A study of central serotoninergic activity in healthy subjects and patients with Type 2 diabetes treated by traditional one-to-one care or Group Care.
OBJECTIVE
Central serotoninergic activity may modulate glucose metabolism via neuroendocrine effectors. Group Care is a clinico-pedagogic intervention that improves metabolic control and quality of life in Type 2 diabetes through lifestyle modification and, possibly, central mechanisms. The hypothesis that central serotoninergic activity is modified in patients followed by Group Care was tested by measuring their hypothalamic- pituitary-adrenal response to citalopram, a selective serotonin reuptake inhibitor.


METHODS
Ten healthy controls and 17 non-obese, non-insulin-treated patients with Type 2 diabetes received, in random order, iv infusions of either 20 mg citalopram or saline. Nine patients had been longterm on Group Care and 8 had always been on traditional one-to-one care. Circulating glucose, insulin, ACTH, cortisol, DHEA, GH and PRL were measured every 15 min for 240 min. Differences between areas under the curves after citalopram and saline (Δ-AUC) were calculated.


RESULTS
Citalopram stimulated ACTH and cortisol secretion in healthy subjects (p=0.026 and p=0.011, respectively) and patients on Group Care (p=0.056 and p=0.038) but not in patients on traditional care. In healthy subjects, basal glucose correlated with growth hormone Δ- AUC (r=0.820; p=0.004) and inversely with insulin Δ-AUC (r=-0.822; p=0.003). The former correlation was preserved in the patients (r=0.637; p=0.026).


CONCLUSIONS
Diabetes may blunt the response of the hypothalamic-pituitary-adrenal axis to citalopram, but this is preserved in patients followed by a long-term intervention model that improves clinical as well as cognitive and emotional variables.
Trento
M
M
Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Corso A.M. Dogliotti 14, Turin, Italy. marina.trento@unito.it
Kucich
C
C
Tibaldi
P
P
Gennari
S
S
Tedesco
S
S
Balbo
M
M
Arvat
E
E
Cavallo
F
F
Ghigo
E
E
Porta
M
M
D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D002490:Central Nervous System / Q000378:metabolism* / Q000502:physiology; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects; D003863:Depression / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000628:therapy*; D005260:Female; D006262:Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D010379:Peer Group; D057285:Precision Medicine / Q000379:methods; D012657:Self-Help Groups; D012701:Serotonin / Q000378:metabolism* / Q000502:physiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects
D000928:Antidepressive Agents; D015283:Citalopram; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors