[Postprandial hyperglycemia. II. Pharmacological approaches].
Besides dietary approaches, various pharmacological means have been recently developed in order to better control postprandial hyperglycaemia. This objective may be obtained: 1) by slowing down the intestinal absorption of carbohydrates; 2) by insuring a better insulin priming soon after the meal; and 3) by inhibiting post-prandial glucagon secretion or action. Some hormones (amylin, glucagon-like peptide-1) can slow gastric emptying while alpha-glucosidase inhibitors (acarbose, miglitol) retard intestinal digestion and resorption of complex carbohydrates. A more physiological post-meal profile of insulin may be obtained in type 2 diabetes by using new insulin secretagogues of the glinide family (repaglinide, nateglinide) with an earlier and shorter insulinotropic action or, mainly in type 1 diabetes but also in type 2 diabetes, by using short-acting insulin analogues (lispro. Asp B28) or inhated insulin the action of which is faster than that of subcutaneous insulin. Post-prandial glucagon secretion can be inhibited by amylin. GLP-1 or insulin while other glucagon antagonists are currently in development.
Scheen
A J
AJ
Service de Diabétologie, Nutrition et Maladies métaboliques, Département de Médecine, CHU Sart Tilman.
Letiexhe
M R
MR
Geronooz
I
I
Paquot
N
N
Jandrain
B
B
D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004040:Dietary Carbohydrates / Q000493:pharmacokinetics; D004791:Enzyme Inhibitors / Q000494:pharmacology; D005934:Glucagon / Q000378:metabolism; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007328:Insulin / Q000494:pharmacology; D007408:Intestinal Absorption; D019518:Postprandial Period; D000520:alpha-Glucosidases / Q000494:pharmacology
D004040:Dietary Carbohydrates; D004791:Enzyme Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D005934:Glucagon; D000520:alpha-Glucosidases
L'hyperglycémie post-prandiale. II. Approches thérapeutiques médicamenteuses.