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Published in: Acta Diabetologica 4/2017

01-04-2017 | Original Article

A pilot study of d-chiro-inositol plus folic acid in overweight patients with type 1 diabetes

Authors: Anna Rita Maurizi, Marika Menduni, Rossella Del Toro, Shadi Kyanvash, Daria Maggi, Chiara Guglielmi, Angelo Lauria Pantano, Giuseppe Defeudis, Elvira Fioriti, Silvia Manfrini, Paolo Pozzilli

Published in: Acta Diabetologica | Issue 4/2017

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Abstract

Aims

To improve insulin sensitivity, insulin-sensitizing drugs such as metformin are commonly used in overweight and obese T1D patients. Similarly to metformin, d-chiro-inositol (DCI), as putative mediator of intracellular insulin action, can act as insulin sensitizer. The aim of this pilot study was to evaluate the hypothesis that DCI plus folic acid may improve glucose control reducing insulin resistance in overweight or obese T1D patients.

Methods

A 24-week randomized control trial was carried out in 26 overweight or obese T1D patients, undergoing intensive insulin therapy. Patients were randomized to 1 g DCI plus 400 mcg folic acid once daily (treated group) or to 400 mcg folic acid only once daily (control group). The primary end point was to evaluate the efficacy of DCI on metabolic control as assessed by HbA1c. As secondary endpoints, BMI and insulin requirement (IR) were evaluated. Paired t test (two tailed) and analysis of variance were used to evaluate differences in HbA1c, BMI and IR at different time points.

Results

A significant reduction in HbA1c levels in treated group versus control group (7.5% ± 0.9 vs. 7.9% ± 1.7, respectively, p < 0.05) was observed. However, no significant reduction in BMI and IR was observed [(BMI 25.7 ± 2.8 vs. 26.7 ± 1.0, respectively, p NS); (IR 0.52 ± 0.26 vs. 0.52 ± 0.19, respectively, p NS)].

Conclusions

This trial demonstrated for the first time that DCI plus folic acid oral supplementation can improve metabolic control in overweight T1D patients.

