate lower insulin secretion in case of lesser LDL cholesterol. This could explain deteriorating glycemic control in response to cholesterol-lowering drugs.
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Affiliation(s)
- Corinna Dannecker
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Robert Wagner
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Julia Hummel
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Andreas Vosseler
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany
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6
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Vosseler A, Zhao D, Fritsche L, Lehmann R, Kantartzis K, Small DM, Peter A, Häring HU, Birkenfeld AL, Fritsche A, Wagner R, Preißl H, Kullmann S, Heni M. No modulation of postprandial metabolism by transcutaneous auricular vagus nerve stimulation: a cross-over study in 15 healthy men. Sci Rep 2020; 10:20466. [PMID: 33235256 PMCID: PMC7686306 DOI: 10.1038/s41598-020-77430-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
Experimental evidence suggests a crucial role of the autonomic nervous system in whole body metabolism with major regulatory effects of the parasympathetic branch in postprandial adaptation. However, the relative contribution of this mechanism is still not fully clear in humans. We therefore compared the effects of transcutaneous auricular vagus nerve stimulation (taVNS, Cerbomed Nemos) with sham stimulation during an oral glucose tolerance test in a randomized, single-blind, cross-over design in 15 healthy lean men. Stimulation was performed for 150 min, 30 min before and during the entire oral glucose tolerance test with stimulation cycles of 30 s of on-phase and 30 s of off-phase and a 25 Hz impulse. Heart rate variability and plasma catecholamine levels were assessed as proxies of autonomic tone in the periphery. Neither analyzed heart rate variability parameters nor plasma catecholamine levels were significantly different between the two conditions. Plasma glucose, insulin sensitivity and insulin secretion were also comparable between conditions. Thus, the applied taVNS device or protocol was unable to achieve significant effects on autonomic innervation in peripheral organs. Accordingly, glucose metabolism remained unaltered. Therefore, alternative approaches are necessary to investigate the importance of the autonomic nervous system in postprandial human metabolism.
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Affiliation(s)
- Andreas Vosseler
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Dongxing Zhao
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Louise Fritsche
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Rainer Lehmann
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Konstantinos Kantartzis
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Dana M Small
- Modern Diet and Physiology Research Center, Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Andreas Peter
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Andreas L Birkenfeld
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Andreas Fritsche
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Robert Wagner
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Hubert Preißl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Martin Heni
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany. .,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany. .,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany. .,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany.
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7
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Jaghutriz BA, Wagner R, Kullmann S, Fritsche L, Eckstein SS, Dannecker C, Willmann C, Randrianarisoa E, Lehn-Stefan A, Hieronimus A, Hudak S, Vosseler D, Lamprinou A, Huber P, Vosseler A, Willmann G, Heyne N, Wolff D, Stefan N, Häring HU, Birkenfeld AL, Peter A, Fritsche A, Heni M. The TUDID Study - Background and Design of a Prospective Cohort. Exp Clin Endocrinol Diabetes 2020; 130:43-48. [PMID: 32911559 DOI: 10.1055/a-1221-9618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Prevalence of both type 1 and type 2 diabetes mellitus is growing worldwide and one major cause for morbidity and mortality. However, not every patient develops diabetes-related complications, but causes for the individual susceptibility are still not fully understood. As a platform to address this, we initiated the TUDID (TUebingen DIabetes Database) study, a prospective, monocentric, observational study that includes adults with diabetes mellitus who are treated in the inpatient clinic of a University Hospital in southern Germany. Besides a thorough clinical examination and extensive laboratory tests (with integrated biobanking), major study focuses are the kidneys, the eyes, the vasculature as well as cognition and mood where standardized investigations for early stages for diabetes complications are performed. Analyses of the data generated by this precise characterization of diabetes-related complications will contribute to our understanding of the development and course of such complications, and thus facilitate the implementation of tailored treatment options that can reduce the risk and severity of diabetes-related complications.
