Abstract

Objective:Initiation and intensification of insulin therapy commonly causes weight gain, a barrier to therapy. A contrasting body of evidence indicates that insulin functions as an adiposity negative feedback signal and reduces food intake, weight gain and adiposity via action in the central nervous system. Basal insulin analogs, detemir (Det) and glargine (Glar), have been associated with less hypoglycemia compared with neutral protamine hagedorn insulin, and Det with less weight gain, especially in patients with higher body mass index (BMI). We sought to determine whether insulin therapy per se causes body weight and fat mass gain when delivered via a clinically relevant subcutaneous (SC) route in the absence of hypoglycemia and glycosuria in non-diabetic lean and diet-induced obese rats.Materials and methods:Rats were exposed to either a low-fat diet (LFD; 13.5% fat) or high-fat diet (HFD; 60% fat), and received Det (0.5 U kg−1), Glar (0.2 U kg−1) or vehicle (Veh) SC once daily for 4 weeks. These dosages of insulin were equipotent in rats with respect to blood–glucose concentration and did not induce hypoglycemia.Results:As predicted by current models of energy homeostasis, neither insulin Det nor Glar therapy affected food intake and weight gain in LFD rats. Det treatment significantly attenuated food intake, body weight gain and fat mass gain relative to the Glar and Veh in high-fat fed animals, mirroring observations in humans.Conclusions:That neither insulin group gained excess weight, suggests weight gain with SC basal insulin therapy may not be inevitable. Our data further suggest that Det possesses a unique property to attenuate the development of obesity associated with a HFD.

Highlights

  • IntroductionDiabetes is epidemic in the US and worldwide.[1] Weight gain is both a risk factor for diabetes and a consequence of initiation and intensification of insulin therapy, as illustrated in landmark diabetes control trials.[2,3,4] Weight gain associated with increased adiposity can worsen insulin resistance leading to higher insulin requirements, and perpetuates a vicious cycle

  • Together with obesity, diabetes is epidemic in the US and worldwide.[1]

  • Insulin potency and dosing We sought to study the effects of insulin Det and Glar on food intake and weight gain at doses that were equipotent with respect to blood–glucose concentration, since insulin is used clinically for glycemic management

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Summary

Introduction

Diabetes is epidemic in the US and worldwide.[1] Weight gain is both a risk factor for diabetes and a consequence of initiation and intensification of insulin therapy, as illustrated in landmark diabetes control trials.[2,3,4] Weight gain associated with increased adiposity can worsen insulin resistance leading to higher insulin requirements, and perpetuates a vicious cycle. Mechanisms involved in weight gain associated with insulin therapy are incompletely understood. Insulin is an anabolic hormone in peripheral tissues.[8] weight gain on insulin initiation or intensification is common, there are reports in randomized, controlled human clinical trials of attenuation of this effect associated with the use of a basal insulin analog, detemir (Det), compared with other insulins used in subjects with type 1 and type 2 diabetes[9] (as reviewed in Hermansen and Davies[10]).

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