insulin sensitivity
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Metabolic Assessment of Metformin in Pregnancy (MoM-P)
PROJECT SUMMARY The objective of the “Metabolic Assessment of Metformin in Pregnancy “(MoM-P) proposal is to assess the physiological effect of metformin on maternal and neonatal metabolism during pregnancy in individuals developing gestational diabetes (GDM). Metformin is increasingly being used for medical treatment of GDM not adequately treated with nutrition and physical activity. There is inconsistency among various organizations (Society for Maternal Fetal Medicine, American College of Obstetrics and Gynecology and the American Diabetes Association) as to metformin’s role in the medical management of GDM. We will examine the metabolic action of metformin in GDM pregnancies and effect on mothers and their offspring. We plan to recruit 50 participants from Massachusetts General Hospital (MGH) for Specific Aims 1, 2 and 3 and 100 participants from Ohio State University college of Medicine (OSUCOM) for Specific Aims 2 and 3. Participants for the study will have been diagnosed with GDM requiring medical management of GDM as part of the DECIDE multicenter randomized controlled trial. The primary site for DECIDE is OSUCOM, with Dr. Mark Landon as the PI. The MoM-P study will recruit participants from the DECIDE trial at MGH and OSUCOM. The MoM-P study aims are: Aim 1: To establish metformin’s effects on endogenous (primarily hepatic) glucose production (EGP) and insulin sensitivity in late pregnancy. We hypothesize that metformin does not lower EGP in pregnancy and hence the need of additional insulin in the medical management of GDM. We will perform infusion of a stable isotope of glucose (6,6 2H2 glucose) to estimate EGP and a HOMA-IR prior to initiation of medical management and again at 37 weeks gestation. Aim 2: Metformin increases GDF15 levels in human GDM pregnancy and is associated with lower nutrient intake, gestational weight gain (GWG) and increased resting energy expenditure (REE). We hypothesize that metformin increases GDF15 concentrations which lead to GI upset, lower caloric intake/GWG and increases REE. In DECIDE participants randomized to metformin vs. insulin, we will measure GDF15 and examine the relationship to ASA-nutrition records, REE with indirect calorimetry and maternal body composition using air displacement plethysmography (ADP) prior to initiation of medication and again at 37 weeks. Aim 3: To compare fetal growth and body composition in neonates exposed and unexposed to metformin in utero. We hypothesize that metformin treatment of GDM decreases fetal weight: 1) directly based on metformin’s effect on neonatal metabolism (fetal AMPK and mTOR pathways) and 2) indirectly by lowering maternal nutritional intake, fat free mass (FFM) and increasing maternal REE, resulting in decreased neonatal FFM and increased fat mass in childhood. In DECIDE participants, we will measure neonatal body composition with 72 hours of delivery using pediatric ADP and a planned follow-up of children at 2 years in the DECIDE protocol with estimates of male and female children’s body composition.
Targeting the brain to improve obesity and type 2 diabetes
The increasing prevalence of obesity and type 2 diabetes (T2D) and associated morbidity and mortality emphasizes the need for a more complete understanding of the mechanisms mediating energy homeostasis to accelerate the identification of new medications. Recent reports indicate that obesity medication, 5-hydroxytryptamine (5-HT, serotonin)2C receptor (5-HT2CR) agonist lorcaserin improves glycemic control in association with weight loss in obese patients with T2D. We examined whether lorcaserin has a direct effect on insulin sensitivity and how this effect is achieved. We clarify that lorcaserin dose-dependently improves glycemic control in a mouse model of T2D without altering body weight. Examining the mechanism of this effect, we reveal a necessary and sufficient neurochemical mediator of lorcaserin’s glucoregulatory effects, via activation of brain pro-opiomelanocortin (POMC) peptides. We observed that lorcaserin reduces hepatic glucose production and improves insulin sensitivity. These data suggest that lorcaserin’s action within the brain represents a mechanistically novel treatment for T2D: findings of significance to a prevalent global disease.
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