1
|
Jalleh RJ, Marathe CS, Trahair LG, Jones KL, Horowitz M. A Biphasic Glucose Response during an Oral Glucose Tolerance Test Is Associated with Greater Plasma Insulin and GLP-1 Responses and a Reduction in 1-Hour Glucose but Does Not Relate to the Rate of Gastric Emptying in Healthy, Older Adults. Nutrients 2023; 15:3889. [PMID: 37764673 PMCID: PMC10534830 DOI: 10.3390/nu15183889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The pattern of the plasma glucose response curve during an oral glucose tolerance test (OGTT) is of prognostic significance with "biphasic" when compared with "monophasic" patterns being associated with greater insulin sensitivity/secretion and a reduced risk of progression to diabetes. The relationships of the glucose response curves with gastric emptying and incretin hormone secretion are not known. METHODS Thirty-six adults (age > 65 years) without known diabetes consumed a 300 mL drink containing 75 g glucose and 150 mg C13-acetate at baseline and follow-up after 5.8 ± 0.1 years. Plasma glucose, glucagon-like peptide-1 (GLP-1), glucose independent insulinotropic polypeptide (GIP) and insulin were measured, and participants classified according to the pattern of their glucose response. Gastric emptying was measured on breath samples (stable isotope breath test). RESULTS At baseline, 22 participants had a "monophasic" and 14 a "biphasic" glucose response. The 1 h plasma glucose response curve was greater and the GLP-1 AUC0-120 min and insulin secretion lower in the monophasic group. There were no differences in gastric emptying, GIP or insulin sensitivity. At the follow-up, the 1 h glucose response curve was greater again, while GLP-1 AUC0-120 min was lower in the monophasic group. CONCLUSIONS A biphasic curve is associated with a higher 60 min glucose response curve and increases in GLP-1, but no difference in either GIP or gastric emptying.
Collapse
Affiliation(s)
- Ryan J Jalleh
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, Northern Adelaide Local Health Network, Adelaide, SA 5112, Australia
| | - Chinmay S Marathe
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Laurence G Trahair
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Karen L Jones
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| |
Collapse
|
2
|
Jalleh RJ, Trahair LG, Wu T, Standfield S, Feinle‐Bisset C, Rayner CK, Horowitz M, Jones KL. Effect of gastric distension with concurrent small intestinal saline or glucose infusion on incretin hormone secretion in healthy individuals: A randomized, controlled, crossover study. Diabetes Obes Metab 2023; 25:1849-1854. [PMID: 36864654 PMCID: PMC10947269 DOI: 10.1111/dom.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
AIM To evaluate the effect of gastric distension, induced using a gastric 'barostat', on the secretion of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) in the presence and absence of small intestinal nutrients in healthy individuals. MATERIALS AND METHODS Eight healthy participants (two females, six males, mean age 69.3 ± 1.2 years, body mass index 23.5 ± 0.8 kg/m2 ) were each studied on four occasions when they received an intraduodenal infusion of either (i) 0.9% saline or (ii) glucose delivered at a rate of 3 kcal/min both with, and without, an intragastric balloon with the pressure set to 8 mmHg above the intragastric minimum distending pressure. RESULTS Following intraduodenal saline or glucose infusion, there was no difference in plasma GLP-1 with or without gastric distension (P = 1.00 for both saline and glucose infusions). There was also no difference in plasma GIP with or without gastric distension (P = 1.00 for saline infusion and P = .99 for glucose infusion). CONCLUSIONS Gastric distension, either alone or during small intestinal glucose exposure, does not stimulate incretin hormone secretion significantly in healthy humans.
Collapse
Affiliation(s)
- Ryan J. Jalleh
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
- Diabetes and Endocrine ServicesNorthern Adelaide Local Health NetworkAdelaideAustralia
| | - Laurence G. Trahair
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
| | - Tongzhi Wu
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
| | - Scott Standfield
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
| | - Christine Feinle‐Bisset
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
| | - Christopher K. Rayner
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Department of Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideAustralia
| | - Michael Horowitz
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Karen L. Jones
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| |
Collapse
|
3
|
Trahair LG, Nauck MA, Wu T, Stevens JE, Buttfield MD, Hatzinikolas S, Pham H, Meier JJ, Rayner CK, Horowitz M, Jones KL. Measurement of Gastric Emptying Using a 13C-octanoic Acid Breath Test with Wagner-Nelson Analysis and Scintigraphy in Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2022; 130:751-757. [PMID: 35231948 DOI: 10.1055/a-1784-6185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Breath tests utilising 13C-labelled substrates for the assessment of gastric emptying have been applied widely. Wagner-Nelson analysis is a pharmacokinetic model that can be utilised to generate a gastric emptying curve from the % 13CO2 measured in breath samples. We compared Wagner-Nelson analysis with (i) scintigraphy and (ii) conventional breath test modelling to quantify gastric emptying in type 2 diabetes. METHODS Thirteen patients (age 68.1±1.5 years, body mass index 31.0±0.9 kg/m2, HbA1c 6.3±0.2%) consumed a mashed potato meal comprising 65 g powdered potato, 20 g glucose, 250 ml water, an egg yolk labelled with 100 μL 13C-octanoic acid and 20MBq 99mTc-calcium phytate. Scintigraphic data were acquired and breath samples collected for 4 hours after the meal. Gastric emptying curves were derived based on each technique; the 50% emptying time and intragastric retention at 60 min were also calculated. RESULTS With Wagner-Nelson analysis, a Kel=0.60 (the elimination constant) best approximated the scintigraphic gastric emptying curve. There was a relationship between the T50 calculated with scintigraphy and by both Wagner-Nelson Kel=0.60 (r2=0.45, P<0.05) and conventional analysis (r2=0.44, P<0.05). There was no significant difference in the 50% gastric emptying time for scintigraphy (68.5±4.8 min) and Wagner-Nelson Kel=0.60 (71.3±4.5 min), however, the 50% gastric emptying time calculated by conventional analysis was much greater at 164.7±6.0 min (P<0.001). CONCLUSION In type 2 diabetes, gastric emptying of a mashed potato meal measured using a 13C-octanoic acid breath test analysed with Wagner-Nelson Kel=0.60 closely reflects measurements obtained with scintigraphy, whereas, in absolute terms, the conventional breath test analysis does not.
Collapse
Affiliation(s)
- Laurence G Trahair
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
| | - Michael A Nauck
- Diabetes Center Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Julie E Stevens
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
- School of Health and Biomedical Sciences, RMIT University, Victoria, Australia
- Division of Health Sciences, University of South Australia, South Australia, Australia
| | - Madeline D Buttfield
- Division of Health Sciences, University of South Australia, South Australia, Australia
| | - Seva Hatzinikolas
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
| | - Hung Pham
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
| | - Juris J Meier
- Diabetes Center Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Christopher K Rayner
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen L Jones
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, South Australia, Australia
| |
Collapse
|
4
|
Stevens JE, Jalleh RJ, Trahair LG, Marathe CS, Horowitz M, Jones KL. Comparative effects of low-carbohydrate, full-strength and low-alcohol beer on gastric emptying, alcohol absorption, glycaemia and insulinaemia in health. Br J Clin Pharmacol 2022; 88:3421-3427. [PMID: 35246999 PMCID: PMC9314679 DOI: 10.1111/bcp.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS The aim of this study was to evaluate the comparative effects of low-carbohydrate (LC), full-strength (FS), and low-alcohol (LA) beer on gastric emptying (GE), ethanol absorption, glycaemia and insulinaemia in health. METHODS Eight subjects (four male, four female; age: 20.4 ± 0.4 years; BMI 22.7 ± 0.4 kg/m2 ) had concurrent measurements of GE, plasma ethanol, blood glucose and plasma insulin for 180 min on three separate occasions after ingesting 600 mL of (i) FS beer (5.0% w/v, 246 kcal, 19.2 g carbohydrate), (ii) LC beer (4.6% w/v, 180 kcal, 5.4 g carbohydrate) and (iii) LA beer (2.6% w/v, 162 kcal, 17.4 g carbohydrate) labelled with 20 MBq 99mTc-calcium phytate, in random order. RESULTS There was no difference in the gastric 50% emptying time (T50) (FS: 89.0 ± 13.5 min vs LC: 79.5 ± 12.9 min vs LA: 74.6 ± 12.4 min; P = .39). Plasma ethanol was less after LA than LC (P < .001) and FS (P < .001), with no difference between LC and FS (P = 1.0). There was an inverse relationship between plasma ethanol at 15 min and GE after LA (r = -0.87, P < .01) and a trend for inverse relationships after LC (r = -0.67, P = .07) and FS (r = -0.69, P = .06). The AUC 0-180 min for blood glucose was greater for LA than LC (P < .001), with no difference between LA and FS (P = .40) or LC and FS (P = 1.0). CONCLUSION In healthy young subjects, GE of FS, LC and LA beer is comparable and a determinant of the plasma ethanol response.
