Abstract
BackgroundThe objective of this study is to compare lactate levels between users and non-users of diabetes medications under the hypothesis that the level of lactate is a marker of oxidative capacity.MethodsThe cross-sectional data of 493 participants aged 61–84 with type 2 diabetes who participated in the Atherosclerosis Risk in Communities Carotid MRI study were analyzed using survey weighted linear regression.ResultsMedian plasma lactate level was 8.58 (95% CI: 8.23, 8.87) mg/dl. Comparing users of diabetic medications with non-users, thiazolidinedione use was significantly associated with lower lactate level (7.57 (6.95–8.25) mg/dL vs. 8.78 (8.43–9.14) mg/dL), metformin use with a slightly higher lactate level (9.02 (8.51–9.58) mg/dL vs. 8.36 (7.96–8.77) mg/dL), and sulfonylurea and insulin use were not associated with lactate level. After adjustment for demographic and lifestyle factors, the plasma lactate level for thiazolidinedione users was 15.78% lower than that for non-users (p<0.001). Considering use of each medication separately and in combination did not change the results.ConclusionIn conclusion, thiazolidinedione use was associated with lower plasma lactate level compared to non-use and metformin use was only marginally associated with a slightly higher lactate level. These results are consistent with the previously demonstrated effects of diabetes medications on oxidative metabolism. Further investigation of the role that diabetes medications play in improvement of oxidative metabolism is warranted.
Highlights
Oxidative capacity is the balance between the body’s demand for energy and the ability to provide that energy through oxidative pathways
The relationship between oxidative capacity and insulin resistance leads to the hypothesis that interventions that lower insulin resistance may impact oxidative capacity
We investigated the difference in plasma lactate levels between users and non-users of diabetes medications among ARIC Carotid MRI Study participants
Summary
Oxidative capacity is the balance between the body’s demand for energy and the ability to provide that energy through oxidative pathways. The use of lactate as a marker of systemic imbalance in oxygen demand and availability allows for the relatively new emergence of population based studies on oxidative capacity [1,2,3]. While a recent Cochrane review suggests that patients taking metformin do not have higher lactate levels, only a few studies with small sample sizes were available and an increase in lactate level would be consistent with some of metformin’s physiologic effects [8]. Since metformin decreases hepatic gluconeogenesis, it decreases lactate utilization and potentially increases lactate levels [9]. The objective of this study is to compare lactate levels between users and non-users of diabetes medications under the hypothesis that the level of lactate is a marker of oxidative capacity
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