515957 research-article2013
MSJ0010.1177/1352458513515957Multiple Sclerosis JournalWens et al.
MULTIPLE SCLEROSIS MSJ JOURNAL
Short Report
Does multiple sclerosis affect glucose tolerance?
Multiple Sclerosis Journal 2014, Vol. 20(9) 1273–1276 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1352458513515957 msj.sagepub.com
I Wens1, U Dalgas2, N Deckx3, N Cools3, and BO Eijnde1
Abstract Based on current literature, it is not clear if multiple sclerosis (MS) patients are at increased risk to develop impaired glucose tolerance (IGT). Eighty-one MS patients and 45 healthy controls (HC) performed an oral glucose tolerance test. IGT was defined as a fasting glucose concentration of 6.1–6.9 mmol/l and two-hour post-load glucose of 7.8–11.1 mmol/l. The prevalence of impaired fasting glucose concentrations (17% vs 2%) and IGT (11% vs 0%) was higher in MS patients than HC. Accordingly, the areas under the glucose and insulin curves were higher in MS patients. The current study demonstrates an elevated IGT-prevalence in MS. Keywords Impaired glucose tolerance, multiple sclerosis, insulin, diabetes type II Date received: 27 July 2013; revised: 11 November 2013; accepted: 28 November 2011
Introduction Multiple sclerosis (MS) is often characterised by a more sedentary lifestyle compared to healthy controls (HC).1 Although physical inactivity in HC is associated with an increased risk of impaired glucose tolerance (IGT),2 contributing to the development of type II diabetes, existing MS-literature is conflicting,3 with studies reporting an increased,4–6 similar7 or decreased8,9 prevalence of IGT and type II diabetes in MS. In addition, several studies reported only fasting glucose concentrations,10–13 which is insufficient to indicate IGT status since, according to the European Society of Cardiology, a two-hour oral glucose tolerance test (OGTT) is the preferable screening tool. Slawta and colleagues reported elevated fasting glucose concentrations in 8% of their female patients, which was similar to percentages reported for the general population.10 However, they were not able to confirm these results in a second study, demonstrating normal fasting glucose concentrations.11 Likewise, White et al. and Mähler et al. reported normal fasting glucose concentrations in small cohorts of MS patients.12,14 In addition, the latter stated that, after an OGTT, glucose tolerance was not impaired in 16 MS patients.14 In contrast, Sternberg and colleagues reported lower glucose concentrations in MS patients compared to HC and found positive correlations between glucose concentrations and Expanded Disability Status Scale (EDSS) as well as the rate of clinical relapses.13
In an attempt to clarify the heterogeneous results of the literature, the present cross-sectional controlled study aimed to investigate the prevalence of IGT, using an OGTT, in a large cohort of MS patients.
Methods Eighty-one MS patients, diagnosed according to the McDonald criteria (EDSS 0.5–6.0) and >18 years, and 45 HC participated in this study, providing a ~2:1 match for gender, age and body mass index (BMI). Exclusion criteria were diabetes mellitus type II and glucose-lowering therapies, other disorders (cardiovascular, pulmonary, renal diseases and cancer), pregnancy, participation in other 1REVAL
Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium 2Section of Sport Science, Department of Public Health, Aarhus University, Denmark 3Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Belgium Corresponding author: Inez Wens, REVAL – Rehabilitation Research Center, Biomedical Research Institute (BIOMED) Hasselt University, Agoralaan building A, Diepenbeek, B-3590, Belgium. Email: [email protected]
Downloaded from msj.sagepub.com at UNIV NEBRASKA LIBRARIES on April 3, 2015
1274
Multiple Sclerosis Journal 20(9)
Table 1. Subject and disease characteristics.
No. (M/F) Age (y) Height (m) Weight (kg) BMI (kg/m2) Smoker Physical activity (MET*h/week) EDSS Type MS (RR/CP) MS treatment (general) Immunomodulatory MS treatment Immunosuppressive MS treatment Hypertension treatment Cholesterol-lowering treatment Beta-blocker Antidepressant Muscle-relaxing drug Analgesics Somnifacient Anticonvulsant
HC
MS
p value
45 (14/31) 46 ± 1.8 1.69 ± 0.01 70.0 ± 1.8 24.4 ± 0.5 5% 18.9 ± 2.7 / / / / / 2% 2% 4% 2% 0% 2% 0% 0%
81 (31/50) 48 ± 1.1 1.69 ± 0.01 73.0 ± 1.5 25.3 ± 0.5 11% 18.9 ± 1.7 2.9 ± 0.14 65% / 35% 85% 77% 8% 10% 7% 3% 18% 19% 22% 6% 13%
/ NS NS NS NS NS NS / / / / / NS NS NS
MSJ0010.1177/1352458513515957Multiple Sclerosis JournalWens et al.
