title: Transaminase levels in the upper normal range are associated with oral hypoglycemic drug therapy failure in patients with type 2 diabetes.
abstract: Incident diabetes and the worsening of diabetes have recently been linked to hepatic steatosis. Aim of our study was to determine whether oral hypoglycemic agent failure is associated with higher transaminase levels (valid measure of liver steatosis). We selected 200 patients, attenders (3 consecutive annual evaluations) in our clinic, with type 2 diabetes among which 100 with oral hypoglycemic agents failure and 100 who were still responsive to oral therapy. Failure to therapy was defined as glycated hemoglobin >7.5% despite maximal-dose oral therapy. We analyzed patient histories and laboratory data. Compared with oral-therapy-responsive patients, those with failure had a significantly higher level mostly of alanine aminotransferase at the time of therapy failure and 2 years before. They were more likely to have had symptoms of hyperglycemia at the time of diabetes diagnosis. Regression analysis indicated that each 5-unit increase in transaminase levels independently increased the risk for oral hypoglycemic agents failure by 1.70. Higher liver transaminase levels, especially in patients who had symptomatic hyperglycemia at diabetes diagnosis, associate with oral hypoglycemic agent failure. The possible pathogenetic link between transaminase and declining islet function might consist of insulin resistance and increased circulating fatty acid levels, in turn causing liver steatosis and beta-cell dysfunction.
authors.affiliation: Gaetano Salvatore Department of Clinical and Experimental Medicine, Magna Græcia University, Catanzaro University Campus S. Venuta, 88100, Catanzaro, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Irace
authors.forename: Marco
authors.initials: M
authors.lastname: Rossetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Carallo
authors.forename: Susanna
authors.initials: S
authors.lastname: Morano
authors.forename: Viviana
authors.initials: V
authors.lastname: Vespertini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Mandosi
authors.forename: Marianna
authors.initials: M
authors.lastname: Maranghi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Fiorentino
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
authors.forename: Agostino
authors.initials: A
authors.lastname: Gnasso
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000201:enzymology*; D005234:Fatty Liver / Q000139:chemically induced; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure
chemical_list: D000410:Alanine Transaminase; D001219:Aspartate Aminotransferases; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents