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Type: Journal article
Title: Comparative effects of proximal and distal small intestinal glucose exposure on glycemia, incretin hormone secretion, and the incretin effect in health and type 2 diabetes
Author: Zhang, X.
Young, R.L.
Bound, M.
Hu, S.
Jones, K.L.
Horowitz, M.
Rayner, C.K.
Wu, T.
Citation: Diabetes Care, 2019; 42(4):520-528
Publisher: American Diabetes Association
Issue Date: 2019
ISSN: 0149-5992
Statement of
Xiang Zhang, Richard L. Young, Michelle Bound, Sanyuan Hu, Karen L. Jones, Michael Horowitz, Christopher K. Rayner and Tongzhi Wu
Abstract: Objective: Cells releasing glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are distributed predominately in the proximal and distal gut, respectively. Hence, the region of gut exposed to nutrients may influence GIP and GLP-1 secretion and impact on the incretin effect and gastrointestinal-mediated glucose disposal (GIGD). We evaluated glycemic and incretin responses to glucose administered into the proximal or distal small intestine and quantified the corresponding incretin effect and GIGD in health and type 2 diabetes mellitus (T2DM). Research Design and Methods: Ten healthy subjects and 10 patients with T2DM were each studied on four occasions. On 2 days, a transnasal catheter was positioned with infusion ports opening 13 cm and 190 cm beyond the pylorus, and 30 g glucose with 3 g 3-O-methylglucose (a marker of glucose absorption) was infused into either site and 0.9% saline into the alternate site over 60 min. Matching intravenous isoglycemic clamp studies were performed on the other 2 days. Blood glucose, serum 3-O-methylglucose, and plasma hormones were evaluated over 180 min. Results: In both groups, blood glucose and serum 3-O-methylglucose concentrations were higher after proximal than distal glucose infusion (all P < 0.001). Plasma GLP-1 increased minimally after proximal, but substantially after distal, glucose infusion, whereas GIP increased promptly after both infusions, with concentrations initially greater, but less sustained, with proximal versus distal infusion (all P < 0.001). Both the incretin effect and GIGD were less with proximal than distal glucose infusion (both P ≤ 0.009). Conclusions: The distal, as opposed to proximal, small intestine is superior in modulating postprandial glucose metabolism in both health and T2DM.
Keywords: Intestine, Small
Diabetes Mellitus, Type 2
Gastric Inhibitory Polypeptide
Blood Glucose
Drug Administration Routes
Double-Blind Method
Postprandial Period
Middle Aged
Glucagon-Like Peptide 1
Healthy Volunteers
Rights: © 2019 by the American Diabetes Association. may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at
DOI: 10.2337/dc18-2156
Grant ID:
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