Antihyperglycaemic medication modifies factors of postprandial satiety in type 2 diabetes.
OBJECTIVE
Type 2 diabetes is characterized by hyperglycaemia, delayed gastric emptying and a blunted response of gut hormones during feeding that may modulate satiety. We hypothesized that it is associated with more hunger when treated by medication.


METHODS
We studied nine type 2 diabetic men (A1C: 6.7+/-0.3%, waist circumference: 104+/-4 cm) after an overnight fast, during 5 h in response to a 2.88 MJ breakfast, twice, in a crossover design, with or without antihyperglycaemic agents. Satiety ratings, thermic effect of meal, gastric emptying, plasma concentrations of gut peptides, leptin, insulin and substrates and intake from a subsequent buffet were determined.


RESULTS
With medication, fasting and postprandial plasma glucose levels were lower but area under the curve (AUC) did not vary vs. without medication. Gastric emptying was shortened, branched chain amino acids (BCAA) AUC and thermic effect were lower, and postprandial glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY3-36) were maintained at higher levels beyond 4 h. Correlations were significant between duration of diabetes and fasting ghrelin (r=0.779, p=0.013) and peak insulin (r=-0.769, p=0.016), 5-h postmeal ghrelin and peak glucose (r=0.822, p=0.007), 5-h glucose and GLP-1 (r=-0.788, p=0.012), and 5-h hunger scores and energy intake at buffet (r=0.828, p=0.006). Without medication, fullness scores correlated with BCAA levels. Visual analogue scale scores, ghrelin and leptin levels did not differ between studies.


CONCLUSIONS
The decrease in factors associated with postprandial satiety with treatment is counterbalanced by higher GLP-1 and PYY3-36. Medication may normalize the link between perception of hunger and subsequent food intake.
Mourad
C
C
Chevalier
S
S
Morais
J A
JA
Lamarche
M
M
Gougeon
R
R
D000368:Aged; D000596:Amino Acids / Q000097:blood; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004151:Dipeptides / Q000097:blood; D005215:Fasting; D005746:Gastric Emptying / Q000187:drug effects; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005905:Glyburide / Q000494:pharmacology; D006801:Humans; D006815:Hunger / Q000502:physiology*; D007004:Hypoglycemic Agents / Q000494:pharmacology*; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008297:Male; D008687:Metformin / Q000494:pharmacology; D008875:Middle Aged; D019518:Postprandial Period / Q000187:drug effects; D012527:Satiation / Q000187:drug effects* / Q000502:physiology; D045162:Thiazolidinediones / Q000494:pharmacology
D000596:Amino Acids; D001786:Blood Glucose; D004151:Dipeptides; D007004:Hypoglycemic Agents; D007328:Insulin; D020738:Leptin; D045162:Thiazolidinediones; C042696:tyrosyltyrosine; D052216:Glucagon-Like Peptide 1; D008687:Metformin; D005905:Glyburide