LEADER 3--lipase and amylase activity in subjects with type 2 diabetes: baseline data from over 9000 subjects in the LEADER Trial
William M Steinberg, Michael A Nauck, Bernard Zinman, Gilbert H Daniels, Richard M Bergenstal, Johannes F E Mann, Lasse Steen Ravn, Alan C Moses, Mette Stockner, Florian M M Baeres, Steven P Marso, John B Buse, LEADER Trial investigators, William M Steinberg, Michael A Nauck, Bernard Zinman, Gilbert H Daniels, Richard M Bergenstal, Johannes F E Mann, Lasse Steen Ravn, Alan C Moses, Mette Stockner, Florian M M Baeres, Steven P Marso, John B Buse, LEADER Trial investigators
Abstract
Objectives: This report from the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial describes baseline lipase and amylase activity in type 2 diabetic subjects without acute pancreatitis symptoms before randomization to the glucagonlike peptide analog liraglutide or placebo.
Methods: The LEADER is an international randomized placebo-controlled trial evaluating the cardiovascular safety of liraglutide in 9340 type 2 diabetic patients at high cardiovascular risk. Fasting lipase and amylase activity was assessed at baseline, before receiving liraglutide or placebo, using a commercial assay (Roche) with upper limit of normal values of 63 U/L for lipase and 100 U/L for amylase.
Results: Either or both enzymes were above the upper limit of normal in 22.7% of subjects; 16.6% (n = 1540) had an elevated lipase level (including 1.2% >3-fold elevated), and 11.8% (n = 1094) had an elevated amylase level (including 0.2% >3-fold elevated). In multivariable regression models, severely reduced kidney function was associated with the largest effect on increasing activity of both. However, even among subjects with normal kidney function, 12.2% and 7.7% had elevated lipase and amylase levels.
Conclusions: In this large study of type 2 diabetic patients, nearly 25% had elevated lipase or amylase levels without symptoms of acute pancreatitis. The clinician must take these data into account when evaluating abdominal symptoms in type 2 diabetic patients.
Trial registration: ClinicalTrials.gov NCT01179048.
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References
- Noel RA, Braun DK, Patterson RE, et al. Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study. Diabetes Care. 2009; 32: 834– 838
- Girman CJ, Kou TD, Cai B, et al. Patients with type 2 diabetes mellitus have higher risk for acute pancreatitis compared with those without diabetes. Diabetes Obes Metab. 2010; 12: 766– 771
- Garg R, Chen W, Pendergrass M. Acute pancreatitis in type 2 diabetes treated with exenatide or sitagliptin: a retrospective observational pharmacy claims analysis. Diabetes Care. 2010; 33: 2349– 2354
- Gonzalez-Perez A, Schlienger RG, Rodriguez LA. Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs: a population-based cohort study. Diabetes Care. 2010; 33: 2580– 2585
- Denker PS, Dimarco PE. Exenatide (exendin-4)-induced pancreatitis: a case report. Diabetes Care. 2006; 29: 471.
- Lee PH, Stockton MD, Franks AS. Acute pancreatitis associated with liraglutide. Ann Pharmacother. 2011; 45: e22.
- Tripathy NR, Basha S, Jain R, et al. Exenatide and acute pancreatitis. J Assoc Physicians India. 2008; 56: 987– 988
- Singh S, Chang HY, Richards TM, et al. Glucagonlike peptide 1-based therapies and risk of hospitalization for acute pancreatitis in type 2 diabetes mellitus: a population-based matched case-control study. JAMA Intern Med. 2013; 173 (7): 534– 539
- Elashoff M, Matveyenko AV, Gier B, et al. Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1–based therapies. Gastroenterology. 2011; 141: 150– 156
- Dore DD, Seeger JD, Arnold Chan K. Use of a claims-based active drug safety surveillance system to assess the risk of acute pancreatitis with exenatide or sitagliptin compared to metformin or glyburide. Curr Med Res Opin. 2009; 25: 1019– 1027
- Alves C, Batel-Marques F, Macedo AF. A meta-analysis of serious adverse events reported with exenatide and liraglutide: acute pancreatitis and cancer. Diabetes Res Clin Pract. 2012; 98: 271– 284
- Dore DD, Bloomgren GL, Wenten M, et al. A cohort study of acute pancreatitis in relation to exenatide use. Diabetes Obes Metab. 2011; 13: 559– 566
- Exenatide LAR New Drug Application Clinical Review. 2012. Available at: . Accessed November 19, 2013
- DeVries JH, Bain SC, Rodbard HW, et al. Sequential intensification of metformin treatment in type 2 diabetes with liraglutide followed by randomized addition of basal insulin prompted by A1C targets. Diabetes Care. 2012; 35: 1446– 1454
