Journal
DIABETES
Volume 64, Issue 9, Pages 3273-3284Publisher
AMER DIABETES ASSOC
DOI: 10.2337/db15-0084
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Funding
- European Diabetes Foundation/Lilly post-doctoral fellowship
- National Institutes of Health (NIH) [5P60-DK-020541]
- Italian Ministry of University and Scientific Research (MIUR) fellowship
- National Science Foundation [CHE-1335708]
- MIUR [08:20082P8CCE_002]
- Progetti di Ateneo of Padua University
- NIH [P01-DK-054441, 1R01-DK-33861]
- JDRF [8-2003-784, 4-2004-804, 16-2006-501]
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The assumption underlying current diabetes treatment is that lowering the level of time-averaged glucose concentrations, measured as HbA(1c), prevents microvascular complications. However, 89% of variation in risk of retinopathy, microalbuminuria, or albuminuria is due to elements of glycemia not captured by mean HbA(1c) values. We show that transient exposure to high glucose activates a multicomponent feedback loop that causes a stable left shift of the glucose concentration-reactive oxygen species (ROS) dose-response curve. Feedback loop disruption by the GLP-1 cleavage product GLP-1(9-36)(amide) reverses the persistent left shift, thereby normalizing persistent overproduction of ROS and its pathophysiologic consequences. These data suggest that hyperglycemic spikes high enough to activate persistent ROS production during subsequent periods of normal glycemia but too brief to affect the HbA(1c) value are a major determinant of the 89% of diabetes complications risk not captured by HbA(1c). The phenomenon and mechanism described in this study provide a basis for the development of both new biomarkers to complement HbA(1c) and novel therapeutic agents, including GLP-1(9-36)(amide), for the prevention and treatment of diabetes complications.
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