The Effectiveness of Myo-Inositol and D-Chiro Inositol Treatment in Type 2 Diabetes

Basilio Pintaudi, Giacoma Di Vieste, Matteo Bonomo, Basilio Pintaudi, Giacoma Di Vieste, Matteo Bonomo

Abstract

Inositol has been used as a supplement in treating several pathologies such as PCOS, metabolic syndrome, and gestational diabetes. Both myo-inositol and its isomer d-chiro-inositol showed insulin mimetic effects in conditions of insulin resistance. Type 2 diabetes (T2DM) is a condition typically caused by insulin resistance. There is a lack of evidence of inositol use in T2DM. We evaluated the effectiveness and safety of myo-inositol and d-chiro-inositol treatment in T2DM. This was a pilot study involving a consecutive sample of patients with T2DM with suboptimal glycemic control (HbA1c 7.0-10.0%) already treated with glucose-lowering agents. Patients (23.1% males, mean age of 60.8 ± 11.7 years) took for three months a combination of myo-inositol (550 mg) and d-chiro-inositol (13.8 mg) orally twice a day as add-on supplement to their glucose-lowering drugs. Possible occurrence of side effects was investigated. After three months of treatment fasting blood glucose (192.6 ± 60.2 versus 160.9 ± 36.4; p = 0.02) and HbA1c levels (8.6 ± 0.9 versus 7.7 ± 0.9; p = 0.02) significantly decreased compared to baseline. There was no significant difference in blood pressure, lipid profile, and BMI levels. None of the participants reported side effects. In conclusion, a supplementation with a combination of myo- and d-chiro-inositol is an effective and safe strategy for improving glycemic control in T2DM.

