Defining the role of GLP-1 in the enteroinsulinar axis in type 2 diabetes using DPP-4 inhibition and GLP-1 receptor blockade

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Benedikt A Aulinger, Anne Bedorf, Gabriele Kutscherauer, Jocelyn de Heer, Jens Juul Holst, Burkhard Göke, Jörg Schirra

Understanding the incretin pathway has led to significant advancements in the treatment of type 2 diabetes (T2D). Still, the exact mechanisms are not fully understood. In a randomized, placebo-controlled, four-period, crossover study in 24 patients with T2D, dipeptidyl peptidase-4 (DPP-4) inhibition and its glucose-lowering actions were tested after an oral glucose tolerance test (OGTT). The contribution of GLP-1 was examined by infusion of the GLP-1 receptor (GLP-1r) antagonist exendin-9. DPP-4 inhibition reduced glycemia and enhanced insulin levels and the incretin effect (IE). Glucagon was suppressed, and gastric emptying (GE) was decelerated. Exendin-9 increased glucose levels and glucagon secretion, attenuated insulinemia and the IE, and accelerated GE. With the GLP-1r antagonist, the glucose-lowering effects of DPP-4 inhibition were reduced by ∼ 50%. However, a significant effect on insulin secretion remained during GLP-1r blockade, whereas the inhibitory effects of DPP-4 inhibition on glucagon and GE were abolished. Thus, in this cohort of T2D patients with a substantial IE, GLP-1 contributed ∼ 50% to the insulin excursion after an OGTT with and without DPP-4 inhibition. Thus, a significant DPP-4-sensitive glucose-lowering mechanism contributes to glycemic control in T2D patients that may be not mediated by circulating GLP-1.

Original languageEnglish
JournalDiabetes
Volume63
Issue number3
Pages (from-to)1079-92
Number of pages14
ISSN0012-1797
DOIs
Publication statusPublished - Mar 2014

    Research areas

  • Blood Glucose, C-Peptide, Cross-Over Studies, Diabetes Mellitus, Type 2, Dipeptidyl-Peptidase IV Inhibitors, Fasting, Female, Gastric Emptying, Glucagon-Like Peptide 1, Glucose Tolerance Test, Humans, Incretins, Insulin, Male, Middle Aged, Pyrazines, Receptors, Glucagon, Triazoles

ID: 117852947