Measuring the effect of a study meal on portal concentrations of glucagon-like peptide 1 (GLP-1) in non diabetic and diabetic patients with liver cirrhosis: transjugular intrahepatic portosystemic stent shunt (TIPSS) as a new method for metabolic measurements.
BACKGROUND
Diabetes in liver cirrhosis is associated with a blunted insulin response, which might be explained by an impaired release of the incretin hormone glucagon-like peptide 1 (GLP-1) into the portal circulation.


OBJECTIVE
To investigate basal and stimulated portal venous and peripheral GLP-1 concentrations in non-diabetic (ND) and diabetic (D) patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic stent shunt (TIPSS) implantation.


METHODS
After elective TIPSS portalvenous and peripheral probes were drawn from 10 ND and 10 D patients with stable liver disease during an oral metabolic test and plasma glucose, immunoreactive GLP-1, insulin and C-peptide were measured.


RESULTS
The study meal led to a significant rise in portal GLP-1 levels in ND and D. Basal and stimulated portal GLP-1 concentrations were not significantly different between ND and D. Peripheral GLP-1 did not differ significantly from portal venous levels. Insulin response in ND was more pronounced in the portal blood than in the periphery and was absent in D.


CONCLUSIONS
TIPSS allows a direct evaluation of hormonal changes in the portal circulation during an oral metabolic tolerance test. A disturbed GLP-1 secretion does not play a role in blunting the insulin response observed in patients with hepatogenous diabetes.
Raddatz
D
D
Department of Gastroenterology & Endocrinology, Georg-August-Universität Göttingen, Göttingen, Germany. draddat@gwdg.de
Nolte
W
W
Rossbach
C
C
Leonhardt
U
U
Buchwald
A
A
Scholz
K H
KH
Ramadori
G
G
D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000097:blood*; D004435:Eating; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D006801:Humans; D007328:Insulin / Q000378:metabolism / Q000502:physiology; D000078790:Insulin Secretion; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood* / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011168:Portal System; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015607:Stents
D007328:Insulin; D052216:Glucagon-Like Peptide 1