Gastric Emptying, Incretin Hormone Secretion, and Postprandial Glycemia in Cystic Fibrosis—Effects of Pancreatic Enzyme Supplementation

Abstract

Pancreatic enzyme supplementation plays an important role in incretin secretion, gastric emptying, and postprandial hyperglycemia in CF.

Cystic fibrosis related diabetes—a new perspective on the optimal management of postprandial glycemia

“…In a small study of adults with CF we demonstrated rapid emptying of a high fat/ carbohydrate meal, associated with marked postprandial hyperglycaemia. Pancreatic enzyme supplementation slowed gastric emptying and markedly decreased the postprandial glycaemic excursion ( Fig.1-2) [41]. We recently reported the same phenomenon in a study of 14 paediatric CF patients (Fig.3) [45].…”

“…Despite the potential importance of abnormal gastric emptying in CF patients, only a limited number of studies have evaluated gastric emptying in this population [33,[41][42][43][44][45], with inconsistent results, attributable to differences in subject characteristics, meal composition, use of pancreatic enzymes and the method used to measure gastric emptying. Studies have reported abnormally rapid [41,42] or delayed [44] emptying, or no difference from controls [33,43,45].…”

“…Studies have reported abnormally rapid [41,42] or delayed [44] emptying, or no difference from controls [33,43,45]. A bimodal pattern of gastric emptying has also been proposed, with more rapid emptying 'early' in the disease reflecting gut adaptations to the high energy diet, and delayed emptying 'later', when malnutrition is more likely to be present [42].…”

“…relating to GLP-1 and GIP secretion is limited and conflicting, probably reflecting methodological inconsistencies [41,49]. Our recent work, in both adult and paediatric CF patients, has provided persuasive evidence of a marked reduction in GLP-1 and GIP secretion in response to a high fat/high carbohydrate meal [41,45].…”

“…Optimising pancreatic enzyme supplementation, through adequate dosing and timing of administration, is an important first step in achieving postprandial glycaemic control, with improved fat digestion stimulating gut hormone secretion and attenuating any tendency for rapid gastric emptying [41]. In the early stages of carbohydrate intolerance, this alone may be an effective management strategy.…”