Glucose-lowering effects and mechanisms of the bile acid-sequestering resin sevelamer

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Andreas Brønden, Kristian Mikkelsen, David P. Sonne, Morten Hansen, Christoffer Våben, Maria N. Gabe, Mette Rosenkilde, Valentina Tremaroli, Hao Wu, Fredrik Bäckhed, Jens F. Rehfeld, Jens J. Holst, Tina Vilsbøll, Filip K. Knop

Aims: Sevelamer, a non-absorbable amine-based resin used for treatment of hyperphosphataemia, has been demonstrated to have a marked bile acid-binding potential alongside beneficial effects on lipid and glucose metabolism. The aim of this study was to investigate the glucose-lowering effect and mechanism(s) of sevelamer in patients with type 2 diabetes. Materials and Methods: In this double-blinded randomized controlled trial, we randomized 30 patients with type 2 diabetes to sevelamer (n = 20) or placebo (n = 10). Participants were subjected to standardized 4-hour liquid meal tests at baseline and after 7 days of treatment. The main outcome measure was plasma glucagon-like peptide-1 excursions as measured by area under the curve. In addition, blood was sampled for measurements of glucose, lipids, glucose-dependent insulinotropic polypeptide, C-peptide, glucagon, fibroblast growth factor-19, cholecystokinin and bile acids. Assessments of gastric emptying, resting energy expenditure and gut microbiota composition were performed. Results: Sevelamer elicited a significant placebo-corrected reduction in plasma glucose with concomitant reduced fibroblast growth factor-19 concentrations, increased de novo synthesis of bile acids, a shift towards a more hydrophilic bile acid pool and increased lipogenesis. No glucagon-like peptide-1-mediated effects on insulin, glucagon or gastric emptying were evident, which points to a limited contribution of this incretin hormone to the glucose-lowering effect of sevelamer. Furthermore, no sevelamer-mediated effects on gut microbiota composition or resting energy expenditure were observed. Conclusions: Sevelamer reduced plasma glucose concentrations in patients with type 2 diabetes by mechanisms that seemed to involve decreased intestinal and hepatic bile acid-mediated farnesoid X receptor activation.

Original languageEnglish
JournalDiabetes, Obesity and Metabolism
Issue number7
Pages (from-to)1623-1631
Publication statusPublished - Jul 2018

    Research areas

  • antidiabetic drug, drug mechanism, GLP-1, glucose metabolism, type 2 diabetes

ID: 200383994