title: Cholinergic blockade with pirenzepine induces dose-related reduction in glucose and insulin responses to a mixed meal in normal subjects and non-insulin dependent diabetics.
abstract: OBJECTIVE
  The aim of the study was to assess the effects of cholinergic blockade with pirenzepine on glucose and insulin responses to a mixed meal in normal subjects and patients with non-insulin dependent diabetes (NIDDM). Further, to assess in normal subjects the relative importance of nocturnal GH suppression by pirenzepine.
  
  
  METHODS
  Placebo, 100 or 200 mg pirenzepine were given to the normal subjects 1 hour before a standard mixed meal. The effects of placebo or 200 mg pirenzepine at night on nocturnal GH secretion and subsequent breakfast carbohydrate tolerance were also studied. NIDDMs were given placebo or 200 mg pirenzepine before the meal.
  
  
  METHODS
  We studied six healthy male volunteers (ages 20-22, body mass indices 20.3-23.3) and ten NIDDMs (eight men, ages 42-74); five obese (BMI 25.5-31.8) and five non-obese (BMI 21.2-24.8).
  
  
  METHODS
  Serial plasma glucose and insulin concentrations were measured for 3 hours after a standard mixed meal.
  
  
  RESULTS
  Acute pretreatment of normal male volunteers with pirenzepine produced a dose-related improvement in carbohydrate tolerance. Peak post-prandial plasma glucose levels were delayed and significantly reduced following 200 mg orally (6.5 +/- 0.1 mmol/l), but not following 100 mg (7.3 +/- 0.3), compared with placebo (7.6 +/- 0.3). Peak insulin levels were similarly delayed and reduced by the 200 mg dose only (36.5 +/- 6.1 mU/l, compared with 49.8 +/- 8.7). Suppression of nocturnal GH by 200 mg pirenzepine at night produced a small reduction in fasting plasma glucose (5.0 +/- 0.1 mmol/l, compared with 5.3 +/- 0.1, P less than 0.02) but did not improve subsequent breakfast carbohydrate tolerance. Peak plasma glucose in NIDDMs was reduced following pirenzepine (12.4 +/- 0.9 mmol/l) compared with placebo (14.3 +/- 1.0, P less than 0.01). This reduction was equally significant in obese and non-obese groups. Peak plasma insulin was also reduced by pirenzepine (22.4 +/- 3.9 mU/l) compared with placebo (42.4 +/- 5.3, P less than 0.01). Insulin suppression was quantitatively greater in obese than in non-obese patients.
  
  
  CONCLUSIONS
  Improvement in carbohydrate tolerance after pirenzepine in normal subjects is dose related and largely independent of GH suppression. Cholinergic blockade can also improve meal carbohydrate tolerance with simultaneous reduction in plasma insulin concentrations in non-insulin dependent diabetics, particularly those with obesity.
authors.affiliation: Department of Medicine, University Hospital of Wales, Cardiff, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Bevan
authors.forename: J
authors.initials: J
authors.lastname: Ara
authors.forename: M D
authors.initials: MD
authors.lastname: Page
authors.forename: M F
authors.initials: MF
authors.lastname: Scanlon
authors.forename: J R
authors.initials: JR
authors.lastname: Peters
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D002940:Circadian Rhythm / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004040:Dietary Carbohydrates / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D013006:Growth Hormone / Q000037:antagonists & inhibitors; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D009765:Obesity / Q000097:blood; D010890:Pirenzepine / Q000494:pharmacology*
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D010890:Pirenzepine; D013006:Growth Hormone