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Reduced Incretin Effect in Type 2 Diabetes - Cause or Consequence of the Diabetic State?

Departments of Internal Medicine F, Gentofte Hospital¹,
Internal Medicine M, Glostrup Hospital²,
Endocrinology, Hvidovre Hospital³,
Biostatistics, Novo Nordisk⁴, and
Medical Physiology, The Panum Institute⁵, University of Copenhagen, Denmark

Correspondence: filipknop{at}dadlnet.dk

Key Words: Glucagon-like peptide-1 • glucose-dependent insulinotropic polypeptide • chronic pancreatitis • incretin effect • type 2 diabetes mellitus.

Objective:We aimed to investigate whether the reduced incretin effect observed in patients with type 2 diabetes mellitus (T2DM) is a primary event in the pathogenesis of T2DM or a consequence of the diabetic state.

Research Design and Methods:Eight patients with chronic pancreatitis (CP) and secondary diabetes mellitus (DM) (HbA₁c: 6.9(6.2-8.0)% (mean (range)); eight patients with CP and normal glucose tolerance (NGT) (HbA₁c: 5.3(4.9-5.7)%); eight patients with T2DM (HbA₁c: 6.9(6.2-8.0)%); and eight healthy subjects (HbA₁c: 5.5(5.1-5.8)%) were studied. Blood was sampled over 4 hours on two separate days following a 50 g oral glucose load and an isoglycemic intravenous glucose infusion, respectively.

Results:The incretin effect (100 % x (beta-cell secretory response_OGTT - beta-cell secretory response_iv)/beta-cell secretory response_OGTT) was significantly (P < 0.05) reduced in patients with CP and secondary DM (31±4 % (mean±SEM)) compared to patients with CP and NGT (68±3 %) and healthy subjects (60±4 %), respectively. In the T2DM-group the incretin effect amounted to 36±6 %, significantly (P < 0.05) lower than in CP patients with NGT and healthy subjects, respectively.

Conclusions:These results suggest that the reduced incretin effect is not a primary event in the development of T2DM, but rather a consequence of the diabetic state.

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				E. Muscelli, A. Mari, A. Casolaro, S. Camastra, G. Seghieri, A. Gastaldelli, J. J. Holst, and E. Ferrannini Separate Impact of Obesity and Glucose Tolerance on the Incretin Effect in Normal Subjects and Type 2 Diabetic Patients Diabetes, May 1, 2008; 57(5): 1340 - 1348. [Abstract] [Full Text] [PDF]

				S. P. Choukem and J.-F. Gautier Comment on: Knop et al. (2007) Reduced Incretin Effect in Type 2 Diabetes: Cause or Consequence of the Diabetic State? Diabetes 56:1951 1959 Diabetes, January 1, 2008; 57(1): e1 - e1. [Full Text] [PDF]

				F. K. Knop, T. Vilsboll, S. Madsbad, T. Krarup, and J. J. Holst Response to Comment on: Knop et al. (2007) Reduced Incretin Effect in Type 2 Diabetes: Cause or Consequence of the Diabetic State? Diabetes 56:1951 1959 Diabetes, January 1, 2008; 57(1): e2 - e3. [Full Text] [PDF]