Collapse
Affiliation(s)
- Julie E. Stevens
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraAustralia
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Clinical and Health SciencesUniversity of South AustraliaAdelaideAustralia
| | - Ryan J. Jalleh
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | | | - Chinmay S. Marathe
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Michael Horowitz
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Karen L. Jones
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Clinical and Health SciencesUniversity of South AustraliaAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| |
Collapse
|
5
|
Marathe CS, Pham H, Wu T, Trahair LG, Rigda RS, Buttfield MDM, Hatzinikolas S, Lange K, Rayner CK, Mari A, Horowitz M, Jones KL. Acute Administration of the GLP-1 Receptor Agonist Lixisenatide Diminishes Postprandial Insulin Secretion in Healthy Subjects But Not in Type 2 Diabetes, Associated with Slowing of Gastric Emptying. Diabetes Ther 2022; 13:1245-1249. [PMID: 35460043 PMCID: PMC9174387 DOI: 10.1007/s13300-022-01258-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION It is uncertain whether lixisenatide has postprandial insulinotropic effects when its effect on slowing gastric emptying is considered, in healthy subjects and type 2 diabetes mellitus (T2DM). We evaluated the effects of single administration of 10 μg sc lixisenatide on glycaemia, insulin secretion and gastric emptying (GE), measured using the 'gold standard' technique of scintigraphy following an oral glucose load (75 g glucose). METHODS Fifteen healthy subjects (nine men, six women; age 67.2 ± 2.3 years) and 15 patients with T2DM (nine men, six women; age 61.9 ± 2.3 years) had measurements of GE, plasma glucose, insulin and C-peptide for 180 min after a radiolabeled 75 g glucose drink on two separate days. All subjects received lixisenatide (10 μg sc) or placebo in a randomised, double-blind, crossover fashion 30 min before the drink. Insulin secretory response (ISR) was determined using the C-peptide deconvolution method. RESULTS GE was markedly slowed by lixisenatide compared with placebo in both healthy subjects (1.45 ± 0.10 kcal/min for placebo vs. 0.60 ± 0.14 kcal/min for lixisenatide) and diabetes (1.57 ± 0.06 kcal/min for placebo vs. 0.75 ± 0.13 kcal/min for lixisenatide) (both P < 0.001) with no difference between the two groups (P = 0.42). There was a moderate to strong inverse correlation between the early insulin secretory response calculated at 60 min and gastric retention at 60 min with lixisenatide treatment in healthy subjects (r = - 0.8, P = 0.0003) and a trend in type 2 diabetes (r = - 0.4, P = NS), compared with no relationships in the placebo arms (r = - 0.02, P = NS, healthy subjects) and (r = - 0.16, P = NS, type 2 diabetes). CONCLUSION The marked slowing of GE of glucose induced by lixisenatide is associated with attenuation in the rise of postprandial glucose in both healthy subjects and diabetes and early insulin secretory response in healthy subjects. CLINICAL TRIALS REGISTRATION NUMBER NCT02308254.
Collapse
Affiliation(s)
- Chinmay S Marathe
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Hung Pham
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Tongzhi Wu
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Laurence G Trahair
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Rachael S Rigda
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Madeline D M Buttfield
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Seva Hatzinikolas
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Kylie Lange
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Christopher K Rayner
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrea Mari
- CNR Institute of Clinical Physiology, Pisa, Italy
| | - Michael Horowitz
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Karen L Jones
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia.
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
| |
Collapse
|
6
|
Aitken LM, Kydonaki K, Blackwood B, Trahair LG, Purssell E, Sekhon M, Walsh TS. Inconsistent relationship between depth of sedation and intensive care outcome: systematic review and meta-analysis. Thorax 2021; 76:1089-1098. [PMID: 33859048 DOI: 10.1136/thoraxjnl-2020-216098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the effect of depth of sedation on intensive care mortality, duration of mechanical ventilation, and other clinically important outcomes. METHODS We searched MEDLINE, Embase, Cochrane Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO from 2000 to 2020. Randomised controlled trials (RCTs) and cohort studies that examined the effect of sedation depth were included. Two reviewers independently screened, selected articles, extracted data and appraised quality. Data on study design, population, setting, patient characteristics, study interventions, depth of sedation and relevant outcomes were extracted. Quality was assessed using Critical Appraisal Skills Programme tools. RESULTS We included data from 26 studies (n=7865 patients): 8 RCTs and 18 cohort studies. Heterogeneity of studies was substantial. There was no significant effect of lighter sedation on intensive care mortality. Lighter sedation did not affect duration of mechanical ventilation in RCTs (mean difference (MD): -1.44 days (95% CI -3.79 to 0.91)) but did in cohort studies (MD: -1.52 days (95% CI -2.71 to -0.34)). No statistically significant benefit of lighter sedation was identified in RCTs. In cohort studies, lighter sedation improved time to extubation, intensive care and hospital length of stay and ventilator-associated pneumonia. We found no significant effects for hospital mortality, delirium or adverse events. CONCLUSION Evidence of benefit from lighter sedation is limited, with inconsistency between observational and randomised studies. Positive effects were mainly limited to low quality evidence from observational studies, which could be attributable to bias and confounding factors.
Collapse
Affiliation(s)
- Leanne M Aitken
- School of Health Sciences, City, University of London, London, UK
| | - Kalliopi Kydonaki
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - Laurence G Trahair
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| | - Mandeep Sekhon
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Timothy S Walsh
- Department of Anaesthesia, Critical Care & Pain Medicine and Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Xie C, Huang W, Wang X, Trahair LG, Pham HT, Marathe CS, Young RL, Jones KL, Horowitz M, Rayner CK, Wu T. Gastric emptying in health and type 2 diabetes: An evaluation using a 75 g oral glucose drink. Diabetes Res Clin Pract 2021; 171:108610. [PMID: 33301790 DOI: 10.1016/j.diabres.2020.108610] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
AIM Gastric emptying is a major determinant of the glycaemic response to carbohydrate and is frequently abnormal in type 2 diabetes (T2DM). There is little information about how chronic glycaemic control affects gastric emptying in T2DM. We evaluated gastric emptying of a 75 g glucose drink in community-based patients with T2DM of short duration with good or poor glycaemic control, and compared this to young and older controls. METHODS T2DM patients managed by diet and/or metformin, either well-controlled or poorly-controlled, together with young and age-matched older controls without diabetes, consumed a 75 g oral glucose drink containing 150 mg 13C-acetate for evaluation of gastric emptying (breath test) and blood glucose over 180 min. RESULTS The gastric half-emptying time (T50) was longer in the older than the young non-diabetic subjects (P = 0.041), but shorter in well-controlled T2DM patients than age-matched older controls (P = 0.043). The T50 in poorly-controlled T2DM patients was shorter than in older controls (P = 0.006), but similar to young non-diabetic subjects. CONCLUSIONS Gastric emptying of a glucose drink is delayed with ageing, but more rapid in patients with T2DM of relatively short duration, regardless of their glycaemic status. These observations support interventions that slow gastric emptying to improve postprandial glycaemia in these patients with T2DM.
Collapse
Affiliation(s)
- Cong Xie
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Weikun Huang
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Xuyi Wang
- Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Laurence G Trahair
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Hung T Pham
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Chinmay S Marathe
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Nutrition, Diabetes & Gut Health, Lifelong Health Theme South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Richard L Young
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Nutrition, Diabetes & Gut Health, Lifelong Health Theme South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Karen L Jones
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Christopher K Rayner
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.
| |
Collapse
|
8
|
Jalleh R, Pham H, Marathe CS, Wu T, Buttfield MD, Hatzinikolas S, Malbert CH, Rigda RS, Lange K, Trahair LG, Feinle-Bisset C, Rayner CK, Horowitz M, Jones KL. Acute Effects of Lixisenatide on Energy Intake in Healthy Subjects and Patients with Type 2 Diabetes: Relationship to Gastric Emptying and Intragastric Distribution. Nutrients 2020; 12:nu12071962. [PMID: 32630191 PMCID: PMC7400134 DOI: 10.3390/nu12071962] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Glucagon-like peptide-1 receptor agonists induce weight loss, which has been suggested to relate to the slowing of gastric emptying (GE). In health, energy intake (EI) is more strongly related to the content of the distal, than the total, stomach. We evaluated the effects of lixisenatide on GE, intragastric distribution, and subsequent EI in 15 healthy participants and 15 patients with type 2 diabetes (T2D). Participants ingested a 75-g glucose drink on two separate occasions, 30 min after lixisenatide (10 mcg) or placebo subcutaneously, in a randomised, double-blind, crossover design. GE and intragastric distribution were measured for 180 min followed by a buffet-style meal, where EI was quantified. Relationships of EI with total, proximal, and distal stomach content were assessed. In both groups, lixisenatide slowed GE markedly, with increased retention in both the proximal (p < 0.001) and distal (p < 0.001) stomach and decreased EI (p < 0.001). EI was not related to the content of the total or proximal stomach but inversely related to the distal stomach at 180 min in health on placebo (r = -0.58, p = 0.03) but not in T2D nor after lixisenatide in either group. In healthy and T2D participants, the reduction in EI by lixisenatide is unrelated to changes in GE/intragastric distribution, consistent with a centrally mediated effect.
Collapse
Affiliation(s)
- Ryan Jalleh
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide SA 5000, Australia; (R.J.); (C.S.M.); (T.W.); (M.H.)
| | - Hung Pham
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Chinmay S. Marathe
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide SA 5000, Australia; (R.J.); (C.S.M.); (T.W.); (M.H.)
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Tongzhi Wu
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide SA 5000, Australia; (R.J.); (C.S.M.); (T.W.); (M.H.)
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Madeline D. Buttfield
- School of Health Sciences, University of South Australia, Adelaide SA 5001, Australia;
| | - Seva Hatzinikolas
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Charles H. Malbert
- Aniscan, Institut National de la Rechercher Agronomique, 35590 Saint-Gilles, France;
| | - Rachael S. Rigda
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Kylie Lange
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Laurence G. Trahair
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Christine Feinle-Bisset
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Christopher K. Rayner
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide SA 5000, Australia; (R.J.); (C.S.M.); (T.W.); (M.H.)
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
| | - Karen L. Jones
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide SA 5000, Australia; (R.J.); (C.S.M.); (T.W.); (M.H.)
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide SA 5000, Australia; (H.P.); (S.H.); (R.S.R.); (K.L.); (L.G.T.); (C.F.-B.); (C.K.R.)
- Correspondence: ; Tel.: +61-8-83137821
| |
Collapse
|
9
|
Marathe CS, Pham H, Marathe JA, Trahair LG, Huynh L, Wu T, Phillips LK, Rayner CK, Nauck MA, Horowitz M, Jones KL. The relationship between plasma GIP and GLP-1 levels in individuals with normal and impaired glucose tolerance. Acta Diabetol 2020; 57:583-587. [PMID: 31848710 DOI: 10.1007/s00592-019-01461-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
AIMS Glucose-dependent insulinotropic polypeptide (GIP) is released primarily from the proximal small intestine and glucagon-like peptide-1 (GLP-1) from the more distal small intestine and colon. Their relative importance to the incretin effect in health has been contentious in the past, although it now appears that GIP has the dominant role. It is uncertain whether there is a relationship between GIP and GLP-1 secretion. We aimed to evaluate the relationship between plasma GIP and GLP-1 responses to a 75-g oral glucose load in individuals with normal (NGT) and impaired glucose tolerance (IGT). METHODS One hundred healthy subjects had measurements of blood glucose, serum insulin, plasma GIP and GLP-1 concentrations for 240 min after a 300 mL drink containing 75 g glucose. RESULTS Fifty had NGT and 41 IGT; 9 had type 2 diabetes and were excluded from analysis. In both groups, there were increases in plasma GIP and GLP-1 following the glucose drink, with no difference in the magnitude of the responses between t = 0-240 min. There was a weak relationship between the iAUC0-240 min for GIP and GLP-1 in the combined (r = 0.23, P = 0.015) and in the IGT (r = 0.34, P = 0.01), but not in the NGT (r = 0.15, P = 0.14) group. CONCLUSIONS There is a weak relationship between oral glucose-induced GIP and GLP-1 secretions in non-diabetic subjects.
Collapse
Affiliation(s)
- Chinmay S Marathe
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia
| | - Hung Pham
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Jessica A Marathe
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia
| | - Laurence G Trahair
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Lian Huynh
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
| | - Tongzhi Wu
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia
| | - Liza K Phillips
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia
| | - Christopher K Rayner
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia
| | - Michael A Nauck
- Diabetes Center Bochum-Hattingen, St. Josef-Hospital, 44791, Bochum, Germany
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia
| | - Karen L Jones
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Level 5 Adelaide Health and Medical Sciences Building, Cnr North Tce and George St, Adelaide, SA, 5005, Australia.
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia.
| |
Collapse
|
10
|
Aitken L, Kydonaki K, Blackwood B, Trahair LG, Purssell E, Sekhon M, Walsh T. The inconsistent relationship between depth of sedation and outcome: a systematic review and meta-analysis. Aust Crit Care 2020. [DOI: 10.1016/j.aucc.2020.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
11
|
Pham H, Marathe CS, Phillips LK, Trahair LG, Hatzinikolas S, Huynh L, Wu T, Nauck MA, Rayner CK, Horowitz M, Jones KL. Longitudinal Changes in Fasting and Glucose-Stimulated GLP-1 and GIP in Healthy Older Subjects. J Clin Endocrinol Metab 2019; 104:6201-6206. [PMID: 31393567 DOI: 10.1210/jc.2019-01262] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT It is not known whether glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) levels correlate within individuals, nor whether levels change with age. Previous studies have all been cross-sectional in design. OBJECTIVE To evaluate longitudinal changes in fasting and glucose-stimulated incretin hormone concentrations in healthy older subjects. PATIENTS AND DESIGN Forty-one healthy older subjects had measurements of plasma GLP-1 and GIP while fasting and after a 75-g oral glucose load on two occasions separated by 5.9 ± 0.1 years [mean age at the initial study: 71.2 ± 3.8 (SD) years]. Breath samples were collected to calculate the gastric 50% emptying time (T50). RESULTS For GLP-1, both fasting concentrations (P < 0.001) and area under the curve 0 to 120 minutes (P = 0.001) were decreased at followup. Fasting GIP was also lower (P = 0.03) at follow up, but there was no change in the area under the curve 0 to 120 minutes (P = 0.26). The gastric emptying T50 was slower at followup (P = 0.008). Neither the change in T50 nor the body mass index at the initial study was a determinant of the change in incretin responses. Between the two study days, fasting GIP (r = 0.72, P < 0.001) correlated well, but not fasting GLP-1 (r = 0.23, P = 0.18). However, both glucose-stimulated GLP-1 (r = 0.50, P = 0.002) and GIP (r = 0.60, P < 0.001) showed correlations between the initial and follow-up studies. CONCLUSIONS Fasting GIP and glucose-stimulated GLP-1 and GIP concentrations correlate within individuals over a follow-up period of ∼5.9 years. Aging is associated with reductions in fasting GLP-1 and GIP, and glucose-stimulated GLP-1, which may predispose to the development of glucose intolerance and type 2 diabetes.
Collapse
Affiliation(s)
- Hung Pham
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Chinmay S Marathe
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Liza K Phillips
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Laurence G Trahair
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Seva Hatzinikolas
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lian Huynh
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tongzhi Wu
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael A Nauck
- Diabetes Center Bochum-Hattingen, St. Josef- Hospital, Bochum, Germany
| | - Christopher K Rayner
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen L Jones
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
12
|
Jones KL, Rigda RS, Buttfield MDM, Hatzinikolas S, Pham HT, Marathe CS, Wu T, Lange K, Trahair LG, Rayner CK, Horowitz M. Effects of lixisenatide on postprandial blood pressure, gastric emptying and glycaemia in healthy people and people with type 2 diabetes. Diabetes Obes Metab 2019; 21:1158-1167. [PMID: 30623563 DOI: 10.1111/dom.13633] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023]
Abstract
AIM To evaluate the effects of the prandial glucagon-like peptide-1 receptor agonist lixisenatide on gastric emptying and blood pressure (BP) and superior mesenteric artery (SMA) blood flow, and the glycaemic responses to a 75-g oral glucose load in healthy people and those with type 2 diabetes (T2DM). MATERIALS AND METHODS Fifteen healthy participants (nine men, six women; mean ± SEM age 67.2 ± 2.3 years) and 15 participants with T2DM (nine men, six women; mean ± SEM age 61.9 ± 2.3 years) underwent measurement of gastric emptying, BP, SMA flow and plasma glucose 180 minutes after a radiolabelled 75-g glucose drink on two separate days. All participants received lixisenatide (10 μg subcutaneously) or placebo in a randomized, double-blind, crossover fashion 30 minutes before the glucose drink. RESULTS Lixisenatide slowed gastric emptying (retention at 120 minutes, P < 0.01), attenuated the rise in SMA flow (P < 0.01) and markedly attenuated the decrease in systolic BP (area under the curve [AUC] 0-120 minutes, P < 0.001) compared to placebo in healthy participants and those with T2DM. Plasma glucose (incremental AUC 0-120 minutes) was greater in participants with T2DM (P < 0.005) than in healthy participants, and lower after lixisenatide in both groups (P < 0.001). CONCLUSIONS In healthy participants and those with T2DM, the marked slowing of gastric emptying of glucose induced by lixisenatide was associated with attenuation of the increments in glycaemia and SMA flow and decrease in systolic BP. Accordingly, lixisenatide may be useful in the management of postprandial hypotension.
Collapse
Affiliation(s)
- Karen L Jones
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rachael S Rigda
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Madeline D M Buttfield
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Seva Hatzinikolas
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Hung T Pham
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Chinmay S Marathe
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Tongzhi Wu
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Laurence G Trahair
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
13
|
Du YT, Piscitelli D, Ahmad S, Trahair LG, Greenfield JR, Samocha-Bonet D, Rayner CK, Horowitz M, Jones KL. Effects of Glutamine on Gastric Emptying of Low- and High-Nutrient Drinks in Healthy Young Subjects-Impact on Glycaemia. Nutrients 2018; 10:E739. [PMID: 29880750 PMCID: PMC6024320 DOI: 10.3390/nu10060739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023] Open
Abstract
Glutamine is a potent stimulus for the release of glucagon-like peptide-1, which increases postprandial insulin and slows gastric emptying (GE). We determined the effects of glutamine on GE of, and glycaemic responses to, low- and high-nutrient drinks in eight healthy males (mean age 21.6 ± 0.7 years and BMI 22.9 ± 0.7 kg/m²). Participants were studied on four occasions on which they consumed either a low-nutrient (beef soup; 18 kcal) or high-nutrient (75 g dextrose; 255 kcal) drink, each with or without 30 g of glutamine (120 kcal), in a randomised, crossover design. GE (2D ultrasound), blood glucose and plasma insulin concentrations were measured concurrently. Glutamine slowed GE (half emptying time (T50)) of both low- (45 ± 3 min vs. 26 ± 2 min, p < 0.001), and high-nutrient, (100 ± 5 min vs. 77 ± 5 min, p = 0.03) drinks, however, there was no effect on GE of the high nutrient drinks when expressed as kcal/min (3.39 ± 0.21 kcal/min vs. 3.81 ± 0.20 kcal/min, p = 0.25). There was no change in blood glucose after the low-nutrient drinks with or without glutamine, despite a slight increase in plasma insulin with glutamine (p = 0.007). The rise in blood glucose following the high-nutrient drink (p = 0.0001) was attenuated during the first 60 min by glutamine (p = 0.007). We conclude that in healthy subjects, glutamine slows GE of both low- and high-nutrient drinks comparably and attenuates the rise in blood glucose after the high-nutrient glucose drink.
Collapse
Affiliation(s)
- Yang T Du
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia.
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Diana Piscitelli
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia.
- School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Saima Ahmad
- School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Laurence G Trahair
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia.
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Jerry R Greenfield
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW 2010, Australia.
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2010, Australia.
| | - Dorit Samocha-Bonet
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2010, Australia.
| | - Christopher K Rayner
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia.
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia.
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia.
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Karen L Jones
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia.
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia.
