A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes

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OBJECTIVENutrient “preloads” given before meals can attenuate postprandial glycemic excursions,at least partly by slowing gastric emptying and stimulating secretion ofthe incretins (i.e., glucagon-like peptide-1 [GLP-1] and glucose-dependent insulinotropicpolypeptide [GIP]). This study was designed to evaluate whether a proteinpreload could improve the efficacy of the dipeptidyl peptidase-4 (DPP-4)inhibitor vildagliptin to increase incretin concentrations, slow gastric emptying,and lower postprandial glycemia in type 2 diabetes.
RESEARCH DESIGN AND METHODSTwenty-two patients with type 2 diabetes treated with metformin were studiedon four occasions, receiving either 50 mg vildagliptin (VILD) or placebo (PLBO) onboth the evening before and the morning of each study day. The latter dose wasfollowed after 60 min by a preload drink containing either 25 gwhey protein (WHEY)or control flavoring (CTRL), and after another 30 min by a 13C-octanoate–labeledmashed potato meal. Plasma glucose and hormones, and gastric emptying, wereevaluated.
RESULTSCompared with PLBO/CTRL, PLBO/WHEY reduced postprandial peak glycemia,increased plasma insulin, glucagon, and incretin hormones (total and intact),and slowed gastric emptying, whereas VILD/CTRL reduced both the peak and areaunder the curve for glucose, increased plasma intact incretins, and slowed gastricemptying but suppressed plasma glucagon and total incretins (P < 0.05 each).Compared with both PLBO/WHEY and VILD/CTRL, VILD/WHEY was associatedwith higher plasma intact GLP-1 and GIP, slower gastric emptying, and lowerpostprandial glycemia (P < 0.05 each).
CONCLUSIONSIn metformin-treated type 2 diabetes, a protein preload has the capacity to enhancethe efficacy of vildagliptin to slow gastric emptying, increase plasma intactincretins, and reduce postprandial glycemia.
Original languageEnglish
JournalDiabetes Care
Issue number4
Pages (from-to)511-517
Number of pages7
Publication statusPublished - 2016

ID: 162893473