Effects of Sustained Treatment With Lixisenatide on Gastric Emptying and Postprandial Glucose Metabolism in Type 2 Diabetes: A Randomized Controlled Trial.

Abstract

OBJECTIVE:

Tachyphylaxis for slowing of gastric emptying is seen with continuous exposure to glucagon-like peptide 1 (GLP-1). We therefore aimed to establish whether prolonged use of a "short-acting" GLP-1 receptor agonist, lixisenatide, achieves sustained slowing of gastric emptying and reduction in postprandial glycemia.

RESEARCH DESIGN AND METHODS:

A total of 30 patients with metformin-treated type 2 diabetes underwent assessment of gastric emptying (scintigraphy) and glucose metabolism (dual tracer technique) after a 75-g glucose drink, before and after 8 weeks' treatment with lixisenatide (20 μg subcutaneously daily) or placebo, in a double-blind randomized parallel design.

RESULTS:

Gastric retention of the glucose drink was markedly increased after lixisenatide versus placebo (ratio of adjusted geometric means for area under the curve [AUC] over 240 min of 2.19 [95% CI 1.82, 2.64], P < 0.001), associated with substantial reductions in the rate of systemic appearance of oral glucose (P < 0.001) and incremental AUC for blood glucose (P < 0.001). Lixisenatide suppressed both glucagon (P = 0.003) and insulin (P = 0.032), but not endogenous glucose production, over 120 min after oral glucose intake. Postprandial glucose lowering over 240 min was strongly related to the magnitude of slowing of gastric emptying by lixisenatide (r = -0.74, P = 0.002) and to the baseline rate of emptying (r = 0.52, P = 0.048) but unrelated to β-cell function (assessed by β-cell glucose sensitivity).

CONCLUSIONS:

Eight weeks' treatment with lixisenatide is associated with sustained slowing of gastric emptying and marked reductions in postprandial glycemia and appearance of ingested glucose. Short-acting GLP-1 receptor agonists therefore potentially represent an effective long-term therapy for specifically targeting postprandial glucose excursions.

• Authors: Christopher K Rayner, Linda E Watson, Liza K Phillips, Kylie Lange, Michelle J Bound, Jacqueline Grivell, Tongzhi Wu, Karen L Jones, Michael Horowitz, Ele Ferrannini, Domenico Tricò, Silvia Frascerra, Andrea Mari, Andrea Natali
• Journal: Diabetes care (Diabetes Care) Vol. 43 Issue 8 Pg. 1813-1821 (08 2020) ISSN: 1935-5548 [Electronic] United States
• PMID: 32471908 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 by the American Diabetes Association.

Chemical References

• Blood Glucose
• Hypoglycemic Agents
• Insulin
• Peptides
• Placebos
• lixisenatide
• Glucagon

Topics

• Aged
• Australia
• Blood Glucose (drug effects, metabolism)
• Diabetes Mellitus, Type 2 (drug therapy, metabolism, physiopathology)
• Double-Blind Method
• Drug Administration Schedule
• Female
• Gastric Emptying (drug effects)
• Glucagon (blood)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (blood)
• Male
• Middle Aged
• Peptides (administration & dosage, pharmacology)
• Placebos
• Postprandial Period (drug effects)
• Time Factors