Genotype-stratified treatment for monogenic insulin resistance: a systematic review

Robert K. Semple, Edinburgh Medical School
Kashyap A. Patel, University of Exeter Medical School
Sungyoung Auh, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Paul W. Franks, Harvard T.H. Chan School of Public Health
Stephen S. Rich, University of Virginia School of Medicine
Robert Wagner, Deutsches Diabetes-Zentrum
Tina Vilsbøll, Steno Diabetes Center Copenhagen
Kimberly K. Vesco, Kaiser Permanente Center for Health Research
Miriam S. Udler, Massachusetts General Hospital
Tiinamaija Tuomi, Helsinki University Hospital
Arianne Sweeting, Faculty of Medicine and Health
Emily K. Sims, Indiana University School of Medicine
Jennifer L. Sherr, Yale School of Medicine
Rebecca M. Reynolds, Edinburgh Medical School
Maria J. Redondo, Baylor College of Medicine
Leanne M. Redman, Pennington Biomedical Research Center
Richard E. Pratley, AdventHealth Translational Research Institute
Rodica Pop-Busui, University of Michigan Medical School
Toni I. Pollin, University of Maryland School of Medicine
Wei Perng, University of Colorado Anschutz Medical Campus
Ewan R. Pearson, University of Dundee School of Medicine
Susan E. Ozanne, University of Cambridge
Katharine R. Owen, University of Oxford Medical Sciences Division
Richard Oram, University of Exeter Medical School
Rinki Murphy, Faculty of Medical and Health Sciences
Viswanathan Mohan, Madras Diabetes Research Foundation
Shivani Misra, Imperial College London
James B. Meigs, Harvard Medical School
Nestoras Mathioudakis, Johns Hopkins University School of Medicine
Chantal Mathieu, KU Leuven– University Hospital Leuven
Ronald C.W. Ma, Chinese University of Hong Kong
Ruth J.F. Loos, Novo Nordisk Foundation Center for Basic Metabolic Research
Siew S. Lim, Monash University
Lori M. Laffel, Harvard Medical School

Document Type

Article

Publication Date

12-1-2023

Abstract

Background: Monogenic insulin resistance (IR) includes lipodystrophy and disorders of insulin signalling. We sought to assess the effects of interventions in monogenic IR, stratified by genetic aetiology. Methods: Systematic review using PubMed, MEDLINE and Embase (1 January 1987 to 23 June 2021). Studies reporting individual-level effects of pharmacologic and/or surgical interventions in monogenic IR were eligible. Individual data were extracted and duplicates were removed. Outcomes were analysed for each gene and intervention, and in aggregate for partial, generalised and all lipodystrophy. Results: 10 non-randomised experimental studies, 8 case series, and 23 case reports meet inclusion criteria, all rated as having moderate or serious risk of bias. Metreleptin use is associated with the lowering of triglycerides and haemoglobin A1c (HbA1c) in all lipodystrophy (n = 111), partial (n = 71) and generalised lipodystrophy (n = 41), and in LMNA, PPARG, AGPAT2 or BSCL2 subgroups (n = 72,13,21 and 21 respectively). Body Mass Index (BMI) is lowered in partial and generalised lipodystrophy, and in LMNA or BSCL2, but not PPARG or AGPAT2 subgroups. Thiazolidinediones are associated with improved HbA1c and triglycerides in all lipodystrophy (n = 13), improved HbA1c in PPARG (n = 5), and improved triglycerides in LMNA (n = 7). In INSR-related IR, rhIGF-1, alone or with IGFBP3, is associated with improved HbA1c (n = 17). The small size or absence of other genotype-treatment combinations preclude firm conclusions. Conclusions: The evidence guiding genotype-specific treatment of monogenic IR is of low to very low quality. Metreleptin and Thiazolidinediones appear to improve metabolic markers in lipodystrophy, and rhIGF-1 appears to lower HbA1c in INSR-related IR. For other interventions, there is insufficient evidence to assess efficacy and risks in aggregated lipodystrophy or genetic subgroups.

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