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Affiliation(s)
- Benjamin Assad Jaghutriz
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Robert Wagner
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Institute of Medical Psychology and Behavioral Neurobiology/fMEG Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Louise Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Sabine S Eckstein
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Corinna Dannecker
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Caroline Willmann
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Elko Randrianarisoa
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Angela Lehn-Stefan
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Anja Hieronimus
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Sarah Hudak
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Dorothea Vosseler
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Apostolia Lamprinou
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Philipp Huber
- Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Vosseler
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | | | - Nils Heyne
- Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Diana Wolff
- Department of Conservative Dentistry, University Hospital Tübingen, Tübingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD e.V.), Tübingen, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany.,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
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8
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Heni M, Wagner R, Willmann C, Jaghutriz BA, Vosseler A, Kübler C, Hund V, Scheffler K, Peter A, Häring HU, Preissl H, Kullmann S, Fritsche A. Insulin Action in the Hypothalamus Increases Second-Phase Insulin Secretion in Humans. Neuroendocrinology 2020; 110:929-937. [PMID: 31689708 DOI: 10.1159/000504551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Animal studies and initial correlative data in humans indicate that insulin action in the brain may affect pancreatic insulin secretion. An important brain region for this process is the hypothalamus, an area that can develop insulin resistance. METHODS Fifteen young, healthy men (27 ± 3 years) with a wide BMI spectrum (20-30 kg/m2) underwent 2 hyperglycemic clamps (target blood glucose: 10 mmol/L). In this double-blind study, subjects received 160 U of insulin or placebo as a nasal spray on 2 days in randomized order. On another day, insulin sensitivity of the hypothalamus was determined by functional magnetic resonance imaging. RESULTS Glucose levels were comparable on both study days. In the whole group, C-peptide levels were not significantly different between conditions. Though, there was a significant interaction between insulin sensitivity of the hypothalamus × nasal spray × time on C-peptide levels (p = 10-6). The group was therefore divided according to median hypothalamic insulin sensitivity. C-peptide concentrations were higher after intranasal insulin compared to placebo spray in the group with a strong hypothalamic insulin response (p < 0.0001, β = 6.00 ± 1.24) and lower in the brain insulin-resistant group (p = 0.005, β = -2.68 ± 0.95). Neither somatostatin nor glucagon kinetics was altered by the nasal spray. CONCLUSIONS In participants with high hypothalamic insulin sensitivity, insulin action in the brain enhanced second-phase insulin secretion from pancreatic beta cells. This reaction could, for example, contribute to late postprandial glucose regulation by suppressing hepatic glucose production by portal venous insulin.
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Affiliation(s)
- Martin Heni
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany,
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany,
- German Center for Diabetes Research (DZD), Neuherberg, Germany,
| | - Robert Wagner
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Caroline Willmann
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Benjamin Assad Jaghutriz
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Vosseler
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Christian Kübler
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Verena Hund
- University Pharmacy, University Hospital, Tübingen, Germany
| | - Klaus Scheffler
- High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Andreas Peter
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Hubert Preissl
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Interfaculty Centre for Pharmacogenomics and Pharma Research at the Eberhard-Karls-University, Tübingen, Germany
- Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Fritsche
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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9
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Schork A, Saynisch J, Vosseler A, Jaghutriz BA, Heyne N, Peter A, Häring HU, Stefan N, Fritsche A, Artunc F. Effect of SGLT2 inhibitors on body composition, fluid status and renin-angiotensin-aldosterone system in type 2 diabetes: a prospective study using bioimpedance spectroscopy. Cardiovasc Diabetol 2019; 18:46. [PMID: 30953516 PMCID: PMC6451223 DOI: 10.1186/s12933-019-0852-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/29/2019] [Indexed: 12/25/2022] Open
Abstract
