Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/65658
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Type: Journal article
Title: Gastric emptying, incretin hormone secretion, and postprandial glycemia in cystic fibrosis - Effects of pancreatic enzyme supplementation
Author: Kuo, P.
Stevens, J.
Russo, A.
Maddox, A.
Wishart, J.
Jones, K.
Greville, H.
Hetzel, D.
Chapman, I.
Horowitz, M.
Rayner, C.
Citation: Journal of Clinical Endocrinology and Metabolism, 2011; 96(5):E851-E855
Publisher: Endocrine Society
Issue Date: 2011
ISSN: 0021-972X
0021-972X
Statement of
Responsibility: 
Paul Kuo, Julie E. Stevens, Antonietta Russo, Anne Maddox, Judith M. Wishart, Karen L. Jones, Hugh Greville, David Hetzel, Ian Chapman, Michael Horowitz, and Christopher K. Rayner
Abstract: Context: Postprandial hyperglycemia is an important clinical problem in cystic fibrosis (CF), but the contribution of fat malabsorption, rapid gastric emptying, and the incretin axis has not been widely considered. Objective: The aim of this study was to evaluate these aspects of gut function in nondiabetic CF patients. Design and Setting: We conducted a randomized, double-blind, placebo-controlled crossover study at a clinical research laboratory. Patients: Five nondiabetic CF patients (three males; age, 25.8 ± 1.0 yr; body mass index, 20.2 ± 1.1 kg/m2) with exocrine pancreatic insufficiency and six healthy subjects of similar age and body mass index participated in the study. Interventions: CF patients consumed a radiolabeled mashed potato meal on 2 separate days, together with four capsules of Creon Forte (100,000 IU lipase) or placebo. Healthy subjects consumed the meal once, without pancreatic enzymes. Main Outcome Measures: Gastric emptying was measured using scintigraphy, and blood was sampled frequently for blood glucose and plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon concentrations. Results: CF patients had more rapid gastric emptying (P < 0.001), impaired secretion of GLP-1 (P < 0.01) and GIP (P < 0.001), and greater postprandial glycemic excursions (P < 0.001) than healthy subjects. Pancreatic enzyme supplementation normalized gastric emptying and GLP-1 secretion and tended to increase glucagon (P = 0.08), but did not completely restore GIP secretion or normalize postprandial blood glucose. There was an excellent correlation between gastric emptying and blood glucose concentration at 60 min (R = 0.75; P = 0.01). Conclusions: Pancreatic enzyme supplementation plays an important role in incretin secretion, gastric emptying, and postprandial hyperglycemia in CF.
Keywords: Pancreas; Humans; Cystic Fibrosis; Hyperglycemia; Gastric Inhibitory Polypeptide; Glucagon; Insulin; Lipase; Dietary Carbohydrates; Blood Glucose; Dietary Fats; Double-Blind Method; Gastric Emptying; Adult; Female; Male; Glucagon-Like Peptide 1; Incretins; Young Adult
Rights: Copyright © 2011 by The Endocrine Society
RMID: 0020107334
DOI: 10.1210/jc.2010-2460
Appears in Collections:Medicine publications

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