- School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| |
Collapse
|
14
|
Trahair LG, Wu T, Feinle‐Bisset C, Marathe CS, Rayner CK, Horowitz M, Jones KL. Comparative effects of small intestinal glucose on blood pressure, heart rate, and noradrenaline responses in obese and healthy subjects. Physiol Rep 2018; 6:e13610. [PMID: 29446224 PMCID: PMC5812881 DOI: 10.14814/phy2.13610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 02/07/2023] Open
Abstract
Meal consumption leads to an increase in sympathetic output to compensate for hemodynamic changes and maintain blood pressure (BP). Obesity is associated with a blunting of the sympathetic response to meal ingestion, but interpretation of studies investigating these responses is compromised by their failure to account for the rate of gastric emptying, which is an important determinant of postprandial cardiovascular and sympathetic responses and, in both health and obesity, exhibits a wide interindividual variation. We sought to determine the effects of intraduodenal glucose infusion, bypassing gastric emptying, on BP, heart rate (HR), and noradrenaline responses in obese and healthy control subjects. 12 obese subjects (age 36.6 ± 3.9 years, body mass index (BMI) 36.1 ± 1.3 kg/m2 ) and 23 controls (age 27.8 ± 2.4 years, BMI 22.4 ± 0.5 kg/m2 ) received intraduodenal infusions of glucose at 1 or 3 kcal/min, or saline, for 60 min (t = 0-60 min), followed by intraduodenal saline (t = 60-120 min). BP and HR were measured with an automatic cuff, and blood samples collected for measurement of plasma noradrenaline. Intraduodenal glucose at 1 kcal/min was associated with a fall in diastolic BP in the control subjects only (P < 0.01), with no change in systolic BP, HR or noradrenaline in either group. In both groups, intraduodenal glucose at 3 kcal/min was associated with a fall in diastolic (P < 0.01), but not systolic, BP, and rises in HR (P < 0.001) and plasma noradrenaline (P < 0.01), with no difference in responses between the groups. We conclude that cardiovascular and sympathetic responses to intraduodenal glucose infusion are comparable between obese and control subjects, and dependent on the rate of glucose delivery.
Collapse
Affiliation(s)
- Laurence G. Trahair
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Tongzhi Wu
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Christine Feinle‐Bisset
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Chinmay S. Marathe
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Christopher K. Rayner
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Michael Horowitz
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Karen L. Jones
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| |
Collapse
|
15
|
Giezenaar C, Trahair LG, Luscombe-Marsh ND, Hausken T, Standfield S, Jones KL, Lange K, Horowitz M, Chapman I, Soenen S. Effects of randomized whey-protein loads on energy intake, appetite, gastric emptying, and plasma gut-hormone concentrations in older men and women. Am J Clin Nutr 2017; 106:865-877. [PMID: 28747330 DOI: 10.3945/ajcn.117.154377] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Protein- and energy-rich supplements are used widely for the management of malnutrition in the elderly. Information about the effects of protein on energy intake and related gastrointestinal mechanisms and whether these differ between men and women is limited.Objective: We determined the effects of whey protein on energy intake, appetite, gastric emptying, and gut hormones in healthy older men and women.Design: Eight older women and 8 older men [mean ± SEM age: 72 ± 1 y; body mass index (in kg/m2): 25 ± 1] were studied on 3 occasions in which they received protein loads of 30 g (120 kcal) or 70 g (280 kcal) or a flavored water control drink (0 kcal). At regular intervals over 180 min, appetite (visual analog scales), gastric emptying (3-dimensional ultrasonography), and blood glucose and plasma gut-hormone concentrations [insulin, glucagon, ghrelin, cholecystokinin, gastric inhibitory polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and peptide tyrosine tyrosine (PYY)] were measured, and ad libitum energy intake was quantified from a buffet meal (180-210 min; energy intake, appetite, and gastric emptying in the men have been published previously).Results: Energy intake at the buffet meal was ∼80% higher in older men than in older women (P < 0.001). Energy intake was not suppressed by protein compared with the control in men or women (P > 0.05). There was no effect of sex on gastric emptying, appetite, gastrointestinal symptoms, glucose, or gut hormones (P > 0.05). There was a protein load-dependent slowing of gastric emptying, an increase in concentrations of insulin, glucagon, cholecystokinin, GIP, GLP-1, and PYY, and an increase in total energy intake (drink plus meal: 12% increase with 30 g and 32% increase with 70 g; P < 0.001). Energy intake at the buffet meal was inversely related to the stomach volume and area under the curve of hormone concentrations (P < 0.05).Conclusion: In older men and women, whey-protein drinks load-dependently slow gastric emptying and alter gut hormone secretion compared with a control but have no suppressive effect on subsequent ad libitum energy intake. This trial was registered at www.anzctr.org.au as ACTRN12612000941864.
Collapse
Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Laurence G Trahair
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- The Commonwealth Scientific and Industrial Research Organisation, Animal, Food and Health Sciences, Adelaide, South Australia, Australia; and
| | - Trygve Hausken
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Scott Standfield
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia;
| |
Collapse
|
16
|
Trahair LG, Rajendran S, Visvanathan R, Chapman M, Stadler D, Horowitz M, Jones KL. Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension. Physiol Rep 2017; 5:5/13/e13341. [PMID: 28684639 PMCID: PMC5506527 DOI: 10.14814/phy2.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023] Open
Abstract
Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH Eight healthy older subjects (age 71.0 ± 1.7 years) and eight subjects with PPH (age 75.5 ± 1.0 years) consumed a 300 mL drink of either water or 75 g glucose (including 150 mg 13C-acetate) in randomized order. BP and heart rate (HR) were measured using an automatic device, SV, CO, and GLS by transthoracic echocardiography and gastric emptying by measurement of 13CO2 In both groups, glucose decreased systolic BP (P < 0.001) and increased HR, SV, and CO (P < 0.05 for all). The fall in systolic BP was greater (P < 0.05), and increase in HR less (P < 0.05), in the PPH group, with no difference in SV or CO Water increased systolic BP (P < 0.05) in subjects with PPH and, in both groups, decreased HR (P < 0.05) without affecting SV, CO, or GLS In subjects with PPH, the hypotensive response to glucose and the pressor response to water were related (R = -0.75, P < 0.05). These observations indicate that, in PPH, the hypotensive response to oral glucose is associated with inadequate compensatory increases in CO and HR, whereas the pressor response to water ingestion is maintained and, possibly, exaggerated.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
| | - Sharmalar Rajendran
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
- Cardiology Unit, Lyell McEwin Hospital Northern Local Health Network, Elizabeth Vale, South Australia, Australia
| | - Renuka Visvanathan
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre School of Medicine The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew Chapman
- Cardiology Unit, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Daniel Stadler
- Cardiology Unit, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
17
|
Wu T, Trahair LG, Little TJ, Bound MJ, Zhang X, Wu H, Sun Z, Horowitz M, Rayner CK, Jones KL. Effects of Vildagliptin and Metformin on Blood Pressure and Heart Rate Responses to Small Intestinal Glucose in Type 2 Diabetes. Diabetes Care 2017; 40:702-705. [PMID: 28258090 DOI: 10.2337/dc16-2391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/16/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate effects of vildagliptin and metformin on blood pressure (BP) and heart rate (HR) responses to intraduodenal (ID) glucose in diet-controlled type 2 diabetes. RESEARCH DESIGN AND METHODS Study A compared vildagliptin (50 mg) and placebo, given 60 min before a 120-min ID glucose infusion at 2 or 4 kcal/min (ID2 or ID4) in 16 patients. Study B compared metformin (850 mg) and placebo, given 30 min before ID2 over 120 min in 9 patients. RESULTS Systolic (P = 0.002) and diastolic (P < 0.001) BP were lower and HR greater (P = 0.005) after vildagliptin compared with placebo, without interaction between vildagliptin and the glucose infusion rate. In contrast, HR was greater after metformin than placebo (P < 0.001), without any difference in systolic or diastolic BP. CONCLUSIONS Vildagliptin reduces BP and increases HR, whereas metformin increases HR without affecting BP during ID glucose infusion in type 2 diabetes. These distinct cardiovascular profiles during enteral nutrient exposure may have implications for postprandial hypotension.
Collapse
Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tanya J Little
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michelle J Bound
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Xiang Zhang
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hang Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
18
|
Trahair LG, Marathe CS, Standfield S, Rayner CK, Feinle-Bisset C, Horowitz M, Jones KL. Effects of small intestinal glucose on glycaemia, insulinaemia and incretin hormone release are load-dependent in obese subjects. Int J Obes (Lond) 2017; 41:225-232. [PMID: 27840416 DOI: 10.1038/ijo.2016.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/10/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Studies concerning the glycaemic response to oral glucose, or meals in obesity have usually failed to account for gastric emptying. It has been suggested that the incretin effect may be diminished in obesity as a result of a reduction in glucagon-like peptide-1 (GLP-1) secretion. We sought to determine the effect of two different rates of intraduodenal glucose infusions on glycaemic, insulinaemic and incretin hormone responses in lean and obese subjects and compare the effects of oral and intraduodenal glucose in obese subjects. SUBJECTS/METHODS Eleven obese subjects (age 37.5±4.1 years, body mass index (BMI) 35.7±1.4 kg m-2) and 12 controls (age 34.7±4.0 years, BMI 23.9±0.7 kg m-2) received intraduodenal infusions of glucose at 1 or 3 kcal min-1, or saline for 60 min (t=0-60 min), followed by intraduodenal saline (t=60-120 min). In obese subjects, an oral glucose tolerance test was performed. Blood glucose, serum insulin, plasma total GLP-1 and total gastric inhibitory polypeptide (GIP) were measured. RESULTS In both the groups (P<0.001), the incremental areas under the curve (iAUC)0-60 min for glucose was greater with the 3 kcal min-1 than the 1 kcal min-1 infusion; the iAUC0-120 min for glucose during 3 kcal min-1 was greater (P<0.05), in the obese. Insulin responses to 1 kcal min-1 and, particularly, 3 kcal min-1 were greater (P<0.001) in the obese. Stimulation of GLP-1 and GIP were greater (P<0.001) in response to 3 kcal min-1, compared with 1 kcal min-1 and saline, without any difference between the groups. In the obese, glycaemic, insulinaemic and GIP, but not GLP-1, responses to oral and intraduodenal glucose were related (P<0.05). CONCLUSIONS The rate of duodenal glucose delivery is a major determinant of glycaemia, insulinaemia and incretin hormone release in obese subjects. Obesity is not apparently associated with impaired GLP-1 secretion.
