Publications by authors named "B Hartmann"

827 Publications

Not all type-2-diabetes patients increase BMI after initiating insulin - Results of latent class analysis from the DPV registry.

Diabetes Technol Ther 2021 Sep 15. Epub 2021 Sep 15.

University of Ulm, Institute of Epidemiology and Medical Biometry, Albert-Einstein-Allee 41, Ulm, Germany, 89081;

Background: Is insulin initiation linked to increasing body mass index (BMI) in all patients with type-2-diabetes (T2D)? To determine distinct longitudinal patterns of delta-BMI over time.

Materials And Methods: 5,057 patients with T2D (55% males, median BMI[IQR]: 30.0[26.9-33.3] kg/m²) aged ≥40 years at diabetes diagnosis and with ≥2 years of follow-up after insulin initiation irrespective of previous or concurrent use of metformin/dipeptidyl peptidase-4-inhibitor from the multicenter prospective diabetes registry DPV were studied. Multiple BMI values were aggregated semi-annually. To analyse BMI change, longitudinal group-based trajectory modeling was applied with delta-BMI (aggregated BMI at respective time-point[i]-baseline) as trajectory variable. Multinomial logistic regression was used to analyze covariates associated with group membership.

Results: Three heterogeneous groups with either relevant BMI increase (delta-BMI:+4.0 kg/m² after two years; 12% of patients); slight BMI increase (+0.4 kg/m²; 80%); or BMI decrease (-3.2 kg/m²; 8%) were identified. Patients with older age [OR(95%CI): 1.37(1.11-1.69)] and obesity [2.05(1.65-2.55)] prior to insulin start were more often in the BMI decreasing group, and less often in the BMI increasing class [0.80(0.67-0.95); 0.82(0.69-0.98)]. A worse HbA1c both at insulin start and during follow-up [1.90(1.60-2.26); 1.17(1.07-1.27)], a higher insulin dose [1.67(1.33-2.10)] and severe hypoglycemic events [2.38(1.60-3.53)] after insulin initiation were all linked with higher odds of belonging to the BMI increasing trajectory.

Conclusions: Patient heterogeneity with respect to weight gain after initiation of insulin therapy in adult T2D was detected by an objective computer algorithm. Older people with obesity should not defer from insulin use due to fear of weight gain.
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http://dx.doi.org/10.1089/dia.2021.0144DOI Listing
September 2021

Colonic lactulose fermentation has no impact on glucagon-like peptide-1 and peptide-YY secretion in healthy young men.

J Clin Endocrinol Metab 2021 Sep 11. Epub 2021 Sep 11.

Novo Nordic Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Context: The colon houses most of our gut microbiota, which ferments indigestible carbohydrates. The products of fermentation have been proposed to influence the secretion of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) from the many endocrine cells in the colonic epithelium. However, little is known about the colonic contribution to fasting or postprandial plasma levels of L-cell products.

Objective: To determine the impact of colonic lactulose fermentation on gut peptide secretion and to evaluate whether colonic endocrine secretion contributes to gut hormone concentrations measurable in the fasting state.

Research Design And Methods: Ten healthy young men were studied on three occasions after an overnight fast. On two study days, lactulose (20 g) was given orally, and compared to water intake on a third study day. For one of the lactulose visits participants underwent a full colonic evacuation. Over a six-hour study protocol, lactulose fermentation was assessed by measuring exhaled hydrogen (H2), while gut peptide secretion, paracetamol and short chain fatty acid levels were measured in plasma.

Results: Colonic evacuation markedly reduced hydrogen exhalation after lactulose intake (p=0.013). Our analysis suggests that the colon does not account for the measurable amounts of GLP-1 and PYY present in the circulation during fasting, and that fermentation and peptide secretion are not acutely related.

Conclusion: Whether colonic luminal contents affect colonic L-cell secretion sufficiently to influence circulating concentrations requires further investigation. Colonic evacuation markedly reduced lactulose fermentation, but hormone releases were unchanged in the present study.
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http://dx.doi.org/10.1210/clinem/dgab666DOI Listing
September 2021

Fortifying a meal with oyster mushroom powder beneficially affects postprandial glucagon-like peptide-1, non-esterified free fatty acids and hunger sensation in adults with impaired glucose tolerance: a double-blind randomized controlled crossover trial.

Eur J Nutr 2021 Sep 10. Epub 2021 Sep 10.

Department of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany.

Purpose: Impaired glucose tolerance (IGT) is a pathophysiological condition characterized by insulin resistance with known metabolic consequences such as postprandial hyperglycemia and hypertriglyceridemia. We hypothesized that fortifying a meal with mushrooms rich in β-glucans may diminish glucose and triglyceride responses by improving postprandial gastrointestinal hormone release.

Methods: In a randomized controlled crossover study, 22 subjects with IGT ingested a meal either enriched with 20 g powder (8.1 g β-glucans) of oven-dried Pleurotus ostreatus (enriched meal, EN) or without enrichment (control meal, CON). Blood was collected before and repeatedly within 4 h after the meal to determine AUC of glucose (primary outcome), insulin, triglycerides, non-esterified free fatty acids (NEFAs), glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP) and ghrelin. Appetite sensations (hunger, satiety, fullness, and desire to eat) were assessed before and after meal consumption by visual analog scales.

