Glucagon-like peptide-1 response to meals and post-prandial hyperglycemia in Type 2 diabetic patients.
BACKGROUND
The impaired response of glucagonlike peptide-1 (GLP-1) to meals in diabetic patients can contribute to the pathogenesis of impaired insulin secretion and post-prandial hyperglycemia. This study is aimed at the assessment of the relationship between meal-induced GLP-1 and post-prandial hyperglycemia in Type 2 diabetic patients.


METHODS
Twenty-one drug-naïve Type 2 diabetic patients were studied. Blood glucose and active GLP-1 levels were measured 0, 30, 60, 90, and 120 min after a standard test meal. A continuous glucose monitoring (CGM) system was applied for the following 3 days. Nutrient intake at each meal was calculated on the basis of patients' food records. For each patient, post-prandial 120-min glucose incremental area under the curve (iAUC) was included in linear regression model exploring its relationship with total energy and carbohydrate intake, and the angular coefficient for total energy (EAC) and carbohydrate (CAC) was calculated.


RESULTS
GLP-1 levels peaked 30 min after the test meal. Logarithmically transformed 60-min GLP-1 iAUC showed a significant inverse correlation with glycated hemoglobin (HbA1c) (p<0.01). A significant inverse correlation of 60-min GLP-1 iAUC was also observed with EAC and CAC (both p<0.01), meaning that patients with a lower GLP-1 response to the test meal had a higher increment of post-prandial glucose for each additional unit of total energy or carbohydrate intake.


CONCLUSIONS
In Type 2 diabetic patients, a lower GLP-1 response to meals is associated with a higher HbA1c, and with a greater degree of meal-induced hyperglycemia, both in a meal test and during CGM in "real-life" conditions.
Section of Geriatric Cardiology, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero- Universitaria Careggi, 50134 Florence, Italy. edoardo.mannucci@fastwebnet.it
E
E
Mannucci
L
L
Pala
M
M
Monami
L
L
Da Vico
G
G
Bardini
I
I
Dicembrini
S
S
Ciani
C
C
Lamanna
N
N
Marchionni
C M
CM
Rotella
D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D004435:Eating / Q000502:physiology*; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000097:blood / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology*
D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin