Glucagon-Like Peptide I Reduces Postprandial Glycemic Excursions in IDDM

Abstract

Effects of human glucagon-like peptide I (GLP-I)(7–36)amide were examined in volunteers having insulin-dependent diabetes mellitus (IDDM) with residual C-peptide (CP) secretion (n = 8, 7 men and 1 woman; age, 31 ± 1.4 years; body mass index, 24.7 ± 0.7 kg/m²; duration of diabetes, 3.2 ± 0.8 years; insulin dose, 0.41 ± 0.05 U · kg⁻¹· day^−1; meal-stimulated CP, 1.0 ± 0.2 nmol/l [means ± SE]). After a mixed meal (Sustacal, 30 kJ/kg body wt), intravenous injection of GLP-I, 1.2 pmol · kg⁻¹ · min⁻¹ through 120 min, virtually abolished increments of plasma glucose, CP, pancreatic polypeptide (PP), and glucagon concentrations, with no significant effect on plasma gastrin levels during the infusions. At reduced dosage (0.75 pmol · kg⁻¹ · min⁻¹), GLP-I had lesser effects on plasma glucose and CP levels. On cessation of intravenous GLP-I infusions after the meals, plasma glucose, CP, PP, and glucagon concentrations rebounded toward control levels by 180 min, and the response of plasma gastrin was prolonged. These rebound responses are consistent with intestinal delivery of food retained in the stomach on escape from inhibition of gastric emptying by GLP-I. Infusion of 1.2 pmol · kg⁻¹ · min⁻¹ GLP-I with 20 g glucose (10% dextrose in water) injected intravenously over 60 min enhanced plasma responses of immunoreactive CP; the mean incremental areas under concentration curves (0–60 min) increased sixfold, but the glycemic excursion was not affected. Thus, in CP-positive IDDM, pharmacological doses of GLP-I reduce glycemic excursions after meals by a mechanism(s) not dependent on stimulation of insulin secretion, presumably involving delayed gastric emptying. This effect of the peptide on blood glucose levels after meals may have therapeutic implications in both IDDM and non-insulin-dependent diabetes.