Background SGLT2-inhibitors are potent antihyperglycemic drugs for patients with type 2 diabetes and have been shown to reduce body weight. However, it is unclear which body compartments are reduced and to what extent. Methods In this longitudinal observational study, we analyzed the body composition of 27 outpatients with type 2 diabetes mellitus during the first week and up to 6 months after initiation of treatment with SGLT2-inhibitors (n = 18 empagliflozin, n = 9 dapagliflozin) using bioimpedance spectroscopy (BCM, Fresenius). Fluid status of hypertensive patients taking medication with hydrochlorothiazide (n = 14) and healthy persons (n = 16) were analyzed for comparison. Results At 6 months, HbA1c decreased by 0.8% (IQR 2.3; 0.4), body weight and BMI by 2.6 kg (1.5; 9.3) and 0.9 kg/m2 (0.4; 3.3), respectively. Bioimpedance spectroscopy revealed significant decrease in adipose tissue mass and fat tissue index while lean tissue parameters remained stable. Overhydration (OH) and extracellular water (ECW) decreased by − 0.5 L/1.73 m2 (− 0.1; − 0.9) and − 0.4 L/1.73 m2 (− 0.1; − 0.8) at day 3, respectively, and returned to the initial value after 3 and 6 months. Plasma renin activity increased by 2.1-fold (0.5; 3.6) at 1 month and returned to the initial level at month 3 and 6. Fluid status of patients with SGLT2 inhibitors after 6 months showed no difference from that of hypertensive patients taking hydrochlorothiazide or healthy persons. Conclusions Body weight reduction under the treatment with SGLT2-inhibitors is caused by reduction of adipose tissue mass and transient loss of extracellular fluid, which is accompanied by upregulation of renin–angiotensin–aldosterone system (RAAS). Permanent loss of extracellular water does not occur under SGLT2 inhibition. Electronic supplementary material The online version of this article (10.1186/s12933-019-0852-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Schork
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany. .,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany. .,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.
| | - Janine Saynisch
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany
| | - Andreas Vosseler
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Benjamin Assad Jaghutriz
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Andreas Peter
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Norbert Stefan
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Andreas Fritsche
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
| | - Ferruh Artunc
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tübingen, Otfried-Müller-Str.10, 72076, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich at the University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Strasse 10, 72076, Tübingen, Germany
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10
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Sailer C, Stefan N, Schmid V, Fritsche L, Vosseler A, Wagner R, Peter A, Fritsche A, Häring HU, Heni M. Der Zusammenhang von LDL-Cholesterin mit Insulinsensitivität und Insulinsekretion. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C Sailer
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - N Stefan
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - V Schmid
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - L Fritsche
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - A Vosseler
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - R Wagner
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - A Peter
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - A Fritsche
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - HU Häring
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
| | - M Heni
- Institut für Diabetesforschung und Metabolische Erkrankungen (IDM) des Helmholtz-Zentrums München an der Eberhard-Karls-Universität, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- Universitätsklinikum Tübingen, Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Tübingen, Germany
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11
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Schmid V, Sailer C, Wagner R, Vosseler A, Stefan N, Häring HU, Fritsche A, Heni M. Die Verfügbarkeit von Glukose und freien Fettsäuren beeinflusst die Substratoxidation im Nüchternzustand. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- V Schmid
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - C Sailer
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - R Wagner
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - A Vosseler
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - N Stefan
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - HU Häring
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - A Fritsche
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - M Heni
- Institut für Diabetesforschung und metabolische Erkrankungen des Helmholtz Zentrums München an der Universität Tübingen (IDM), Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Tübingen, Germany
- Innere Medizin IV, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Tübingen, Germany
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12
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Heni M, Wagner R, Willmann C, Jaghutriz BA, Vosseler A, Kübler C, Peter A, Häring HU, Preissl H, Kullmann S, Fritsche A. Insulinwirkung im Gehirn stimuliert die Insulinsekretion – Ergebnisse aus hyperglykämischen Clamps. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Heni
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - R Wagner
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - C Willmann
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - BA Jaghutriz
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - A Vosseler
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - C Kübler
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
| | - A Peter
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - HU Häring
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - H Preissl
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - S Kullmann
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - A Fritsche
- Universitätsklinikum Tübingen, Innere Medizin IV (Diabetologie, Nephrologie, Angiologie, Klinische Chemie), Tübingen, Germany
- Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrum München an der Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
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