ClinicalTrial.Gov ID

NCT02730949.
Literature
1.
go back to reference The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRef The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRef
2.
go back to reference Pozzilli P, Buzzetti R (2007) A new expression of diabetes: double diabetes. Trends Endocrinol Metab 18(2):52–57CrossRefPubMed Pozzilli P, Buzzetti R (2007) A new expression of diabetes: double diabetes. Trends Endocrinol Metab 18(2):52–57CrossRefPubMed
3.
go back to reference Pozzilli P, Guglielmi C (2009) Double diabetes: a mixture of type 1 and type 2 diabetes in youth. Endocr Dev 14:151–166PubMed Pozzilli P, Guglielmi C (2009) Double diabetes: a mixture of type 1 and type 2 diabetes in youth. Endocr Dev 14:151–166PubMed
4.
go back to reference Ortega Juan F et al (2014) Metformin does not attenuate the acute insulin-sensitizing effect of a single bout of exercise in individuals with insulin resistance. Acta Diabetol 51(5):749–755CrossRefPubMed Ortega Juan F et al (2014) Metformin does not attenuate the acute insulin-sensitizing effect of a single bout of exercise in individuals with insulin resistance. Acta Diabetol 51(5):749–755CrossRefPubMed
5.
go back to reference Vella S, Buetow L et al (2010) The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia 53(5):809–820CrossRefPubMed Vella S, Buetow L et al (2010) The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia 53(5):809–820CrossRefPubMed
6.
go back to reference Larner J, Brautigan DL, Thorner MO (2010) d-Chiro-inositol glycans in insulin signaling and insulin resistance. Mol Med 16(11–12):543–551PubMedPubMedCentral Larner J, Brautigan DL, Thorner MO (2010) d-Chiro-inositol glycans in insulin signaling and insulin resistance. Mol Med 16(11–12):543–551PubMedPubMedCentral
7.
8.
go back to reference Ortmeyer HK, Bodkin NL, Lilley K, Larner J, Hansen BC (1993) Chiro-inositol deficiency and insulin resistance. I. Urinary excretion rate of chiro-inositol is directly associated with insulin resistance in spontaneously in diabetic rhesus monkeys. Endocrinology 132:640–645PubMed Ortmeyer HK, Bodkin NL, Lilley K, Larner J, Hansen BC (1993) Chiro-inositol deficiency and insulin resistance. I. Urinary excretion rate of chiro-inositol is directly associated with insulin resistance in spontaneously in diabetic rhesus monkeys. Endocrinology 132:640–645PubMed
9.
go back to reference Larner J, Craig JW (1996) Urinary myo-inositol-to chiro-inositol ratios and insulin resistance. Diabetes Care 19(1):76–78CrossRefPubMed Larner J, Craig JW (1996) Urinary myo-inositol-to chiro-inositol ratios and insulin resistance. Diabetes Care 19(1):76–78CrossRefPubMed
10.
go back to reference Gluck G, Anguelova T et al (2010) Synergistic effects of d-chiro-inositol and manganese on blood glucose and body weight of streptozotocin-induced diabetic rats. Curr Bioact Compd 6:90–96CrossRef Gluck G, Anguelova T et al (2010) Synergistic effects of d-chiro-inositol and manganese on blood glucose and body weight of streptozotocin-induced diabetic rats. Curr Bioact Compd 6:90–96CrossRef
11.
go back to reference Yao Y, Shan F, Bian J et al (2008) d-Chiro-inositol-enriched tartary buckwheat bran extract lowers the blood glucose level in KK-Ay mice. J Agric Food Chem 56(21):10027–10031CrossRefPubMed Yao Y, Shan F, Bian J et al (2008) d-Chiro-inositol-enriched tartary buckwheat bran extract lowers the blood glucose level in KK-Ay mice. J Agric Food Chem 56(21):10027–10031CrossRefPubMed
12.
go back to reference Suzuki S, Kawasaki H et al (1994) Urinary chiro-inositol excretion is an index marker of insulin sensitivity in Japanese type II diabetes. Diabetes Care 17:1465–1468CrossRefPubMed Suzuki S, Kawasaki H et al (1994) Urinary chiro-inositol excretion is an index marker of insulin sensitivity in Japanese type II diabetes. Diabetes Care 17:1465–1468CrossRefPubMed
13.
go back to reference Sudchada P, Saokaew S et al (2012) Effect of folic acid supplementation on plasma total homocysteine levels and glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 98(1):151–158CrossRefPubMed Sudchada P, Saokaew S et al (2012) Effect of folic acid supplementation on plasma total homocysteine levels and glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 98(1):151–158CrossRefPubMed
14.
go back to reference Solini A, Santini E, Ferrannini E (2006) Effect of short-term folic acid supplementation on insulin sensitivity and inflammatory markers in overweight subjects. Int J Obes 30:1197–1202CrossRef Solini A, Santini E, Ferrannini E (2006) Effect of short-term folic acid supplementation on insulin sensitivity and inflammatory markers in overweight subjects. Int J Obes 30:1197–1202CrossRef
