Sarbolouki S, Javanbakht MH, Derakhshanian H, Hosseinzadeh P, Zareei M, Hashemi SB, Dorosty AR, Eshraghian MR, Djalali M
Correspondence: Dr Mahmoud Djalali, mjalali87@yahoo.com
ABSTRACT
Introduction Diabetes mellitus is the most common metabolic disorder in humans, and its incidence is increasing rapidly worldwide. Although polyunsaturated fatty acids have beneficial effects on diabetes mellitus, previous data regarding the possible positive effects of n-3 fatty acids on glycaemic indices were inconclusive. We conducted a double-blind randomised clinical trial to determine the effects of eicosapentaenoic acid (EPA), an n-3 polyunsaturated fatty acid, on overweight patients with type 2 diabetes mellitus (T2DM).
Methods This double-blind, placebo-controlled randomised clinical trial was conducted on a total of 67 overweight patients with T2DM for a duration of three months. Of these 67 patients, 32 received 2 g purified EPA daily, while 35 received a placebo of 2 g corn oil daily. The patients’ fasting plasma glucose (FPG), serum insulin, glycated haemoglobin (HbA1c) and insulin sensitivity indices were assessed.
Results After three months of EPA supplementation, the group that received EPA showed significant decreases in FPG (p < 0.001), HbA1c (p = 0.01) and homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.032), when compared to the placebo group. EPA supplementation resulted in decreased serum insulin levels, with the levels between the EPA and placebo groups showing a significant difference (p = 0.004).
Conclusion The results of our study indicate that EPA supplementation could improve insulin sensitivity. It was able to decrease serum insulin, FPG, HbA1c and HOMA-IR. EPA could have beneficial effects on glycaemic indices in patients with T2DM.
Keywords: diabetes mellitus, eicosapentaenoic acid, insulin sensitivity
Singapore Med J 2013; 54(7): 387-390; http://dx.doi.org/10.11622/smedj.2013139
REFERENCES
1. International Diabetes Federation. Diabetes Atlas. Belgium: IDF, 2000. | ||||
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-53. http://dx.doi.org/10.2337/diacare.27.5.1047 | ||||
3. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352:837-53. http://dx.doi.org/10.1016/S0140-6736(98)07019-6 | ||||
4. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321:405-12. http://dx.doi.org/10.1136/bmj.321.7258.405 | ||||
5. Nettleton JA, Katz R. n-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review. J Am Diet Assoc 2005; 105:428-40. http://dx.doi.org/10.1016/j.jada.2004.11.029 | ||||
6. Sirtori CR, Crepaldi G, Manzato E, et al. One-year treatment with ethyl esters of n-3 fatty acids in patients with hypertriglyceridemia and glucose intolerance: reduced triglyceridemia, total cholesterol and increased HDL-C without glycaemic alterations. Atherosclerosis 1998; 137:419-27. http://dx.doi.org/10.1016/S0021-9150(97)00298-0 | ||||
7. Borkman M, Chisholm DJ, Furler SM, et al. Effects of fish oil supplementation on glucose and lipid metabolism in NIDDM. Diabetes 1989; 38:1314-9. http://dx.doi.org/10.2337/diabetes.38.10.1314 | ||||
8. Vessby B. n-3 fatty acids and blood glucose control in diabetes mellitus. J Intern Med Suppl 1989; 731:207-10. | ||||
9. Axelrod L, Camuso J, Williams E, et al. Effects of a small quantity of omega-3 fatty acids on cardiovascular risk factors in NIDDM. A randomized, prospective, double33 blind, controlled study. Diabetes Care 1994; 17:37-44. http://dx.doi.org/10.2337/diacare.17.1.37 | ||||
10. Browning LM, Krebs JD, Moore CS, et al. The impact of long chain n-3 polyunsaturated fatty acid supplementation on inflammation, insulin sensitivity and CVD risk in a group of overweight women with an inflammatory phenotype. Diabetes Obes Metab 2007; 9:70-80. http://dx.doi.org/10.1111/j.1463-1326.2006.00576.x | ||||
