Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 2, March-April, p. 333–338
doi: 10.17219/acem/61609
Publication type: original article
Language: English
Download citation:
L-carnitine treatment of insulin resistance: A systematic review and meta-analysis
1 Department of Gastroenterology, the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
2 Department of Anesthesiology, the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
3 Central Laboratory, the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
4 Department of Critical Care Medicine, the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
5 Department of Cardiac & Thoracic Surgery, the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
Abstract
Background. L-carnitine has been used for several years as an adjuvant therapy in oxidative stress, blood sugar, high-sensitivity C-reactive protein (CRP), anemia, etc. However, the efficacy of L-carnitine treating insulin resistance (IR) remains controversial. Homeostasis model assessment of Insulin Resistance (HOMA-IR) is widely used in the clinical evaluation of patients with IR.
Objectives. A meta-analysis, including randomized controlled trials (RCTs), was performed to assess the effect of L-carnitine on HOMA-IR patients.
Material and Methods. The Cochrane Library, PubMed, and EMBASE databases were systematically searched to identify RCTs which evaluated the effects of L-carnitine on HOMA-IR patients. We screened relevant studies according to predefined inclusion and exclusion criteria. In the selected articles, we extracted the data: study design, sample size, age, L-carnitine dose and regimen, body mass index (BMI) of patients, mode of administration, study duration and study outcomes.
Results. A total of 5 studies were included for the meta-analysis. The result showed L-carnitine was useful in the treatment of IR (WMD –0.724, CI –0.959 –0.488, p < 0.0001). Evaluation at 3, 6, 9, 12 months, the p-values were 0.875, 0.165, 0.031, 0, 007, respectively.
Conclusion. L-carnitine was useful in treating patients with IR. L-carnitine can treat IR more effectively with prolonging the medication time. However, more RCTs with long-term L-carnitine treatment of IR are needed to confirm the viewpoint.
Key words
insulin resistance, meta-analysis, L-carnitine
References (23)
- Shulman GI. Cellular mechanisms of insulin resistance. J Clin Invest. 2000;106:171–176.
- Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015;19:160–164.
- Güçlü F, Özmen B, Hekimsoy Z, Kirmaz C. Effects of a statin group drug, pravastatin, on the insulin resistance in patients with metabolic syn-drome. Biomed Pharmacother. 2004;58:614–618.
- Shores NJ,Keeffe EB. Is oral l-acyl-carnitine an effective therapy for hepatic encephalopathy? Review of the literature. Digestive Diseases and Sciences. 2008;53:2330–2333.
- Mingrone G. Carnitine in type 2 diabetes. Ann N Y Acad Sci. 2004; 1033:99–107.
- Bonora E, Targher G, Alberiche M, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: Studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23, 57–63.
- Mingorance C, Rodriguez-Rodriguez R, Justo ML, Alvarez de Sotomayor M, Herrera MD. Critical update for the clinical use of L-carnitine analogs in cardiometabolic disorders. Vasc Health Risk Manag. 2011, 7, 169–176.
- Takenaka T, Kanno Y, Ohno Y, Suzuki H. Key role of insulin resistance in vascular injury among hemodialysis patients. Metabolism. 2007; 56:153–159.
- Mihalik SJ, Goodpaster BH, Kelley DE, et al. Increased levels of plasma acylcarnitines in obesity and type 2 diabetes and identification of a marker of glucolipotoxicity. Obesity (Silver Spring). 2010; 18:1695–1700.
- Yang SK, Xiao L, Song PA, Xu X, Liu FY, Sun L. Effect of L-carnitine therapy on patients in maintenance hemodialysis: A systematic review and meta-analysis. J Nephrol. 2014;27:317–329.
- Molfino A, Cascino A, Conte C, Ramaccini C, Rossi Fanelli F, Laviano A. Caloric restriction and L-carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism. J Parenter Enteral Nutr. 2010;34:295–299.
- Malaguarnera M, Gargante MP, Russo C, et al. L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis: A randomized and controlled clinical trial. Am J Gastroenterol. 2010;105:1338–1345.
- Higgins JP and Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558.
- Bloomer RJ, Fisher-Wellman KH, Tucker PS. Effect of oral acetyl L-carnitine arginate on resting and postprandial blood biomarkers in pre-diabetics. Nutr Metab (Lond). 2009;6:25.
- Vaneckova I, Maletinska L, Behuliak M, Nagelova V, Zicha J, Kunes J. Obesity-related hypertension: Possible pathophysiological mechanisms. J Endocrinol. 2014;223:R63–78.
- Derosa G, Maffioli P, At Salvadeo S, et al. Sibutramine and L-carnitine compared to sibutramine alone on insulin resistance in diabetic pa-tients. Internal Medicine. 2010;49:1717–1725.
- Schooneman MG, Vaz FM, Houten SM and Soeters MR. Acylcarnitines: Reflecting or inflicting insulin resistance? Diabetes. 2013;62:1–8.
- Emami Naini A, Moradi M, Mortazavi M, et al. Effects of oral L-carnitine supplementation on lipid profile, anemia, and quality of life in chronic renal disease patients under hemodialysis: A Randomized, double-blinded, placebo-controlled trial. J Nutr Metab. 2012;2012:1–6.
- Biolo G, Stulle M, Bianco F, et al. Insulin action on glucose and protein metabolism during L-carnitine supplementation in maintenance haemodialysis patients. Nephrol Dial Transplant. 2008;23:991–997.
- Malaguarnera M, Vacante M, Bertino G, et al. The supplementation of acetyl-L-carnitine decreases fatigue and increases quality of life in patients with hepatitis C treated with pegylated interferon-alpha 2b plus ribavirin. J Interferon Cytokine Res. 2011;31:653–659.
- Hong ES, Kim EK, Kang SM, et al. Effect of carnitine-orotate complex on glucose metabolism and fatty liver: A double-blind, place-bo-controlled study. J Gastroenterol Hepatol. 2014;29:1449–1457.
- Malaguarnera M, Vacante M, Giordano M, et al. Oral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: A randomized, double-blind, placebo-controlled study. Am J Clin Nutr. 2011;93:799–808.
- Donjacour CE, Aziz NA, Overeem S, Kalsbeek A, Pijl H, Lammers GJ. Glucose and fat metabolism in narcolepsy and the effect of sodium ox-ybate: A hyperinsulinemic-euglycemic clamp study. Sleep. 2014; 37:795–801.