Collapse
Affiliation(s)
- L G Trahair
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - C S Marathe
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - S Standfield
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - C K Rayner
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - C Feinle-Bisset
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - M Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - K L Jones
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
19
|
Wu T, Zhang X, Trahair LG, Bound MJ, Little TJ, Deacon CF, Horowitz M, Jones KL, Rayner CK. Small Intestinal Glucose Delivery Affects the Lowering of Blood Glucose by Acute Vildagliptin in Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:4769-4778. [PMID: 27598511 DOI: 10.1210/jc.2016-2813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT The rate of gastric emptying is an important determinant of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) secretion and may influence the magnitude of glucose lowering by dipeptidyl peptidase-4 (DPP-4) inhibitors. OBJECTIVE To evaluate the effects of the DPP-4 inhibitor, vildagliptin (VILD), during intraduodenal (ID) glucose infusion at 2 different rates within the physiological range of gastric emptying, in type 2 diabetes. PARTICIPANTS AND DESIGN A total of 16 diet-controlled type 2 diabetic patients were studied on 4 separate days in double-blind, randomized, fashion. On each day, either 5-mg VILD or placebo (PLBO) was given 60 minutes before a 120-minute ID glucose infusion at 2 or 4 kcal/min (ID2 or ID4). Plasma glucose and hormones were measured frequently. RESULTS Plasma glucose, insulin, C-peptide, glucagon, total GIP, and total and intact GLP-1 concentrations were higher during ID4 than ID2 (P < .01 for each). Compared with PLBO, VILD was associated with higher intact GLP-1, insulin, and C-peptide and lower glucose and total GIP and GLP-1 (P < .01 for each), without affecting glucagon. There were significant interactions between the rate of ID glucose and VILD treatment on plasma glucose, intact and total GLP-1, and GIP (P < .05 for each) but not insulin, C-peptide, or glucagon. The reduction in glucose and the increment in intact GLP-1 after VILD vs PLBO were 3.3- and 3.8-fold greater, respectively, during ID4 compared with ID2. CONCLUSIONS/INTERPRETATION These observations warrant further study to clarify whether type 2 diabetic patients with relatively more rapid gastric emptying have greater glucose lowering during treatment with DPP-4 inhibitors.
Collapse
Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Xiang Zhang
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Laurence G Trahair
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Michelle J Bound
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Tanya J Little
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Carolyn F Deacon
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Michael Horowitz
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Karen L Jones
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Christopher K Rayner
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Rigda RS, Trahair LG, Little TJ, Wu T, Standfield S, Feinle-Bisset C, Rayner CK, Horowitz M, Jones KL. Regional specificity of the gut-incretin response to small intestinal glucose infusion in healthy older subjects. Peptides 2016; 86:126-132. [PMID: 27780735 DOI: 10.1016/j.peptides.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023]
Abstract
The importance of the region, as opposed to the length, of small intestine exposed to glucose in determining the secretion of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) remains unclear. We sought to compare the glycemic, insulinemic and incretin responses to glucose administered to the proximal (12-60cm beyond the pylorus), or more distal (>70cm beyond the pylorus) small intestine, or both. 10 healthy subjects (9M,1F; aged 70.3±1.4years) underwent infusion of glucose via a catheter into the proximal (glucose proximally; GP), or distal (glucose distally; GD) small intestine, or both (GPD), on three separate days in a randomised fashion. Blood glucose, serum insulin and plasma GLP-1, GIP and CCK responses were assessed. The iAUC for blood glucose was greater in response to GPD than GP (P<0.05), with no difference between GD and GP. GP was associated with minimal GLP-1 response (P=0.05), but substantial increases in GIP, CCK and insulin (P<0.001 for all). GPD and GD both stimulated GLP-1, GIP, CCK and insulin (P<0.001 for all). Compared to GP, GPD induced greater GLP-1, GIP and CCK responses (P<0.05 for all). Compared with GPD, GD was associated with greater GLP-1 (P<0.05), but reduced GIP and CCK (P<0.05 for both), responses. We conclude that exposure of glucose to the distal small intestine appears necessary for substantial GLP-1 secretion, while exposure of both the proximal and distal small intestine result in substantial secretion of GIP.
Collapse
Affiliation(s)
- Rachael S Rigda
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Tanya J Little
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Scott Standfield
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Christine Feinle-Bisset
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia.
| |
Collapse
|
21
|
Trahair LG, Kimber TE, Flabouris K, Horowitz M, Jones KL. Gastric emptying, postprandial blood pressure, glycaemia and splanchnic flow in Parkinson’s disease. World J Gastroenterol 2016; 22:4860-4867. [PMID: 27239112 PMCID: PMC4873878 DOI: 10.3748/wjg.v22.i20.4860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/27/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine gastric emptying, blood pressure, mesenteric artery blood flow, and blood glucose responses to oral glucose in Parkinson’s disease.
METHODS: Twenty-one subjects (13 M, 8 F; age 64.2 ± 1.6 years) with mild to moderate Parkinson’s disease (Hoehn and Yahr score 1.4 ± 0.1, duration of known disease 6.3 ± 0.9 years) consumed a 75 g glucose drink, labelled with 20 MBq 99mTc-calcium phytate. Gastric emptying was quantified with scintigraphy, blood pressure and heart rate with an automated device, superior mesenteric artery blood flow by Doppler ultrasonography and blood glucose by glucometer for 180 min. Autonomic nerve function was evaluated with cardiovascular reflex tests and upper gastrointestinal symptoms by questionnaire.
RESULTS: The mean gastric half-emptying time was 106 ± 9.1 min, gastric emptying was abnormally delayed in 3 subjects (14%). Systolic and diastolic blood pressure fell (P < 0.001) and mesenteric blood flow and blood glucose (P < 0.001 for both) increased, following the drink. Three subjects (14%) had definite autonomic neuropathy and 8 (38%) had postprandial hypotension. There were no significant relationships between changes in blood pressure, heart rate or mesenteric artery blood flow with gastric emptying. Gastric emptying was related to the score for autonomic nerve function (R = 0.55, P < 0.01). There was an inverse relationship between the blood glucose at t = 30 min (R = -0.52, P < 0.05), while the blood glucose at t = 180 min was related directly (R = 0.49, P < 0.05), with gastric emptying.
CONCLUSION: In mild to moderate Parkinson’s disease, gastric emptying is related to autonomic dysfunction and a determinant of the glycaemic response to oral glucose.
Collapse
|
22
|
Marathe CS, Horowitz M, Trahair LG, Bound M, Checklin H, Lange K, Rayner CK, Jones KL. Effect of duodenal glucose load on blood pressure in type 2 diabetes. Diabetes Res Clin Pract 2016; 113:38-40. [PMID: 26972959 DOI: 10.1016/j.diabres.2016.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/14/2016] [Accepted: 01/17/2016] [Indexed: 02/07/2023]
Abstract
Postprandial hypotension occurs frequently in diabetes. We show in 9 type 2 patients, that the fall in systolic blood pressure is greater in response to intraduodenal glucose infused at 4 kcal/min than 2 kcal/min, implying that strategies to slow gastric emptying may be effective in the management of postprandial hypotension.
Collapse
Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Laurence G Trahair
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Michelle Bound
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Helen Checklin
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Kylie Lange
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| |
Collapse
|
23
|
Giezenaar C, Trahair LG, Rigda R, Hutchison AT, Feinle-Bisset C, Luscombe-Marsh ND, Hausken T, Jones KL, Horowitz M, Chapman I, Soenen S. Lesser suppression of energy intake by orally ingested whey protein in healthy older men compared with young controls. Am J Physiol Regul Integr Comp Physiol 2015; 309:R845-54. [PMID: 26290103 PMCID: PMC4666943 DOI: 10.1152/ajpregu.00213.2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/13/2015] [Indexed: 02/07/2023]
Abstract
Protein-rich supplements are used widely for the management of malnutrition in young and older people. Protein is the most satiating of the macronutrients in young. It is not known how the effects of oral protein ingestion on energy intake, appetite, and gastric emptying are modified by age. The aim of the study was to determine the suppression of energy intake by protein compared with control and underlying gastric-emptying and appetite responses of oral whey protein drinks in eight healthy older men (69-80 yr) compared with eight young male controls (18-34 yr). Subjects were studied on three occasions to determine the effects of protein loads of 30 g/120 kcal and 70 g/280 kcal compared with a flavored water control-drink (0 g whey protein) on energy intake (ad libitum buffet-style meal), and gastric emptying (three-dimensional-ultrasonography) and appetite (0-180 min) in a randomized, double-blind, cross-over design. Energy intake was suppressed by the protein compared with control (P = 0.034). Suppression of energy intake by protein was less in older men (1 ± 5%) than in young controls (15 ± 2%; P = 0.008). Cumulative energy intake (meal+drink) on the protein drink days compared with the control day increased more in older (18 ± 6%) men than young (1 ± 3%) controls (P = 0.008). Gastric emptying of all three drinks was slower in older men (50% gastric-emptying time: 68 ± 5 min) than young controls (36 ± 5 min; P = 0.007). Appetite decreased in young, while it increased in older (P < 0.05). In summary, despite having slower gastric emptying, elderly men exhibited blunted protein-induced suppression of energy intake by whey protein compared with young controls, so that in the elderly men, protein ingestion increased overall energy intake more than in the young men.
