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Diabetic Medicine
Year: 2008  |  Volume: 25  |  Issue: 11  |  Page No.: 1268 - 1275

Four weeks of near-normalization of blood glucose has no effect on postprandial GLP-1 and GIP secretion, but augments pancreatic B-cell responsiveness to a meal in patients with Type 2 diabetes

P. V. Hojberg, T. Vilsboll, M. Zander, F. K. Knop, T. Krarup, A. Volund, J. J. Holst and S. Madsbad    

Abstract: Objective   The aim of the present study was to investigate whether 4 weeks of near-normalization of blood glucose (BG) improves incretin hormone secretion and pancreatic B-cell function during a mixed meal.

Research design and methods   Nine patients with Type 2 diabetes in poor glycaemic control [glycated haemoglobin (HbA1c) 8.0 ± 0.4%] were investigated before and after 4 weeks of near-normalization of BG (mean BG 6.4 ± 0.3 mmol/l) using insulin treatment. HbA1c after insulin treatment was 6.6 ± 0.3%. For comparison, nine healthy control subjects were also studied. Postprandial glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) incremental responses were assessed during a mixed meal test. Fasting and postprandial pancreatic B-cell function was determined from calculations of insulin secretion rates in relation to plasma glucose.

Results   There was no difference in IAUCtotalGLP-1 or in IAUCtotalGIP between the two experimental days. B-cell sensitivity to glucose (insulinogenic index) did not differ before and after insulin treatment in the fasting state (0.21 ± 0.17 vs. 0.25 ± 0.10 pmol kg−1 min−1/mmol l−1), but improved significantly during the first 30 min after start of the meal (0.28 ± 0.07 vs. 0.46 ± 0.06 pmol kg−1 min−1/mmol l−1) and during the following 4 h (0.34 ± 0.09 vs. 0.56 ± 0.07 pmol kg−1 min−1/ mmol l−1). The B-cell responsiveness to changes in plasma glucose, expressed as the slope of the linear relationship between the insulin secretion rate and the concomitant plasma glucose increased from 0.59 ± 0.16 to 0.94 ± 0.13 pmol kg−1 min−1/ mmol l−1 (P < 0.07).

Conclusions   Four weeks of near-normalization of BG had no effect on postprandial secretion of incretin hormones. Nevertheless, several parameters of meal-induced insulin secretion improved after insulin treatment.

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