MULTIPLE SCLEROSIS MSJ JOURNAL
Short Report
Does multiple sclerosis affect glucose tolerance?
Multiple Sclerosis Journal 2014, Vol. 20(9) 1273–1276 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1352458513515957 msj.sagepub.com
I Wens1, U Dalgas2, N Deckx3, N Cools3, and BO Eijnde1
Abstract Based on current literature, it is not clear if multiple sclerosis (MS) patients are at increased risk to develop impaired glucose tolerance (IGT). Eighty-one MS patients and 45 healthy controls (HC) performed an oral glucose tolerance test. IGT was defined as a fasting glucose concentration of 6.1–6.9 mmol/l and two-hour post-load glucose of 7.8–11.1 mmol/l. The prevalence of impaired fasting glucose concentrations (17% vs 2%) and IGT (11% vs 0%) was higher in MS patients than HC. Accordingly, the areas under the glucose and insulin curves were higher in MS patients. The current study demonstrates an elevated IGT-prevalence in MS. Keywords Impaired glucose tolerance, multiple sclerosis, insulin, diabetes type II Date received: 27 July 2013; revised: 11 November 2013; accepted: 28 November 2011
Introduction Multiple sclerosis (MS) is often characterised by a more sedentary lifestyle compared to healthy controls (HC).1 Although physical inactivity in HC is associated with an increased risk of impaired glucose tolerance (IGT),2 contributing to the development of type II diabetes, existing MS-literature is conflicting,3 with studies reporting an increased,4–6 similar7 or decreased8,9 prevalence of IGT and type II diabetes in MS. In addition, several studies reported only fasting glucose concentrations,10–13 which is insufficient to indicate IGT status since, according to the European Society of Cardiology, a two-hour oral glucose tolerance test (OGTT) is the preferable screening tool. Slawta and colleagues reported elevated fasting glucose concentrations in 8% of their female patients, which was similar to percentages reported for the general population.10 However, they were not able to confirm these results in a second study, demonstrating normal fasting glucose concentrations.11 Likewise, White et al. and Mähler et al. reported normal fasting glucose concentrations in small cohorts of MS patients.12,14 In addition, the latter stated that, after an OGTT, glucose tolerance was not impaired in 16 MS patients.14 In contrast, Sternberg and colleagues reported lower glucose concentrations in MS patients compared to HC and found positive correlations between glucose concentrations and Expanded Disability Status Scale (EDSS) as well as the rate of clinical relapses.13
In an attempt to clarify the heterogeneous results of the literature, the present cross-sectional controlled study aimed to investigate the prevalence of IGT, using an OGTT, in a large cohort of MS patients.
Methods Eighty-one MS patients, diagnosed according to the McDonald criteria (EDSS 0.5–6.0) and >18 years, and 45 HC participated in this study, providing a ~2:1 match for gender, age and body mass index (BMI). Exclusion criteria were diabetes mellitus type II and glucose-lowering therapies, other disorders (cardiovascular, pulmonary, renal diseases and cancer), pregnancy, participation in other 1REVAL
Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium 2Section of Sport Science, Department of Public Health, Aarhus University, Denmark 3Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Belgium Corresponding author: Inez Wens, REVAL – Rehabilitation Research Center, Biomedical Research Institute (BIOMED) Hasselt University, Agoralaan building A, Diepenbeek, B-3590, Belgium. Email: [email protected]
Downloaded from msj.sagepub.com at UNIV NEBRASKA LIBRARIES on April 3, 2015
1274
Multiple Sclerosis Journal 20(9)
Table 1. Subject and disease characteristics.
No. (M/F) Age (y) Height (m) Weight (kg) BMI (kg/m2) Smoker Physical activity (MET*h/week) EDSS Type MS (RR/CP) MS treatment (general) Immunomodulatory MS treatment Immunosuppressive MS treatment Hypertension treatment Cholesterol-lowering treatment Beta-blocker Antidepressant Muscle-relaxing drug Analgesics Somnifacient Anticonvulsant
HC
MS
p value
45 (14/31) 46 ± 1.8 1.69 ± 0.01 70.0 ± 1.8 24.4 ± 0.5 5% 18.9 ± 2.7 / / / / / 2% 2% 4% 2% 0% 2% 0% 0%
81 (31/50) 48 ± 1.1 1.69 ± 0.01 73.0 ± 1.5 25.3 ± 0.5 11% 18.9 ± 1.7 2.9 ± 0.14 65% / 35% 85% 77% 8% 10% 7% 3% 18% 19% 22% 6% 13%
/ NS NS NS NS NS NS / / / / / NS NS NS