References

    1. Pak Y., Huang L. C., Lilley K. J., Larner J. In vivo conversion of [3H]myoinositol to [3H]chiroinositol in rat tissues. The Journal of Biological Chemistry. 1992;267(24):16904–16910.
    1. Ortmeyer H. K., Huang L. C., Zhang L., Hansen B. C., Larner J. Chiroinositol deficiency and insulin resistance. II. Acute effects of D-chiroinositol administration in streptozotocin-diabetic rats, normal rats given a glucose load, and spontaneously insulin-resistant rhesus monkeys. Endocrinology. 1993;132(2):646–651.
    1. Ortmeyer H. K. Dietary myoinositol results in lower urine glucose and in lower postprandial plasma glucose in obese insulin resistant rhesus monkeys. Obesity Research. 1996;4(6):569–575. doi: 10.1002/j.1550-8528.1996.tb00271.x.
    1. Croze M. L., Soulage C. O. Potential role and therapeutic interests of myo-inositol in metabolic diseases. Biochimie. 2013;95(10):1811–1827. doi: 10.1016/j.biochi.2013.05.011.
    1. Larner J. D-chiro-inositol-its functional role in insulin action and its deficit in insulin resistance. International Journal of Experimental Diabetes Research. 2002;3(1):47–60. doi: 10.1080/15604280212528.
    1. Unfer V., Porcaro G. Updates on the myo-inositol plus D-chiro-inositol combined therapy in polycystic ovary syndrome. Expert Review of Clinical Pharmacology. 2014;7(5):623–631. doi: 10.1586/17512433.2014.925795.
    1. Dinicola S., Chiu T. T. Y., Unfer V., Carlomagno G., Bizzarri M. The rationale of the myo-inositol and D-chiro-inositol combined treatment for polycystic ovary syndrome. Journal of Clinical Pharmacology. 2014;54:1079–1092. doi: 10.1002/jcph.362.
    1. Unfer V., Carlomagno G., Dante G., Facchinetti F. Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology. 2012;28(7):509–515. doi: 10.3109/09513590.2011.650660.
    1. Giordano D., Corrado F., Santamaria A., et al. Effects of myo-inositol supplementation in postmenopausal women with metabolic syndrome: a perspective, randomized, placebo-controlled study. Menopause. 2011;18(1):102–104. doi: 10.1097/gme.0b013e3181e8e1b1.
    1. Santamaria A., Giordano D., Corrado F., et al. One-year effects of myo-inositol supplementation in postmenopausal women with metabolic syndrome. Climacteric. 2012;15(5):490–495. doi: 10.3109/13697137.2011.631063.
    1. Crawford T. J., Crowther C. A., Alsweiler J., Brown J. Antenatal dietary supplementation with myo-inositol in women during pregnancy for preventing gestational diabetes. The Cochrane Database of Systematic Reviews. 2015;(12) doi: 10.1002/14651858.CD011507.CD011507
    1. Santamaria A., Di Benedetto A., Petrella E., et al. Myo-inositol may prevent gestational diabetes onset in overweight women: a randomized, controlled trial. Journal of Maternal-Fetal and Neonatal Medicine. 2015;23:1–4. doi: 10.3109/14767058.2015.1121478.
    1. D'Anna R., Di Benedetto A., Scilipoti A., et al. Myo-inositol supplementation for prevention of gestational diabetes in obese pregnant women: a randomized controlled trial. Obstetrics & Gynecology. 2015;126(2):310–315. doi: 10.1097/aog.0000000000000958.
    1. D'Anna R., Scilipoti A., Giordano D., et al. 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. 2013;36(4):854–857. doi: 10.2337/dc12-1371.
    1. Corrado F., D'Anna R., di Vieste G., et al. The effect of myoinositol supplementation on insulin resistance in patients with gestational diabetes. Diabetic Medicine. 2011;28(8):972–975. doi: 10.1111/j.1464-5491.2011.03284.x.
    1. Lubin V., Shojai R., Darmon P., Cosson E. A pilot study of gestational diabetes mellitus not controlled by diet alone: first-line medical treatment with myoinositol may limit the need for insulin. Diabetes & Metabolism. 2016;42(3):192–195. doi: 10.1016/j.diabet.2016.01.005.
    1. Samuel V. T., Shulman G. I. Mechanisms for insulin resistance: common threads and missing links. Cell. 2012;148(5):852–871. doi: 10.1016/j.cell.2012.02.017.
    1. Campbell I. W., Howlett H. C. S. Worldwide experience of metformin as an effective glucose-lowering agent: a meta-analysis. Diabetes/Metabolism Reviews. 1995;11(supplement 1):S57–S62. doi: 10.1002/dmr.5610110509.
    1. Johansen K. Efficacy of metformin in the treatment of NIDDM: meta-analysis. Diabetes Care. 1999;22(1):33–37. doi: 10.2337/diacare.22.1.33.
    1. Turner R. C., Cull C. A., Frighi V., Holman R. R. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999;281(21):2005–2012.
    1. Nathan D. M., Buse J. B., Davidson M. B., et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193–203. doi: 10.2337/dc08-9025.
    1. Perk J., DeBacker G., Gohlke H., et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) European Heart Journal. 2012;33(13):1635–1701. doi: 10.1093/eurheartj/ehs092.
    1. Standards of medical care in diabetes-2016. Diabetes Care. 2016;39(supplement 1)
    1. Sun T.-H., Heimark D. B., Nguygen T., Nadler J. L., Larner J. Both myo-inositol to chiro-inositol epimerase activities and chiro-inositol to myo-inositol ratios are decreased in tissues of GK type 2 diabetic rats compared to Wistar controls. Biochemical and Biophysical Research Communications. 2002;293(3):1092–1098. doi: 10.1016/s0006-291x(02)00313-3.
    1. International Diabetes Federation. 2015, .
    1. Shichiri M., Kishikawa H., Ohkubo Y., Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000;23(supplement 2):B21–B29.
    1. Holman R. R., Paul S. K., Bethel M. A., Matthews D. R., Neil H. A. W. 10-Year follow-up of intensive glucose control in type 2 diabetes. The New England Journal of Medicine. 2008;359(15):1577–1589. doi: 10.1056/nejmoa0806470.
    1. Monami M., Lamanna C., Marchionni N., Mannucci E. Comparison of different drugs as add-on treatments to metformin in type 2 diabetes: a meta-analysis. Diabetes Research and Clinical Practice. 2008;79(2):196–203. doi: 10.1016/j.diabres.2007.08.024.
    1. Liu S.-C., Tu Y.-K., Chien M.-N., Chien K.-L. Effect of antidiabetic agents added to metformin on glycaemic control, hypoglycaemia and weight change in patients with type 2 diabetes: a network meta-analysis. Diabetes, Obesity and Metabolism. 2012;14(9):810–820. doi: 10.1111/j.1463-1326.2012.01606.x.
    1. Sudchada P., Saokaew S., Sridetch S., Incampa S., Jaiyen S., Khaithong W. 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 Research and Clinical Practice. 2012;98(1):151–158. doi: 10.1016/j.diabres.2012.05.027.
    1. Agostini R., Rossi F., Pajalich R. Myoinositol/folic acid combination for the treatment of erectile dysfunction in type 2 diabetes men: a double-blind, randomized, placebo-controlled study. European Review for Medical and Pharmacological Sciences. 2006;10(5):247–250.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться