A randomised trial of enteric-coated nutrient pellets to stimulate gastrointestinal peptide release and lower glycaemia in type 2 diabetes
| Autor: | Jing Ma, Karen L. Jones, Helen L. Checklin, Christopher K. Rayner, Julie E. Stevens, Michael Horowitz, James H. Meyer, Judith M. Wishart |
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| Přispěvatelé: | Ma, J, Checklin, HL, Wishart, Judith, Stevens, Julie, Jones, K, Horowitz, M, Meyer, JH, Rayner, C.K. |
| Rok vydání: | 2013 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Time Factors Colon Endocrinology Diabetes and Metabolism Pellets Incretin Ileum Stimulation Type 2 diabetes Biology chemistry.chemical_compound Glucagon-Like Peptide 1 Internal medicine Internal Medicine medicine Humans Insulin Cross-Over Studies digestive oral and skin physiology lauric acid Lauric Acids Middle Aged Glucagon medicine.disease Glucagon-like peptide-1 Lauric acid incretin Metformin Endocrinology Postprandial medicine.anatomical_structure glucagon-like peptide-1 Diabetes Mellitus Type 2 chemistry Area Under Curve Hyperglycemia Female Tablets Enteric-Coated hormones hormone substitutes and hormone antagonists |
| Zdroj: | Diabetologia. 56:1236-1242 |
| ISSN: | 1432-0428 0012-186X |
| DOI: | 10.1007/s00125-013-2876-2 |
| Popis: | Glucagon-like peptide-1 (GLP-1), an important mediator of postprandial glycaemia, could potentially be stimulated by delivering small quantities of nutrient to a long length of distal gut. We aimed to determine whether enteric-coated pellets, releasing small amounts of lauric acid throughout the ileum and colon, could reduce glycaemic responses to meals in type 2 diabetes, associated with stimulation of GLP-1.Eligible patients, who had type 2 diabetes controlled by diet or metformin, were each studied on two occasions in a hospital setting. After an overnight fast, patients consumed 5 g active pellets (47% lauric acid by weight) or placebo with breakfast (T = 0 min) and lunch (T = 240 min), in a crossover design with order randomised by the hospital pharmacy and allocation concealed by numbered containers. Patients and investigators making measurements were blinded to the intervention. Blood was sampled frequently for blood glucose (the primary outcome) and hormone assays.Eight patients were randomised (four to receive either intervention first), and all completed the study without adverse effects. Blood glucose was lower after breakfast (T = 0-240 min, area under the curve (AUC) 2,075 ± 368 vs 2,216 ± 163 mmol/l × min) and lunch (T = 240-480 min, AUC 1,916 ± 115 vs 2,088 ± 151 mmol/l × min) (p = 0.02 for each) after active pellets than after placebo. Plasma GLP-1 concentrations were higher after breakfast (p = 0.08) and lunch (p = 0.04) for active pellets. While there were no differences in insulin or glucose-dependent insulinotropic polypeptide concentrations, glucagon concentrations were higher after breakfast and lunch (p = 0.002 for each) for active pellets.Delivering small amounts of nutrient to the ileum and colon can stimulate substantial endogenous GLP-1 release and attenuate postprandial glycaemia. This novel approach has therapeutic potential in type 2 diabetes.Australian New Zealand Clinical Trials Registry ACTRN12612000600842.The study was funded by Meyer Nutriceuticals. |
| Databáze: | OpenAIRE |
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