GLUCOSAMINE ET DIABETE
Transcription
GLUCOSAMINE ET DIABETE
GLUCOSAMINE ET DIABETE QUESTION : Est-ce que la glucosamine est contre-indiquée chez les diabétiques? AUTEUR : Mélanie Lecault (FÉVRIER 2008) P : population adulte souffrant d’arthrose et de diabète I : glucosamine C : placebo O : contrôle de la glycémie CONTEXTE : Question suscitée lors de la réalisation d’un PICO sur la glucosamine et l’ostéoarthrite. J’avais aussi une notion lointaine que la glucosamine était contre-indiquée chez les diabétiques à cause de l’effet sur la glycémie. RECHERCHE : Cochrane : glucosamine AND diabetes (7 résultats; 0 pertinent) DARE : glucosamine AND diabetes (0 résultat) CRCT: glucosamine AND diabetes (45 résultats; 3 pertinents) PubMed : glucosamine AND diabetes limité aux «clinical trials» et aux «randomized controlled trials» (67 résultats; 4 pertinents dont 3 trouvés dans le CRCT et une exclue car infusion de glucosamine Trip Database : glucosamine (1 résultat, et deux liens pertinents) RESULTATS : 1) Muniyappa R, Karne RJ, Hall G, Crandon SK, Bronstein JA, Ver MR, Hortin GL, Quon MJ. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes 2006; 55(11):3142-50. Glucosamine is a popular nutritional supplement used to treat osteoarthritis. Intravenous administration of glucosamine causes insulin resistance and endothelial dysfunction. However, rigorous clinical studies evaluating the safety of oral glucosamine with respect to metabolic and cardiovascular pathophysiology are lacking. Therefore, we conducted a randomized, placebocontrolled, double-blind, crossover trial of oral glucosamine at standard doses (500 mg p.o. t.i.d.) in lean (n = 20) and obese (n = 20) subjects. Glucosamine or placebo treatment for 6 weeks was followed by a 1-week washout and crossover to the other arm. At baseline, and after each treatment period, insulin sensitivity was assessed by hyperinsulinemic-isoglycemic glucose clamp (SI(Clamp)) and endothelial function evaluated by brachial artery blood flow (BAF; Doppler ultrasound) and forearm skeletal muscle microvascular recruitment (ultrasound with microbubble contrast) before and during steady-state hyperinsulinemia. Plasma glucosamine pharmacokinetics after oral dosing were determined in each subject using a high-performance liquid chromatography method. As expected, at baseline, obese subjects had insulin resistance and endothelial dysfunction when compared with lean subjects (SI(Clamp) [median {25th-75th percentile}] = 4.3 [2.9-5.3] vs. 7.3 [5.7-11.3], P < 0.0001; insulin-stimulated changes in BAF [% over basal] = 12 [-6 to 84] vs. 39 [2-108], P < 0.04). Leur conclusion: When compared with placebo, glucosamine did not cause insulin resistance or endothelial dysfunction in lean subjects or significantly worsen these findings in obese subjects. The half-life of plasma glucosamine after oral dosing was approximately 150 min, with no significant changes in steady-state glucosamine levels detectable after 6 weeks of therapy. We conclude that oral glucosamine at standard doses for 6 weeks does not cause or significantly worsen insulin resistance or endothelial dysfunction in lean or obese subjects. 2) Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Archives of internal medicine 2003; 163(13): 1587-90. BACKGROUND: With increasing use of glucosamine-containing supplements for the treatment of osteoarthritis, there is increasing concern in the medical community about possible toxic effects. The present study was undertaken to determine whether glucosamine supplementation altered hemoglobin A1c concentrations in patients with well-controlled diabetes mellitus. OBJECTIVE: To evaluate possible effects of glucosamine supplementation on glycemic control in a selected population of patients with type 2 diabetes mellitus. DESIGN: Placebo-controlled, double-blinded, randomized clinical trial. SETTING: Outpatient, diabetes monitoring clinic. PATIENTS: Patients were typically elderly patients, evenly divided between men and women. Most of the patients were being treated with 1 or 2 drugs for glycemic control. INTERVENTION: In daily doses for 90 days, patients received either placebo or a combination of 1500 mg of glucosamine hydrochloride with 1200 mg of chondroitin sulfate (Cosamin DS; Nutramax Laboratories Inc, Edgewood, Md).Main Outcome Measure Hemoglobin A1c levels before and after 90 days of therapy. RESULTS: There were 4 withdrawals from the glucosamine-treated group. Three were related to comorbidities (myocardial infarction, congestive heart failure, and atrial fibrillation) and 1 to a possible adverse reaction (excessive flatus). No other patient reported any adverse effects of glucosamine therapy, and no patient had any change in their diabetes management. Mean hemoglobin A1c concentrations were not significantly different between groups prior to glucosamine therapy. Posttreatment hemoglobin A1c concentrations were not significantly different between groups, nor were there any significant differences within groups before and after treatment. CONCLUSION: This study demonstrates that oral glucosamine supplementation does not result in clinically significant alterations in glucose metabolism in patients with type 2 diabetes mellitus. CONCLUSION: La glucosamine en hautes doses par voie intraveineuse (Monauni et al 2000) cause une augmentation de la résistance à l’insuline chez les animaux et les humains