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.
Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Corso A.M. Dogliotti 14, Turin, Italy. marina.trento@unito.it
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M
Trento
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C
Kucich
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P
Tibaldi
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Gennari
S
S
Tedesco
M
M
Balbo
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Arvat
F
F
Cavallo
E
E
Ghigo
M
M
Porta
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