Collapse
Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Laurence G Trahair
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Rachael Rigda
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Amy T Hutchison
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Christine Feinle-Bisset
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia; Commonwealth Scientific and Industrial Research Organisation Animal, Food and Health Sciences, Adelaide, Australia; and
| | - Trygve Hausken
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia;
| |
Collapse
|
24
|
Marathe CS, Horowitz M, Trahair LG, Wishart JM, Bound M, Lange K, Rayner CK, Jones KL. Relationships of Early And Late Glycemic Responses With Gastric Emptying During An Oral Glucose Tolerance Test. J Clin Endocrinol Metab 2015. [PMID: 26171801 DOI: 10.1210/jc.2015‐2482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT The early glycemic response during a 75-g oral glucose tolerance test (OGTT) is directly related to the rate of gastric emptying (GE). There is little information about the effect of GE on the blood glucose at either 60 min (a predictor of diabetes) or 120 min (used diagnostically). OBJECTIVE This study aimed to evaluate the relationships between glycemic responses at 30, 60, and 120 min and GE following a 75-g OGTT in subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes (T2D). DESIGN, SETTING, AND SUBJECTS Eighty-two subjects in the general community without diabetes (57 NGT, 25 IGT) and 16 with T2D consumed a 75-g glucose drink labeled with (99m)Tc-sulfur colloid. GE (by scintigraphy) and glycemia were measured from t = 0-120 min and relationships between blood glucose (absolute, change from baseline, and area under the curve) and GE at 30, 60, and 120 min determined. RESULTS There were no differences in GE. There were relationships between the blood glucose at 30 min and GE (NGT: r = 0.40; P < .01; IGT: r = 0.49; P = .02; T2D: r = 0.62; P = .01). There was also a relationship between the blood glucose at 60 min and GE in IGT (r = 0.52; P = .02) and T2D (r = 0.77; P < .01), but not NGT (r = 0.16; P = .24). In NGT, there was an inverse relationship between blood glucose at 120 min and GE (r = -0.30; P = .02), but not in IGT (r = 0.05; P = .82) or T2D (r = 0.37; P = .16). CONCLUSIONS GE is a determinant of the glycemic response to an OGTT in NGT, IGT, and T2D but these relationships differ and are time dependent.
Collapse
Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Michael Horowitz
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Laurence G Trahair
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Judith M Wishart
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Michelle Bound
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Kylie Lange
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Christopher K Rayner
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Karen L Jones
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| |
Collapse
|
25
|
Marathe CS, Horowitz M, Trahair LG, Wishart JM, Bound M, Lange K, Rayner CK, Jones KL. Relationships of Early And Late Glycemic Responses With Gastric Emptying During An Oral Glucose Tolerance Test. J Clin Endocrinol Metab 2015; 100:3565-71. [PMID: 26171801 DOI: 10.1210/jc.2015-2482] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT The early glycemic response during a 75-g oral glucose tolerance test (OGTT) is directly related to the rate of gastric emptying (GE). There is little information about the effect of GE on the blood glucose at either 60 min (a predictor of diabetes) or 120 min (used diagnostically). OBJECTIVE This study aimed to evaluate the relationships between glycemic responses at 30, 60, and 120 min and GE following a 75-g OGTT in subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes (T2D). DESIGN, SETTING, AND SUBJECTS Eighty-two subjects in the general community without diabetes (57 NGT, 25 IGT) and 16 with T2D consumed a 75-g glucose drink labeled with (99m)Tc-sulfur colloid. GE (by scintigraphy) and glycemia were measured from t = 0-120 min and relationships between blood glucose (absolute, change from baseline, and area under the curve) and GE at 30, 60, and 120 min determined. RESULTS There were no differences in GE. There were relationships between the blood glucose at 30 min and GE (NGT: r = 0.40; P < .01; IGT: r = 0.49; P = .02; T2D: r = 0.62; P = .01). There was also a relationship between the blood glucose at 60 min and GE in IGT (r = 0.52; P = .02) and T2D (r = 0.77; P < .01), but not NGT (r = 0.16; P = .24). In NGT, there was an inverse relationship between blood glucose at 120 min and GE (r = -0.30; P = .02), but not in IGT (r = 0.05; P = .82) or T2D (r = 0.37; P = .16). CONCLUSIONS GE is a determinant of the glycemic response to an OGTT in NGT, IGT, and T2D but these relationships differ and are time dependent.
Collapse
Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Michael Horowitz
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Laurence G Trahair
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Judith M Wishart
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Michelle Bound
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Kylie Lange
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Christopher K Rayner
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| | - Karen L Jones
- Discipline of Medicine (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia; and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., M.H., L.G.T., J.M.W., M.B., K.L., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia
| |
Collapse
|
26
|
Trahair LG, Horowitz M, Stevens JE, Feinle-Bisset C, Standfield S, Piscitelli D, Rayner CK, Deane AM, Jones KL. Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes. Diabetologia 2015; 58:1769-78. [PMID: 26048234 DOI: 10.1007/s00125-015-3638-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/30/2015] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS A postprandial fall in BP occurs frequently in older individuals and in patients with type 2 diabetes. The magnitude of this decrease in BP is related to the rate of gastric emptying (GE). Intravenous administration of glucagon-like peptide-1 (GLP-1) attenuates the hypotensive response to intraduodenal glucose in healthy older individuals. We sought to determine the effects of exogenous GLP-1 on BP, GE, superior mesenteric artery (SMA) flow and glycaemic response to oral ingestion of glucose in healthy older individuals and patients with type 2 diabetes. METHODS Fourteen older volunteers (six men, eight women; age 72.1 ± 1.1 years) and ten patients with type 2 diabetes (six men, four women; age 68.7 ± 3.4 years; HbA1c 6.6 ± 0.2% [48.5 ± 2.0 mmol/mol]; nine with blood glucose managed with metformin, two with a sulfonylurea and one with a dipeptidyl-peptidase 4 inhibitor) received an i.v. infusion of GLP-1 (0.9 pmol kg(-1) min(-1)) or saline (154 mmol/l NaCl) for 150 min (t = -30 min to t = 120 min) in randomised order. At t = 0 min, volunteers consumed a radiolabelled 75 g glucose drink. BP was assessed with an automated device, GE by scintigraphy and SMA flow by ultrasonography. Blood glucose and serum insulin were measured. RESULTS GLP-1 attenuated the fall in diastolic BP after the glucose drink in older individuals (p < 0.05) and attenuated the fall in systolic and diastolic BP in patients with type 2 diabetes (p < 0.05). GE was faster in patients with type 2 diabetes than in healthy individuals (p < 0.05). In both groups, individuals had slower GE (p < 0.001), decreased SMA flow (p < 0.05) and a lower degree of glycaemia (p < 0.001) when receiving GLP-1. CONCLUSIONS/INTERPRETATION Intravenous GLP-1 attenuates the hypotensive response to orally administered glucose and decreases SMA flow, probably by slowing GE. GLP-1 and 'short-acting' GLP-1 agonists may be useful in the management of postprandial hypotension.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Trahair LG, Horowitz M, Jones KL. Postprandial hypotension is associated with more rapid gastric emptying in healthy older individuals. J Am Med Dir Assoc 2015; 16:521-3. [PMID: 25769959 DOI: 10.1016/j.jamda.2015.01.097] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postprandial hypotension (PPH) occurs frequently in older individuals with disease and/or living in residential care, but its prevalence in "healthy" older individuals has not been evaluated in large cohorts. PPH is associated with substantial morbidity and increased mortality; current management is suboptimal. Recent studies suggest that the magnitude of the postprandial fall in blood pressure (BP) is related to the rate of gastric emptying (GE), so that relatively more rapid GE may potentially be a risk factor for PPH. We aimed to determine the prevalence of, and evaluate the association of GE with PPH. METHODS A total of 88 healthy "older", community-dwelling residents (47 women, 41 men; age 71.0 ± 0.5 years) attended a clinical research laboratory on a single occasion. Individuals consumed a 300 mL drink containing 75 g glucose and 150 mg C(13)-acetate. Exhaled breath was obtained for analysis of (13)CO2 and calculation of the 50% GE time (T50). BP and heart rate were assessed with an automated device. RESULTS Eleven (12.8%) of 86 subjects had PPH (2 had diabetes and were excluded). GE was faster in subjects with PPH than the remainder of the group (T50 118.0 ± 9.4 vs 142.3 ± 4.6 minutes, P < .05). CONCLUSIONS We conclude the prevalence of PPH in a cohort of otherwise healthy "older" individuals is 12.8% and PPH is associated with relatively more rapid GE. Therapies that slow GE may be useful in the management of PPH.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia; National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia; National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia; National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia.