en interférant avec la régulation du transport du glucose. L’étude de Muniyappa et al n’a pas montré de détérioration de la résistance à l’insuline chez des sujets non-diabétiques. Malgré qu’il s’agit d’une étude bien conçue, les sujets diabétiques étaient exclus, et la durée ne nous permet pas de conclure à l’innocuité de la glucosamine, puisque les patients l’utilisent en général pour plus de six semaines. L’étude de Scroggie et al impliquait des patients dont le diabète était bien contrôlé et stable. L’étude était très petite (n=22 et n=12). La maladie semblait légèrement moins sévère dans le groupe placebo puisque ce groupe prenait moins d’hypoglycémiants oraux, mais les valeurs d’HbA1c étaient semblables. L’étude était courte encore une fois (trois mois) et ne permet pas de se prononcer sur l’utilisation de la glucosamine à long terme. Une autre étude (Albert et al 2007) encore plus courte (deux semaines) et très petite (n=12) n’ont pas démontré d’effet délétère de la glucosamine chez les diabétiques. Donc, les études ayant examiné l’effet de la glucosamine orale sur le contrôle glycémique, chez les patients diabétiques ou non, n’ont pas démontré d’effet néfaste. Cependant, les études sont peu nombreuses et très courtes. Nous ne pouvons donc pas nous prononcer sur l’effet de la glucosamine à long terme. Des opinions d’experts (Marshall et al 2006; Trip Database) affirment qu’aucune donnée ne porte à croire que l’effet à long terme serait différent de l’effet observé à court terme chez les diabétiques. On recommande quand même une surveillance plus étroite de la glycémie lors de l’introduction de la glucosamine. Il faut toutefois être prudent chez les non-diabétiques car il serait possible que la glucosamine aggrave l’intolérance au glucose chez des patients nondiagnostiqués (Biggee et al). Autres références non citées en entier ci-haut: Albert SG et al. The effect of glucosamine on serum HDL cholesterol and apolipoprotein A1 levels in people with diabetes. Diabetes Care 2007; 30(11): 2800-3. Biggee BA et al. Effects of oral glucosamine sulphate on serum glucose and insulin during an oral glucose tolerance test of subjects with osteoarthritis. Annals of Rheumatic Diseases 2007: 66: 260-2. Marshall PD,Tweed EM. Do glucosamine and chondroitin worsen blood sugar control in diabetes? The Journal of Family Practice 2006;55 (12):1091-3. Monauni T et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes 2000; 49: 926-35. Trip Database: Can glucosamine worsen control in type 2 diabetes? [http://www.clinicalanswers.nhs.uk/index.cfm?question=7494]. Date de parution: 6 février 2008. Consulté : 23 février 2008. Question: Can glucosamine worsen control in type 2 diabetes? Answer:In 2002 UK Medicine Information, as part of their FAQ series, answered the question “Is it safe for people with diabetes to take glucosamine?”. We recommend you read the full article, although the summary paragraph states:“Whilst further long-term safety studies are needed for glucosamine, existing data does not indicate that oral administration adversely affects hyperglycaemic control in diabetes. Nevertheless, it would be prudent to monitor the diabetic patient for altered response if they start taking glucosamine.” A 2005 article ‘An Evidence-based Systemic Review of Glucosamine Conducted by the Natural Standard Research Collaboration’ [2], this reports: “… The effect of glucosamine on glucose levels or insulin resistance has been controversial, and it remains unclear if interactions with agents possessing glycemic properties may occur. Despite initial concerns about use in diabetic patients based largely on in vitro and rat studies noting insulin resistance and possible glycemic effects and preliminary human work, more recent human research reports no significant effects (including on hemoglobin A1c levels in patients with type 2 diabetes after 90 days of therapy). Clinically relevant effects on blood sugars have not been noted in several clinical trials.” A 2006 UK Medicines Information article ‘Glucosamine – what are the adverse effects?’ [3], includes the following:“Glucosamine does not appear to adversely affect plasma blood glucose in patients without diabetes. However, data relating to its effects in patients with diabetes are lacking. It may be wise for patients with diabetes to monitor their blood glucose levels more closely if they start to take glucosamine, increase their dose or change the product taken.” Finally, also in 2006, the American Family Physicians Inquiries Network reported [4]:“Despite theoretical risks based on animal models given high intravenous doses, glucosamine/chondroitin (1500 mg/1200 mg daily) does not adversely affect short-term glycemic control for patients whose diabetes is well-controlled, or for those without diabetes or glucose intolerance (SOR: A, consistent, good-quality patient-oriented evidence). Some preliminary evidence suggests that glucosamine may worsen glucose intolerance for patients with untreated or undiagnosed glucose intolerance or diabetes (SOR: C, extrapolation from disease-oriented evidence). Long-term effects are unknown; however, no compelling theoretical or incidental data suggest that long-term results should be different (SOR: C, expert opinion). Further studies are required to clarify the effects of glucosamine on patients with poorly controlled diabetes or glucose intolerance.”