15.
go back to reference Setola E, Monti LD et al (2004) Insulin resistance and endothelial function are improved after folate and vitamin B12 therapy in patients with metabolic syndrome: relationship between homocysteine levels and hyperinsulinemia. Eur J Endocrinol 151(4):483–489CrossRefPubMed Setola E, Monti LD et al (2004) Insulin resistance and endothelial function are improved after folate and vitamin B12 therapy in patients with metabolic syndrome: relationship between homocysteine levels and hyperinsulinemia. Eur J Endocrinol 151(4):483–489CrossRefPubMed
16.
go back to reference D’Anna R, Scilipoti A et al (2013) Myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care 36(4):854–857CrossRefPubMedPubMedCentral D’Anna R, Scilipoti A et al (2013) Myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care 36(4):854–857CrossRefPubMedPubMedCentral
17.
go back to reference Cianci A, Panella M, Caruso S et al (2015) d-Chiro-inositol and alpha lipoic acid treatment of metabolic and menses disorders in women with PCOS. Gynecol Endocrinol 31(6):483–486CrossRefPubMed Cianci A, Panella M, Caruso S et al (2015) d-Chiro-inositol and alpha lipoic acid treatment of metabolic and menses disorders in women with PCOS. Gynecol Endocrinol 31(6):483–486CrossRefPubMed
18.
go back to reference La Marca A, Grisendi V et al (2015) The menstrual cycle regularization following d-chiro-inositol treatment in PCOS women: a retrospective study. Gynecol Endocrinol 31(1):52–56CrossRefPubMed La Marca A, Grisendi V et al (2015) The menstrual cycle regularization following d-chiro-inositol treatment in PCOS women: a retrospective study. Gynecol Endocrinol 31(1):52–56CrossRefPubMed
19.
go back to reference Laganà AS, Barbaro L, Pizzo A (2015) Evaluation of ovarian function and metabolic factors in women affected by polycystic ovary syndrome after treatment with d-chiro-inositol. Arch Gynecol Obstet 291(5):1181–1186CrossRefPubMed Laganà AS, Barbaro L, Pizzo A (2015) Evaluation of ovarian function and metabolic factors in women affected by polycystic ovary syndrome after treatment with d-chiro-inositol. Arch Gynecol Obstet 291(5):1181–1186CrossRefPubMed
20.
go back to reference Nestler John E et al (1999) Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome. N Engl J Med 340:1314–1320CrossRefPubMed Nestler John E et al (1999) Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome. N Engl J Med 340:1314–1320CrossRefPubMed
21.
go back to reference Galazis N, Galazi M, Atiomo W (2011) d-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review. Gynecol Endocrinol 27(4):256–262CrossRefPubMed Galazis N, Galazi M, Atiomo W (2011) d-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review. Gynecol Endocrinol 27(4):256–262CrossRefPubMed
22.
go back to reference Ku BJ, Kim HJ, Park KS (2007) The clinical study to evaluate the safety and efficacy of d-chiro-inositol in patients with type 2 diabetes. Korean J Med 72(1):29–36 Ku BJ, Kim HJ, Park KS (2007) The clinical study to evaluate the safety and efficacy of d-chiro-inositol in patients with type 2 diabetes. Korean J Med 72(1):29–36
23.
go back to reference Yoo KH, Kim JH et al (2007) Effect of pinitol on glucose metabolism and adipocytokines in uncontrolled type 2 diabetes. Diabetes Res Clin Pract 77(1):S247–S251PubMed Yoo KH, Kim JH et al (2007) Effect of pinitol on glucose metabolism and adipocytokines in uncontrolled type 2 diabetes. Diabetes Res Clin Pract 77(1):S247–S251PubMed
25.
go back to reference Dang NT, Mukai R, Yoshida K, Ashida H (2010) Pinitol and myo-inositol stimulate translocation of glucose transporter 4 in skeletal muscle of C57BL/6 mice. Biosci Biotechnol Biochem 74(5):1062–1067CrossRefPubMed Dang NT, Mukai R, Yoshida K, Ashida H (2010) Pinitol and myo-inositol stimulate translocation of glucose transporter 4 in skeletal muscle of C57BL/6 mice. Biosci Biotechnol Biochem 74(5):1062–1067CrossRefPubMed
Metadata
Title
A pilot study of d-chiro-inositol plus folic acid in overweight patients with type 1 diabetes
Authors
Anna Rita Maurizi
Marika Menduni
Rossella Del Toro
Shadi Kyanvash
Daria Maggi
Chiara Guglielmi
Angelo Lauria Pantano
Giuseppe Defeudis
Elvira Fioriti
Silvia Manfrini
Paolo Pozzilli
Publication date
01-04-2017
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 4/2017
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-016-0954-x

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