| |
Collapse
|
28
|
Plummer MP, Jones KL, Cousins CE, Trahair LG, Meier JJ, Chapman MJ, Horowitz M, Deane AM. Hyperglycemia potentiates the slowing of gastric emptying induced by exogenous GLP-1. Diabetes Care 2015; 38:1123-9. [PMID: 25784665 DOI: 10.2337/dc14-3091] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/23/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Acute hyperglycemia markedly slows gastric emptying. Exogenous GLP-1 also slows gastric emptying, leading to diminished glycemic excursions. The primary objective was to determine whether hyperglycemia potentiates the slowing of gastric emptying induced by GLP-1 administration. RESEARCH DESIGN AND METHODS Ten healthy participants were studied on 4 separate days. Blood glucose was clamped at hyperglycemia using an intravenous infusion of 25% dextrose (∼12 mmol/L; hyper) on 2 days, or maintained at euglycemia (∼6 mmol/L; eu) on 2 days, between t = -15 and 240 min. During hyperglycemic and euglycemic days, participants received intravenous GLP-1 (1.2 pmol/kg/min) and placebo in a randomized double-blind fashion. At t = 0 min, subjects ingested 100 g beef mince labeled with 20 MBq technetium-99m-sulfur colloid and 3 g 3-O-methyl-glucose (3-OMG), a marker of glucose absorption. Gastric emptying was measured scintigraphically from t = 0 to 240 min and serum 3-OMG taken at regular intervals from t = 15 to 240 min. The areas under the curve for gastric emptying and 3-OMG were analyzed using one-way repeated-measures ANOVA with Bonferroni-Holm adjusted post hoc tests. RESULTS Hyperglycemia slowed gastric emptying (eu/placebo vs. hyper/placebo; P < 0.001) as did GLP-1 (eu/placebo vs. eu/GLP-1; P < 0.001). There was an additive effect of GLP-1 and hyperglycemia, such that gastric emptying was markedly slower compared with GLP-1 administration during euglycemia (eu/GLP-1 vs. hyper/GLP-1; P < 0.01). CONCLUSIONS Acute administration of exogenous GLP-1 profoundly slows gastric emptying during hyperglycemia in excess of the slowing induced by GLP-1 during euglycemia. Studies are required to determine the effects of hyperglycemia on gastric emptying with the subcutaneously administered commercially available GLP-1 agonists in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Mark P Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Caroline E Cousins
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Juris J Meier
- Diabetes Division, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
29
|
Wu T, Trahair LG, Bound MJ, Deacon CF, Horowitz M, Rayner CK, Jones KL. Effects of sitagliptin on blood pressure and heart rate in response to intraduodenal glucose infusion in patients with Type 2 diabetes: a potential role for glucose-dependent insulinotropic polypeptide? Diabet Med 2015; 32:595-600. [PMID: 25388434 DOI: 10.1111/dme.12622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/18/2014] [Accepted: 10/28/2014] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate the effects of the dipeptidyl peptidase-4 inhibitor sitagliptin on blood pressure and heart rate, measured during a previously reported study, in which the effects of sitagliptin during intraduodenal glucose infusion at the rate of 2 kcal/min on glucose homeostasis were examined in patients with Type 2 diabetes. METHODS A total of 10 people with Type 2 diabetes were studied on two different days, 30 min after oral ingestion of sitagliptin (100 mg) or placebo. Intraduodenal glucose was infused at 2 kcal/min (60 g over 120 min), and blood pressure, heart rate, plasma glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (total and intact), glucose, insulin and glucagon responses were evaluated. RESULTS In response to intraduodenal glucose infusion, heart rate (treatment effect: P = 0.001) and serum insulin concentration (treatment × time interaction: P = 0.041) were higher after sitagliptin treatment than placebo, without a significant difference in blood pressure, plasma glucagon or glucose. During intraduodenal glucose infusion, there was a substantial increase in plasma total glucose-dependent insulinotropic polypeptide on both days (time effect: P < 0.001), but not in total glucagon-like peptide-1. After sitagliptin, plasma intact glucagon-like peptide-1 concentration increased slightly (treatment × time interaction: P = 0.044) and glucose-dependent insulinotropic polypeptide concentration increased substantially (treatment × time interaction: P = 0.003).The heart rate response to intraduodenal glucose was related directly to plasma intact glucose-dependent insulinotropic polypeptide concentrations (r = 0.75, P = 0.008). CONCLUSIONS Sitagliptin increased the heart rate response to intraduodenal glucose infusion at 2 kcal/min in people with Type 2 diabetes, which was associated with augmentation of plasma intact glucose-dependent insulinotropic polypeptide concentrations. These observations warrant further clarification of a potential role for glucose-dependent insulinotropic polypeptide in the control of the 'gut-heart' axis.
Collapse
Affiliation(s)
- T Wu
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | | | | | | | | | | | | |
Collapse
|
30
|
Trahair LG, Horowitz M, Hausken T, Feinle-Bisset C, Rayner CK, Jones KL. Effects of exogenous glucagon-like peptide-1 on the blood pressure, heart rate, mesenteric blood flow, and glycemic responses to intraduodenal glucose in healthy older subjects. J Clin Endocrinol Metab 2014; 99:E2628-34. [PMID: 25210879 DOI: 10.1210/jc.2014-2475] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Studies relating to the cardiovascular effects of glucagon-like peptide-1 (GLP-1) and its agonists, which slow gastric emptying, have not discriminated between fasting and postprandial, blood pressure (BP) and heart rate (HR). OBJECTIVE To determine whether exogenous GLP-1 modulates the effects of an intraduodenal (ID) glucose infusion on BP, HR, and splanchnic blood flow in healthy older subjects. DESIGN A double-blind randomized trial was conducted. SETTING Community-dwelling residents attended a clinical research laboratory. PATIENTS Ten healthy "older" subjects (9 male, 1 female; age 73.2 ± 1.5 y) were studied. INTERVENTIONS Intravenous infusion of GLP-1 (0.9 pmol/kg/min), or saline (0.9%) for 90 min (t = -30-60 min). Between t = 0-60 min, ID glucose was infused at 3 kcal/min. MAIN OUTCOME MEASURES BP, HR, superior mesenteric artery (SMA) flow, blood glucose, and serum insulin were measured. RESULTS During the fasting period (t = -30-0 min), GLP-1 had no effect on BP or HR. In response to ID glucose (t = 0-60 min), systolic BP decreased (P < .001), and both HR (P < .001) and SMA flow (P < .05) increased, on both days. GLP-1 attenuated the maximum decrease in systolic BP (P < .05), tended to increase HR (P = .09), and increased SMA flow (P < .01). GLP-1 diminished the glycemic response (P < .05). CONCLUSIONS In healthy older subjects, acute administration of GLP-1 attenuates the hypotensive response to ID glucose, and potentiates the increase in SMA flow.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine (L.G.T., M.H., C.F.-B., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia; National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (L.G.T., M.H., C.F.-B., C.K.R., K.L.J.), The University of Adelaide, Adelaide 5005, Australia; and Section for Gastroenterology (T.H.), Department of Clinical Medicine, University of Bergen, N-5020 Bergen, Norway
| | | | | | | | | | | |
Collapse
|
31
|
Trahair LG, Horowitz M, Marathe CS, Lange K, Standfield S, Rayner CK, Jones KL. Impact of gastric emptying to the glycemic and insulinemic responses to a 75-g oral glucose load in older subjects with normal and impaired glucose tolerance. Physiol Rep 2014; 2:2/11/e12204. [PMID: 25413324 PMCID: PMC4255811 DOI: 10.14814/phy2.12204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The majority of studies relating to the oral glucose tolerance test (OGTT) have not taken gastric emptying (GE), which exhibits a substantial inter-individual variation, into account. We sought to evaluate the impact of GE, on the glycemic and insulinemic responses to a 75-g oral glucose load in older subjects with normal and impaired glucose tolerance. Eighty-seven healthy 'older' subjects (47F, 40M; age 71.0 ± 0.5 year) were given a drink comprising of 75-g glucose and 150 mg C(13)-acetate made up to 300 mL with water on a single occasion. Exhaled breath was obtained for analysis of (13)CO2 and calculation of the 50% GE time (T50). Blood glucose, serum insulin and plasma glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) were measured, and the insulin sensitivity index (ISI), and the disposition index (DI), were calculated. Thirty-one subjects had normal glucose tolerance (NGT) and 46 had impaired glucose tolerance (IGT). Blood glucose at t = 60 min and t = 120 min were related inversely to ISI (P < 0.001) and DI P < 0.001). The rise in blood glucose at t = 60 min was related inversely to the T50 in all subjects (P < 0.01), and those with IGT (P < 0.001), but not NGT. There were no significant relationships between the blood glucose at t = 120 min with the T50, but in both groups the change in blood glucose from baseline at t = 180 min was related (NGT: P < 0.001; IGT: P < 0.001) to the T50. We conclude that in NGT and IGT, the effect of GE on both the 'early' and 'late' glycemic responses to a 75-g oral glucose load is complementary to that of insulin sensitivity.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Chinmay S Marathe
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Scott Standfield
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
32
|
Abstract
BACKGROUND Postprandial hypotension (PPH) is an important clinical problem, which has received inappropriately little attention. METHODS A systematic search of the databases PubMed, Embase, Cochrane Library, and Web of Knowledge, from their inception to the present time, was conducted to identify studies relevant to the epidemiology, pathophysiology, and/or management of PPH. RESULTS A total of 417 full-text papers were retrieved from database searching and, following screening, 248 were retained. Of these, 167 papers were considered eligible for inclusion. CONCLUSIONS PPH occurs commonly in older people and represents a major cause of morbidity. Although the pathophysiology of PPH remains poorly defined, diverse factors, including impairments in sympathetic and baroreflex function, release of vasodilatory peptides, the rate of small intestinal nutrient delivery, gastric distension, and splanchnic blood pooling, appear important. Current pharmacologic and nonpharmacologic management is suboptimal. Research into the pathophysiology of PPH represents a priority so that management can be targeted more effectively.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; NHMRC Center of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; NHMRC Center of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; NHMRC Center of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.
| |
Collapse
|
33
|
Umapathysivam MM, Lee MY, Jones KL, Annink CE, Cousins CE, Trahair LG, Rayner CK, Chapman MJ, Nauck MA, Horowitz M, Deane AM. Comparative effects of prolonged and intermittent stimulation of the glucagon-like peptide 1 receptor on gastric emptying and glycemia. Diabetes 2014; 63:785-90. [PMID: 24089511 PMCID: PMC3900552 DOI: 10.2337/db13-0893] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Acute administration of glucagon-like peptide 1 (GLP-1) and its agonists slows gastric emptying, which represents the major mechanism underlying their attenuation of postprandial glycemic excursions. However, this effect may diminish during prolonged use. We compared the effects of prolonged and intermittent stimulation of the GLP-1 receptor on gastric emptying and glycemia. Ten healthy men received intravenous saline (placebo) or GLP-1 (0.8 pmol/kg ⋅ min), as a continuous 24-h infusion ("prolonged"), two 4.5-h infusions separated by 20 h ("intermittent"), and a 4.5-h infusion ("acute") in a randomized, double-blind, crossover fashion. Gastric emptying of a radiolabeled mashed potato meal was measured using scintigraphy. Acute GLP-1 markedly slowed gastric emptying. The magnitude of the slowing was attenuated with prolonged but maintained with intermittent infusions. GLP-1 potently diminished postprandial glycemia during acute and intermittent regimens. These observations suggest that short-acting GLP-1 agonists may be superior to long-acting agonists when aiming specifically to reduce postprandial glycemic excursions in the treatment of type 2 diabetes.