11. Navas-Carretero S, Pérez-Granados AM, Schoppen S, Vaquero MP. An oily fish diet increases insulin sensitivity compared to a red meat diet in young iron-deficient women. Br J Nutr 2009; 102:546-53. http://dx.doi.org/10.1017/S0007114509220794 | ||||
12. Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self management education. Diabetes Care 2012; 35 suppl 1:S101-S8. http://dx.doi.org/10.2337/dc12-s101 | ||||
13. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28:412-9. http://dx.doi.org/10.1007/BF00280883 | ||||
14. Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85:2402-10. http://dx.doi.org/10.1210/jc.85.7.2402 | ||||
15. Kaushik M, Mozaffarian D, Spiegelman D, et al. Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus. Am J Clin Nutr 2009; 90:613-20. http://dx.doi.org/10.3945/ajcn.2008.27424 | ||||
16. Heine RJ. Dietary fish oil and insulin action in humans. Ann N Y Acad Sci 1993; 683:110-21. http://dx.doi.org/10.1111/j.1749-6632.1993.tb35698.x | ||||
17. Connor WE, Prince MJ, Ullmann D, et al. The hypotriglyceridemic effect of fish oil in adult-onset diabetes without adverse glucose control. Ann N Y Acad Sci 1993; 683:337-40. http://dx.doi.org/10.1111/j.1749-6632.1993.tb35725.x | ||||
18. Mori TA, Bao DQ, Burke V, et al. Dietary fish as a major component of a weight-loss diet: effect on serum lipids, glucose, and insulin metabolism in overweight hypertensive subjects. Am J Clin Nutr 1999; 70:817-25. | ||||
19. Egert S, Fobker M, Andersen G, et al. Effects of dietary-linolenic acid, eicosapentaenoic acid or docosahexaenoic acid on parameters of glucose metabolism in healthy volunteers. Ann Nutr Metab 2008; 53:182-7. http://dx.doi.org/10.1159/000172980 | ||||
20. Mahmoudabadi MM, Djalali M, Djazayery SA, et al. Effects of eicosapentaenoic acid and vitamin C on glycaemic indices, blood pressure, and serum lipids in type 2 diabetic Iranian males. J Res Med Sci 2011; 16 suppl 1:S361-7. | ||||
21. Griffin MD, Sanders TA, Davies IG, et al. Effects of altering the 1 ratio of dietary n-6 to n-3 fatty acids on insulin sensitivity, lipoprotein size, and postprandial lipemia in men and postmenopausal women aged 45-70 y: the OPTILIP Study. Am J Clin Nutr 2006; 84:1290-8. | ||||
22. Rasic-Milutinovic Z, Perunicic G, Pljesa S, et al. Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients. Ren Fail 2007; 29:321-9. http://dx.doi.org/10.1080/08860220601184092 | ||||
23. Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr 2006; 83 (6 suppl):1505S-19S. | ||||
24. Lichtenstein AH, Schwab US. Relationship of dietary fat to glucose metabolism. Atherosclerosis 2000; 150:227-43. http://dx.doi.org/10.1016/S0021-9150(99)00504-3 | ||||
25. Nugent C, Prins JB, Whitehead JP, et al. Arachidonic acid stimulates glucose uptake in 3T3-L1 adipocytes by increasing GLUT1 and GLUT4 levels at the plasma membrane. Evidence for involvement of lipoxygenase metabolites and peroxisome proliferator-activated receptor gamma. J Biol Chem 2001; 276:9149-57. http://dx.doi.org/10.1074/jbc.M009817200 | ||||
26. Figueras M, Olivan M, Busquets S, López-Soriano FJ, Argilés JM. Effects of eicosapentaenoic acid (EPA) treatment on insulin sensitivity in an animal model of diabetes: improvement of the inflammatory status. Obesity (Silver Spring) 2011; 19:362-9. http://dx.doi.org/10.1038/oby.2010.194 | ||||
27. Menzaghi C, Trischitta V, Doria A. Genetic influences of adiponectin on insulin resistance, type 2 diabetes, and cardiovascular disease. Diabetes 2007; 56:1198-209. http://dx.doi.org/10.2337/db06-0506 | ||||
28. Rosenson RS. Effects of peroxisome proliferator-activated receptors on lipoprotein metabolism and glucose control in type 2 diabetes mellitus. Am J Cardiol 2007; 99:96B-104B. http://dx.doi.org/10.1016/j.amjcard.2006.11.010 |