- Lando HM, Alattar M, Dua AP. Elevated amylase and lipase levels in patients using glucagonlike peptide-1 receptor agonists or dipeptidyl-peptidase-4 inhibitors in the outpatient setting. Endocr Pract. 2012; 18: 472– 477
- Malloy J, Gurney K, Shan K, et al. Increased variability and abnormalities in pancreatic enzyme concentrations in otherwise asymptomatic subjects with type 2 diabetes. Diabetes Metab Syndr Obes. 2012; 5: 419– 424
- Bastyr EJ, Barkin J, Botros FT, et al. High incidence of elevated lipase and amylase in type 2 diabetes patients (T2DM) (abstract). Pancreas. 2009; 38: 980
- Steinberg WM, Rosenstock J, DeVries JH, et al. Elevated serum lipase activity in adults with type 2 diabetes and no gastrointestinal symptoms (abstract). Gastroenterology. 2012; 142 (suppl 1): S93– S94
- Steinberg WM, DeVries JH, Wadden TA, et al. Longitudinal monitoring of lipase and amylase in adults with type 2 diabetes and obesity: evidence from two phase 3 randomized clinical trials with once daily GLP-1 analog liraglutide. Gastroenterology. 2012; 142 (suppl 1): S850– S851
- Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62: 102– 111
- Marso SP, Poulter NR, Nissen SE, et al. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013; 166: 823– 830 e825
- Kimmel PL, Tenner S, Habwe VQ, et al. Trypsinogen and other pancreatic enzymes in patients with renal disease: a comparison of high-efficiency hemodialysis and continuous ambulatory peritoneal dialysis. Pancreas. 1995; 10: 325– 330
- Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013; 144: 1252– 1261
- Green CL. Identification of alpha-amylase as a secretion of the human fallopian tube and tubelike epithelium of müllerian and mesonephric duct origin. Am J Obstet Gynecol. 1957; 73: 402– 408
- Berk JE, Shimamura J, Fridhandler L. Tumor-associated hyperamylasemia. Am J Gastroenterol. 1977; 68: 572– 577
- Whitten RO, Chandler WL, Thomas MG, et al. Survey of alpha-amylase activity and isoamylases in autopsy tissue. Clin Chem. 1988; 34: 1552– 1555
- Apple F, Benson P, Preese L, et al. Lipase and pancreatic amylase activities in tissues and in patients with hyperamylasemia. Am J Clin Pathol. 1991; 96: 610– 614
- Shimamura J, Fridhandler L, Berk JE. Does human pancreas contain salivary-type isoamylase? Gut. 1975; 16: 1006– 1009
- Fridhandler L, Berk JE, Ueda M. Isolation and measurement of pancreatic amylase in human serum and urine. Clin Chem. 1972; 18: 1493– 1497
- Sinha S, Khan H, Timms PM, et al. Pancreatic-type hyperamylasemia and hyperlipasemia secondary to ruptured ovarian cyst: a case report and review of the literature. J Emerg Med. 2010; 38: 463– 466
- Tietz NW, Shuey DF. Lipase in serum—the elusive enzyme: an overview. Clin Chem. 1993; 39: 746– 756
- Jocken JW, Moro C, Goossens GH, et al. Skeletal muscle lipase content and activity in obesity and type 2 diabetes. J Clin Endocrinol Metab. 2010; 95: 5449– 5453
- Langin D, Dicker A, Tavernier G, et al. Adipocyte lipases and defect of lipolysis in human obesity. Diabetes. 2005; 54: 3190– 3197
- Whitcomb DC, Lowe ME. Human pancreatic digestive enzymes. Dig Dis Sci. 2007; 52: 1– 17
- Wanke M. Pathogenese und morphologisches Bild akuter Pankreaserkrankungen. In: Forell MM, ed. Pankreas. Hdb Inn Med, 5. Aufl, Bd 3, Teil 6. Berlin-Heidelberg-New York: Springer; 1976: S520– S615
- Boivin M, Lanspa SJ, Zinsmeister AR, et al. Are diets associated with different rates of human interdigestive and postprandial pancreatic enzyme secretion? Gastroenterology. 1990; 99: 1763– 1771
- Ricketts J, Brannon PM. Amount and type of dietary fat regulate pancreatic lipase gene expression in rats. J Nutr. 1994; 124: 1166– 1171
- Junge W, Malyusz M, Ehrens HJ. The role of the kidney in the elimination of pancreatic lipase and amylase from blood. J Clin Chem Clin Biochem. 1985; 23: 387– 392
- Moller-Peterson J, Dati F. Renal handling of pancreatic lipase. Clin Chem. 1984; 30: 343– 344
- Malyusz M, Wrigge P, Caliebe D, et al. Renal handling of 125I-labelled homologous pancreatic lipase and amylase in the rat. J Clin Chem Clin Biochem. 1988; 26: 611– 615
- Hardt PD, Hauenschild A, Jaeger C, et al. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig Dis Sci. 2003; 48: 1688– 1692
- Lazarus SS, Volk BW. Pancreas in maturity-onset diabetes. Pathogenetic considerations. Arch Pathol. 1961; 71: 44– 59
- Butler AE, Campbell-Thompson M, Gurlo T, et al. Marked expansion of exocrine and endocrine pancreas with incretin therapy in humans with increased exocrine pancreas dysplasia and the potential for glucagon-producing neuroendocrine tumors. Diabetes. 2013; 62: 2595– 2604
Source: PubMed