Collapse
Affiliation(s)
| | - Michael Y. Lee
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Karen L. Jones
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | | | - Caroline E. Cousins
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Chris K. Rayner
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Marianne J. Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Adam M. Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
- Corresponding author: Adam M. Deane,
| |
Collapse
|
34
|
Sim JA, Horowitz M, Summers MJ, Trahair LG, Goud RS, Zaknic AV, Hausken T, Fraser JD, Chapman MJ, Jones KL, Deane AM. Mesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years. Intensive Care Med 2013; 39:258-66. [PMID: 23096428 DOI: 10.1007/s00134-012-2719-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/13/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare nutrient-stimulated changes in superior mesenteric artery (SMA) blood flow, glucose absorption and glycaemia in individuals older than 65 years with, and without, critical illness. METHODS Following a 1-h 'observation' period (t (0)-t (60)), 0.9 % saline and glucose (1 kcal/ml) were infused directly into the small intestine at 2 ml/min between t (60)-t (120), and t (120)-t (180), respectively. SMA blood flow was measured using Doppler ultrasonography at t (60) (fasting), t (90) and t (150) and is presented as raw values and nutrient-stimulated increment from baseline (Δ). Glucose absorption was evaluated using serum 3-O-methylglucose (3-OMG) concentrations during, and for 1 h after, the glucose infusion (i.e. t (120)-t (180) and t (120)-t (240)). Mean arterial pressure was recorded between t (60)-t (240). Data are presented as median (25th, 75th percentile). RESULTS Eleven mechanically ventilated critically ill patients [age 75 (69, 79) years] and nine healthy volunteers [70 (68, 77) years] were studied. The magnitude of the nutrient-stimulated increase in SMA flow was markedly less in the critically ill when compared with healthy subjects [Δt (150): patients 115 (-138, 367) versus health 836 (618, 1,054) ml/min; P = 0.001]. In patients, glucose absorption was reduced during, and for 1 h after, the glucose infusion when compared with health [AUC(120-180): 4.571 (2.591, 6.551) versus 11.307 (8.447, 14.167) mmol/l min; P < 0.001 and AUC(120-240): 26.5 (17.7, 35.3) versus 40.6 (31.7, 49.4) mmol/l min; P = 0.031]. A close relationship between the nutrient-stimulated increment in SMA flow and glucose absorption was evident (3-OMG AUC(120-180) and ∆SMA flow at t (150): r (2) = 0.29; P < 0.05). CONCLUSIONS In critically ill patients aged >65 years, stimulation of SMA flow by small intestinal glucose infusion may be attenuated, which could account for the reduction in glucose absorption.
Collapse
Affiliation(s)
- Jennifer A Sim
- Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Trahair LG, Vanis L, Gentilcore D, Lange K, Rayner CK, Horowitz M, Jones KL. Effects of variations in duodenal glucose load on blood pressure, heart rate, superior mesenteric artery blood flow and plasma noradrenaline in healthy young and older subjects. Clin Sci (Lond) 2012; 122:271-9. [PMID: 21942924 DOI: 10.1042/cs20110270] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PPH (postprandial hypotension), leading to increased morbidity and mortality, is an important clinical problem, particularly in the elderly and individuals with autonomic dysfunction. The magnitude of the postprandial fall in BP (blood pressure) appears to be dependent on the rate of nutrient entry into the small intestine and may be related to changes in splanchnic blood flow and sympathetic nerve activity. We aimed at determining the comparative effects of different ID (intraduodenal) glucose loads on BP, HR (heart rate), SMA (superior mesenteric artery) flow and vascular conductance and plasma NA (noradrenaline) in 'young' and 'older' subjects. A total of 12 'young' (six male and six female; age, 22.2±2.3 years) and 12 'older' (six male and six female; age, 68.7±1.0 years) subjects, the latter who have been studied previously [Vanis, Gentilcore, Rayner, Wishart, Horowitz, Feinle-Bisset and Jones (2011) Am. J. Physiol. Regul. Integr. Comp. Physiol., 300, R1524-R1531], had measurements of BP, HR, SMA flow and plasma NA before, and during, ID infusions of glucose at 1, 2 or 3 kcal/min ('G1', 'G2' and 'G3') (where 1 kcal≈4.184 J), or 'S' (saline) for 60 min. In 'young' subjects, there was no change in BP during any of the four infusions. In contrast, in 'older' subjects, SBP (systolic BP) fell during 'G2', and 'G3' (P<0.005 for both), but not during 'S' or 'G1'. In 'young' and 'older' subjects HR increased during 'G2' (P<0.05) and 'G3' (P<0.001), a response that was greater (P<0.05) in the young, but not during 'S' or 'G1'. The rise in SMA flow and vascular conductance in response to ID glucose were load-dependent in both 'young' and 'older' subjects (P<0.001 for all), with no difference between them. Plasma NA rose in response to 'G2' and 'G3' (P<0.05) in the young, but in 'G3' (P<0.05) only in the 'older' subjects, with no difference between them. Hence, in response to small intestinal glucose infusions at 1, 2 and 3 kcal/min, 'older', but not 'young', subjects exhibit a comparable fall in BP in response to the two higher glucose loads, which may reflect an inadequate, compensatory, rise in HR, in the 'older' subjects, but not a greater increase in SMA conductance.
Collapse
Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia
| | | | | | | | | | | | | |
Collapse
|
36
|
Trahair LG, Horowitz M, Rayner CK, Gentilcore D, Lange K, Wishart JM, Jones KL. Comparative effects of variations in duodenal glucose load on glycemic, insulinemic, and incretin responses in healthy young and older subjects. J Clin Endocrinol Metab 2012; 97:844-51. [PMID: 22238398 DOI: 10.1210/jc.2011-2583] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Aging is associated with deteriorating glucose tolerance. Studies assessing glucose tolerance and subsequent insulin and incretin hormone release often fail to take into account the rate of gastric emptying when evaluating these responses. OBJECTIVE Our objective was to determine the comparative effects of variations in the small intestinal glucose load on the glycemic, insulinemic, and incretin responses in healthy young and older subjects. MATERIALS AND METHODS Twelve healthy young (six males, six females; age 22.2±2.3 yr) and 12 older (six males, six females; age 68.7±1.0 yr) subjects had measurements of blood glucose, serum insulin and plasma incretin hormones [glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)] and calculations of insulin resistance (homeostatic model assessment) and β-cell function corrected for insulin sensitivity, before and during intraduodenal infusions of glucose at 1, 2, or 3 kcal/min or saline for 60 minutes. The study was double-blinded and randomized, and performed in the Discipline of Medicine at the Royal Adelaide Hospital. RESULTS At baseline, blood glucose and serum insulin were slightly higher in the older subjects (P<0.001), whereas GLP-1 and GIP were comparable between groups. In both groups, the glycemic, insulinemic, and GLP-1 responses were dependent on the duodenal glucose load in a nonlinear fashion (P<0.001). The glycemic response was greater (P<0.001) in the older subjects, whereas GLP-1 and GIP responses were comparable between groups. The older subjects were more insulin resistant (P<0.001) and had impaired β-cell function, particularly at higher glucose loads (P<0.05). CONCLUSION When glucose is infused into the small intestine at equal rates in healthy young and older subjects, GLP-1 and GIP responses are comparable, indicating that impaired incretin secretion does not account for age-related glucose intolerance.
Collapse
Affiliation(s)
- Laurence G Trahair
- University of Adelaide, Discipline of Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
| | | | | | | | | | | | | |
Collapse
|
37
|
Vanis L, Gentilcore D, Lange K, Gilja OH, Rigda RS, Trahair LG, Feinle-Bisset C, Rayner CK, Horowitz M, Jones KL. Effects of variations in intragastric volume on blood pressure and splanchnic blood flow during intraduodenal glucose infusion in healthy older subjects. Am J Physiol Regul Integr Comp Physiol 2012; 302:R391-9. [PMID: 22129616 DOI: 10.1152/ajpregu.00464.2011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The postprandial reduction in blood pressure (BP) is triggered by the interaction of nutrients with the small intestine and associated with an increase in splanchnic blood flow. Gastric distension may attenuate the postprandial fall in BP. The aim of this study was to determine the effects of differences in intragastric volume, including distension at a low (100 ml) volume, on BP and superior mesenteric artery (SMA) blood flow responses to intraduodenal glucose in healthy older subjects. BP and heart rate (HR; automated device), SMA blood flow (Doppler ultrasound), mesenteric vascular resistance (MVR), and plasma norepinephrine of nine male subjects (65-75 yr old) were measured after an overnight fast on 4 separate days in random order. On each day, subjects were intubated with a nasoduodenal catheter, incorporating a duodenal infusion port, and orally with a second catheter, incorporating a barostat bag, positioned in the fundus. Each subject received a 60-min (t = 0-60 min) intraduodenal glucose infusion (3 kcal/min) and gastric distension at a volume of 1) 0 ml (V0), 2) 100 ml (V100), 3) 300 ml (V300), or 4) 500 ml (V500). Systolic BP fell (P < 0.05) during V0, but not during V100, V300, or V500. In contrast, HR (P < 0.01) and SMA blood flow (P < 0.001) increased and MVR decreased (P < 0.05) comparably on all 4 days. Plasma norepinephrine rose (P < 0.01) in response to intraduodenal glucose, with no difference between the four treatments. There was a relationship between the areas under the curve for the change in systolic BP from baseline with intragastric volume (r = 0.60, P < 0.001). In conclusion, low-volume (≤100 ml) gastric distension has the capacity to abolish the fall in BP induced by intraduodenal glucose in healthy older subjects without affecting SMA blood flow or MVR. These observations support the concept that nonnutrient gastric distension prior to a meal has potential therapeutic applications in the management of postprandial hypotension.
Collapse
Affiliation(s)
- Lora Vanis
- Univ. of Adelaide Discipline of Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|