title: Effects of Miglitol, Acarbose, and Sitagliptin on Plasma Insulin and Gut Peptides in Type 2 Diabetes Mellitus: A Crossover Study.
abstract: BACKGROUND
  Both dipeptidyl peptidase-4 inhibitors and α-glucosidase inhibitors (α-GI) have been reported to change the incretin and insulin secretion. To examine the effects of acarbose, miglitol, and sitagliptin on glucose metabolism and secretion of gut peptides, we conducted a crossover study in patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  Eleven Japanese patients with T2DM underwent four meal tolerance tests with single administration of acarbose, miglitol, sitagliptin, or nothing. Fasting and postprandial plasma levels of glucose, insulin, glucagon, active glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), ghrelin, and des-acyl ghrelin were measured.
  
  
  RESULTS
  Early-phase insulin secretion was reduced following acarbose and miglitol, and the areas under the curve (AUC) of insulin at 180 min following acarbose and miglitol were significantly lower than sitagliptin. AUC of plasma glucose at 180 min after acarbose, miglitol, and sitagliptin tended to be lower than in controls, and plasma glucose levels at 30-60 min following miglitol were significantly lower than in controls. Plasma glucagon, ghrelin, and des-acyl ghrelin levels did not differ among the four conditions. Postprandial plasma active GLP-1 levels and AUC of GLP-1 increased significantly in both the sitagliptin and miglitol groups compared to control. Postprandial plasma total GIP levels increased following sitagliptin but decreased after acarbose and miglitol. Changes in incretin levels tended to be greater with miglitol than acarbose.
  
  
  CONCLUSIONS
  These results showed that sitagliptin and α-GIs, miglitol more so than acarbose, improved hyperglycemia in patients with T2DM after single administration, and had different effects on insulin and incretin secretion.
  
  
  BACKGROUND
  UMIN-CTR number, UMIN000009981.
authors.affiliation: Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan, intron@med.miyazaki-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ueno
authors.forename: Wakaba
authors.initials: W
authors.lastname: Tsuchimochi
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Wang
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yamashita
authors.forename: Chikako
authors.initials: C
authors.lastname: Tsubouchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagamine
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sakoda
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakazato