TY - JOUR
T1 - Genotype-stratified treatment for monogenic insulin resistance
T2 - a systematic review
AU - Semple, Robert K.
AU - Patel, Kashyap A.
AU - Auh, Sungyoung
AU - Franks, Paul W.
AU - Rich, Stephen S.
AU - Wagner, Robert
AU - Vilsbøll, Tina
AU - Vesco, Kimberly K.
AU - Udler, Miriam S.
AU - Tuomi, Tiinamaija
AU - Sweeting, Arianne
AU - Sims, Emily K.
AU - Sherr, Jennifer L.
AU - Reynolds, Rebecca M.
AU - Redondo, Maria J.
AU - Redman, Leanne M.
AU - Pratley, Richard E.
AU - Pop-Busui, Rodica
AU - Pollin, Toni I.
AU - Perng, Wei
AU - Pearson, Ewan R.
AU - Ozanne, Susan E.
AU - Owen, Katharine R.
AU - Oram, Richard
AU - Murphy, Rinki
AU - Mohan, Viswanathan
AU - Misra, Shivani
AU - Meigs, James B.
AU - Mathioudakis, Nestoras
AU - Mathieu, Chantal
AU - Ma, Ronald C.W.
AU - Loos, Ruth J.F.
AU - Lim, Siew S.
AU - Laffel, Lori M.
AU - Kwak, Soo Heon
AU - Josefson, Jami L.
AU - Hood, Korey K.
AU - Hivert, Marie France
AU - Hirsch, Irl B.
AU - Hattersley, Andrew T.
AU - Nolan, John J.
AU - Njølstad, Pål Rasmus
AU - Nakabuye, Mariam
AU - Ried-Larsen, Mathias
AU - Hansen, Torben
AU - Guasch-Ferré, Marta
AU - Clemmensen, Christoffer
AU - Andersen, Mette K.
AU - Thuesen, Anne Cathrine B.
AU - Merino, Jordi
AU - ADA/EASD PMDI
N1 - Publisher Copyright:
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023. corrected publication 2024.
PY - 2023
Y1 - 2023
N2 - Background: Monogenic insulin resistance (IR) includes lipodystrophy and disorders of insulin signalling. We sought to assess the effects of interventions in monogenic IR, stratified by genetic aetiology. Methods: Systematic review using PubMed, MEDLINE and Embase (1 January 1987 to 23 June 2021). Studies reporting individual-level effects of pharmacologic and/or surgical interventions in monogenic IR were eligible. Individual data were extracted and duplicates were removed. Outcomes were analysed for each gene and intervention, and in aggregate for partial, generalised and all lipodystrophy. Results: 10 non-randomised experimental studies, 8 case series, and 23 case reports meet inclusion criteria, all rated as having moderate or serious risk of bias. Metreleptin use is associated with the lowering of triglycerides and haemoglobin A1c (HbA1c) in all lipodystrophy (n = 111), partial (n = 71) and generalised lipodystrophy (n = 41), and in LMNA, PPARG, AGPAT2 or BSCL2 subgroups (n = 72,13,21 and 21 respectively). Body Mass Index (BMI) is lowered in partial and generalised lipodystrophy, and in LMNA or BSCL2, but not PPARG or AGPAT2 subgroups. Thiazolidinediones are associated with improved HbA1c and triglycerides in all lipodystrophy (n = 13), improved HbA1c in PPARG (n = 5), and improved triglycerides in LMNA (n = 7). In INSR-related IR, rhIGF-1, alone or with IGFBP3, is associated with improved HbA1c (n = 17). The small size or absence of other genotype-treatment combinations preclude firm conclusions. Conclusions: The evidence guiding genotype-specific treatment of monogenic IR is of low to very low quality. Metreleptin and Thiazolidinediones appear to improve metabolic markers in lipodystrophy, and rhIGF-1 appears to lower HbA1c in INSR-related IR. For other interventions, there is insufficient evidence to assess efficacy and risks in aggregated lipodystrophy or genetic subgroups.
AB - Background: Monogenic insulin resistance (IR) includes lipodystrophy and disorders of insulin signalling. We sought to assess the effects of interventions in monogenic IR, stratified by genetic aetiology. Methods: Systematic review using PubMed, MEDLINE and Embase (1 January 1987 to 23 June 2021). Studies reporting individual-level effects of pharmacologic and/or surgical interventions in monogenic IR were eligible. Individual data were extracted and duplicates were removed. Outcomes were analysed for each gene and intervention, and in aggregate for partial, generalised and all lipodystrophy. Results: 10 non-randomised experimental studies, 8 case series, and 23 case reports meet inclusion criteria, all rated as having moderate or serious risk of bias. Metreleptin use is associated with the lowering of triglycerides and haemoglobin A1c (HbA1c) in all lipodystrophy (n = 111), partial (n = 71) and generalised lipodystrophy (n = 41), and in LMNA, PPARG, AGPAT2 or BSCL2 subgroups (n = 72,13,21 and 21 respectively). Body Mass Index (BMI) is lowered in partial and generalised lipodystrophy, and in LMNA or BSCL2, but not PPARG or AGPAT2 subgroups. Thiazolidinediones are associated with improved HbA1c and triglycerides in all lipodystrophy (n = 13), improved HbA1c in PPARG (n = 5), and improved triglycerides in LMNA (n = 7). In INSR-related IR, rhIGF-1, alone or with IGFBP3, is associated with improved HbA1c (n = 17). The small size or absence of other genotype-treatment combinations preclude firm conclusions. Conclusions: The evidence guiding genotype-specific treatment of monogenic IR is of low to very low quality. Metreleptin and Thiazolidinediones appear to improve metabolic markers in lipodystrophy, and rhIGF-1 appears to lower HbA1c in INSR-related IR. For other interventions, there is insufficient evidence to assess efficacy and risks in aggregated lipodystrophy or genetic subgroups.
U2 - 10.1038/s43856-023-00368-9
DO - 10.1038/s43856-023-00368-9
M3 - Journal article
AN - SCOPUS:85174334890
VL - 3
JO - Communications Medicine
JF - Communications Medicine
SN - 2730-664X
IS - 1
M1 - 134
ER -