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

BA Aulinger, A Bedorf, G Kutscherauer, J de Heer… - Diabetes, 2014 - Am Diabetes Assoc
BA Aulinger, A Bedorf, G Kutscherauer, J de Heer, JJ Holst, B Göke, J Schirra
Diabetes, 2014Am Diabetes Assoc
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 …
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.
Am Diabetes Assoc