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Type: Journal article
Title: Small intestinal glucose delivery affects the lowering of blood glucose by acute vildagliptin in type 2 diabetes
Author: Wu, T.
Zhang, X.
Trahair, L.
Bound, M.
Little, T.
Deacon, C.
Horowitz, M.
Jones, K.
Rayner, C.
Citation: Journal of Clinical Endocrinology and Metabolism, 2016; 101(12):4769-4778
Publisher: Oxford University Press
Issue Date: 2016
ISSN: 0021-972X
Statement of
Tongzhi Wu, Xiang Zhang, Laurence G. Trahair, Michelle J. Bound, Tanya J. Little, Carolyn F. Deacon, Michael Horowitz, Karen L. Jones, and Christopher K. Rayner
Abstract: Context: The rate of gastric emptying is an important determinant of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) secretion, and may influence the magnitude of glucose-lowering by dipeptidyl peptidase-4 (DPP-4) inhibitors. Objective: To evaluate the effects of the DPP-4 inhibitor, vildagliptin, during intraduodenal (ID) glucose infusion at two different rates within the physiological range of gastric emptying, in type 2 diabetes. Participants and Design: A total of 16 diet-controlled type 2 diabetic patients were studied on four separate days in double-blind, randomized, fashion. On each day, either 50mg vildagliptin or placebo was given 60min prior to a 120min ID glucose infusion at 2 or 4kcal/min (ID2 or ID4). Plasma glucose and hormones were measured frequently. Results: Plasma glucose, insulin, C-peptide, glucagon, total GIP, and total and intact GLP-1 concentrations were higher during ID4 than ID2 (P<0.01 for each). Compared with placebo, vildagliptin was associated with higher intact GLP-1, insulin and C-peptide, and lower glucose and total GIP and GLP-1 (P<0.01 for each), without affecting glucagon. There were significant interactions between the rate of ID glucose and vildagliptin treatment on plasma glucose, intact and total GLP-1, and GIP (P<0.05 for each), but not insulin, C-peptide or glucagon. The reduction in glucose and the increment in intact GLP-1 after vildagliptin vs. placebo were 3.3 and 3.8 fold greater respectively, during ID4 compared to ID2. Conclusions/Interpretation: These observations warrant further study to clarify whether type 2 diabetic patients with relatively more rapid gastric emptying have greater glucose-lowering during treatment with DPP-4 inhibitors.
Keywords: Duodenum
Diabetes Mellitus, Type 2
Blood Glucose
Infusions, Parenteral
Double-Blind Method
Middle Aged
Dipeptidyl-Peptidase IV Inhibitors
Outcome Assessment, Health Care
Rights: Copyright © 2016 by the Endocrine Society
DOI: 10.1210/jc.2016-2813
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