Early changes in respiratory quotient and resting energy expenditure predict later weight changes in patients treated for poorly controlled type 2 diabetes

Abstract Aim This study looked at whether early changes in resting energy expenditure (REE) and respiratory quotient (RQ) are correlated with later weight changes in patients with type 2 diabetes (T2D) being treated with insulin or GLP-1 analogues, or diet. Methods A total of 67 patients (age: 57±9 years; BMI: 33.7±5.0kg/m 2 ; HbA 1c : 9.9±1.5%) began taking an insulin analogue at bedtime (INS, n =28; initial dose: 0.2 IU/kg) or a GLP-1 analogue (GLP-1, n =23), or only a dietary intervention (diet, n =16; restricted carbohydrates and calories). Their respiratory exchanges were monitored on days 0, 1 and 2 before breakfast. Results Two days after starting the bedtime insulin analogue, fasting glycaemia improved (INS: −65±41mg/dL; GLP-1: −29±48mg/dL; diet: −31±46mg/dL; P P P P P 1c improved (INS, n =16: −1.7±1.4%; GLP-1, n =12: −2.1±1.4%; diet, n =5: −1.7±2.8%; NS), while weight changes differed (INS: +1.5±4.3kg; GLP-1: −2.8±2.8kg; diet: −2.2±2.7kg; P P P P Conclusion In poorly controlled patients with T2D and two days after the introduction of a bedtime insulin analogue, REE decreased by −9% while RQ increased by +5%, pointing to a reduction of lipid oxidation. These changes were predictive of later weight gain.