Results: Postprandial glucose, insulin, triglycerides, GIP and ghrelin concentrations as well as the corresponding AUCs did not differ between EN and CON. NEFAs-AUC was 14% lower (P = 0.026) and GLP-1-AUC 17% higher (P = 0.001) after EN compared to CON. Appetite ratings did not differ between treatments, except for hunger (AUC 22% lower after EN vs. CON; P = 0.031).

Conclusion: The observed immediate postprandial metabolic changes indicate that an easily manageable fortification of a single meal with powder from dried oyster mushrooms as β-glucan source may improve postprandial metabolism. If the effect is preserved long term, this measure can diminish the risk for further development of overweight/obesity and type 2 diabetes in subjects with IGT.

Clinical Trial Registration: German Clinical Trial Register on 09/08/2018; trial-ID: DRKS00015244.
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http://dx.doi.org/10.1007/s00394-021-02674-1DOI Listing
September 2021

Gastrointestinal hormones and β-cell function after gastric bypass and sleeve gastrectomy: an RCT (Oseberg).

J Clin Endocrinol Metab 2021 Aug 31. Epub 2021 Aug 31.

Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.

Context: Whether Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differentially affect postprandial gastrointestinal hormones and β-cell function in type 2 diabetes remains unclear.

Objective: To compare gastrointestinal hormones and β-cell function assessed by an oral glucose tolerance test (OGTT) 5 weeks and 1 year after surgery hypothesizing higher GLP-1 levels and greater β-cell response to glucose after RYGB than after SG.

Design, Setting, Patients, And Interventions: Randomized, triple blind, single-center trial at a tertiary care center in Norway. Primary outcomes; diabetes remission and IVGTT derived β-cell function. Participants with obesity and type 2 diabetes allocated (1:1) to RYGB or SG.

Main Outcome Measures: Gastrointestinal hormone profiles and insulin secretion [β-cell glucose sensitivity (β-GS)] derived from 180 minutes OGTTs.

Results: 106 patients (67% women), mean (SD) age 48 (10) years. Diabetes remission rates at 1-year were higher after RYGB than after SG, 77% versus 48%, p = 0.002. Incremental area under the curve (iAUC0-180) glucagon-like peptide-1 (GLP-1) and β-GS increased more after RYGB than after SG, 1-year between-group difference 1173 pmol/l*min (95% CI 569 to 1776), p = 0.0010, and 0.45 pmol/kg/min/mmol (95% CI 0.15 to 0.75), p = 0.0032, respectively. Post-surgery, fasting and postprandial ghrelin levels were higher and decremental AUC0-180 ghrelin, iAUC0-180 glucose-dependent insulinotropic polypeptide, and iAUC0-60 glucagon were greater after RYGB than after SG. Diabetes remission at 1 year was associated with higher β-GS and higher GLP-1 secretion.

Conclusions: RYGB was associated with greater improvement in β-cell function and higher postprandial GLP-1 levels than SG.
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http://dx.doi.org/10.1210/clinem/dgab643DOI Listing
August 2021

Effects of a Lifestyle Intervention on Bone Turnover in Persons with Type 2 Diabetes: A post hoc Analysis of the U-TURN Trial.

Med Sci Sports Exerc 2021 08 24. Epub 2021 Aug 24.

The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Introduction/Purpose.

The increased risk of fractures with type 2 diabetes (T2D) is suggested to be caused by decreased bone turnover. Current international guidelines recommend lifestyle modifications, including exercise, as first-line treatment for T2D. The aim of this study was to investigate the effects of an exercise-based lifestyle intervention on bone turnover and bone mineral density (BMD) in persons with T2D.

Methods: Persons with T2D were randomized to either a 12-months lifestyle intervention (n = 64) or standard care (n = 34). The lifestyle intervention included five to six weekly aerobic training sessions, half of them combined with resistance training. Serum markers of bone turnover (osteocalcin (OC), N-terminal propeptide of type-I procollagen (PINP), reflecting bone formation, and carboxyterminal collagen I crosslinks (CTX-I), reflecting bone resorption) and BMD (by DXA) were measured before the intervention and at follow-up.

Results: From baseline to follow-up, s-PINP increased by 34 % (95 % CI: 17 - 50 %), s-CTX-I by 36 % (95 % CI: 1 - 71 %), and s-OC by 31 % (95 % CI: 11 - 51 %) more in the lifestyle intervention group compared with standard care. Loss of weight and fat mass were the strongest mediators of the increased bone turnover. BMD was unaffected by the intervention ([INCREMENT] BMD: 0.1 %, 95 % CI: -1.1 to 1.2 %).

Conclusions: A 12-months intensive exercise-based lifestyle intervention led to a substantial but balanced increase in bone turnover in persons with T2D. The increased bone turnover combined with a preserved BMD, despite a considerable weight loss, is likely to reflect improved bone health and warrants further studies addressing the impact of exercise on risk of fractures in persons with T2D.
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http://dx.doi.org/10.1249/MSS.0000000000002776DOI Listing
August 2021
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