title: Influence of gastrointestinal factors on glucose metabolism in patients with cirrhosis.
abstract: OBJECTIVE
  The impaired glucose tolerance in cirrhosis is poorly understood. We evaluated the influence of gastrointestinal-mediated glucose disposal and incretin effect in patients with cirrhosis.
  
  
  METHODS
  Non-diabetic patients with Child-Pugh A or B cirrhosis (n = 10) and matched healthy controls (n = 10) underwent a 50-g oral glucose tolerance test (OGTT) and an isoglycemic intravenous glucose infusion. We presented data as median ± interquartile range and compared groups using non-parametric analysis of variance.
  
  
  RESULTS
  Patients with cirrhosis were glucose intolerant compared with healthy controls (4-h OGTTAUC : 609 ± 458 vs 180 ± 155 min × mmol/L; P = 0.005), insulin resistant (homeostatic model assessment for insulin resistance: 3.7 ± 4.9 vs 2.6 ± 1.4; P = 0.014) and had fasting hyperglucagonemia (8 ± 3 vs 3 ± 4 pmol/L; P = 0.027). Isoglycemia was achieved using 35 ± 12 g of intravenous glucose in patients with cirrhosis compared with 24 ± 10 g in healthy controls (P = 0.003). The gastrointestinal-mediated glucose disposal was markedly lower in patients with cirrhosis (30 ± 23 vs 52 ± 20%; P = 0.003). Despite higher levels of the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic peptide patients with cirrhosis had reduced incretin effect (35 ± 44 vs 55 ± 30%; P = 0.008).
  
  
  CONCLUSIONS
  Impaired gastrointestinal-mediated glucose disposal and reduced incretin effect may contribute to the glucose intolerance seen in patients with cirrhosis.
authors: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.|NNF Center for Basic Metabolic Research, Department of Biomedical Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Anders E
authors: AE
authors: Junker
authors: Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors: Lise L
authors: LL
authors: Gluud
authors: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors: Jens J
authors: JJ
authors: Holst
authors: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.|NNF Center for Basic Metabolic Research, Department of Biomedical Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Filip K
authors: FK
authors: Knop
authors: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors: Tina
authors: T
authors: Vilsbøll
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D054795:Incretins; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged
chemical_list: D054795:Incretins; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D005947:Glucose
keywords: GIP; GLP-1; cirrhosis; glucagon; glucose