RT Journal Article
SR Electronic
T1 Exogenous Glucose–Dependent Insulinotropic Polypeptide Worsens Post prandial Hyperglycemia in T ype 2 Diabetes
JF Diabetes
JO Diabetes
FD American Diabetes Association
SP 1342
OP 1349
DO 10.2337/db08-0958
VO 58
IS 6
A1 Chia, Chee W.
A1 Carlson, Olga D.
A1 Kim, Wook
A1 Shin, Yu-Kyong
A1 Charles, Cornelia P.
A1 Kim, Hee Seung
A1 Melvin, Denise L.
A1 Egan, Josephine M.
YR 2009
UL http://diabetes.diabetesjournals.org/content/58/6/1342.abstract
AB OBJECTIVE Glucose-dependent insulinotropic polypeptide (GIP), unlike glucagon-like peptide (GLP)-1, lacks glucose-lowering properties in patients with type 2 diabetes. We designed this study to elucidate the underlying pathophysiology. RESEARCH DESIGN AND METHODS Twenty-two insulin-naïve subjects with type 2 diabetes were given either synthetic human GIP (20 ng · kg−1 · min−1) or placebo (normal saline) over 180 min, starting with the first bite of a mixed meal (plus 1 g of acetaminophen) on two separate occasions. Frequent blood samples were obtained over 6 h to determine plasma GIP, GLP-1, glucose, insulin, glucagon, resistin, and acetaminophen levels. RESULTS Compared with placebo, GIP induced an early postprandial increase in insulin levels. Intriguingly, GIP also induced an early postprandial augmentation in glucagon, a significant elevation in late postprandial glucose, and a decrease in late postprandial GLP-1 levels. Resistin and acetaminophen levels were comparable in both interventions. By immunocytochemistry, GIP receptors were present on human and mouse α-cells. In αTC1 cell line, GIP induced an increase in intracellular cAMP and glucagon secretion. CONCLUSIONS GIP, given to achieve supraphysiological plasma levels, still had an early, short-lived insulinotropic effect in type 2 diabetes. However, with a concomitant increase in glucagon, the glucose-lowering effect was lost. GIP infusion further worsened hyperglycemia postprandially, most likely through its suppressive effect on GLP-1. These findings make it unlikely that GIP or GIP receptor agonists will be useful in treating the hyperglycemia of patients with type 2 diabetes.